HCV and Fatigue
Most people infected with chronic hepatitis C virus (HCV) have few symptoms or physical
signs of the virus in the first two decades after infection. However, about 20 percent of
those with HCV develop vague symptoms, including mild intermittent fatigue and malaise.
Fatigue, which may lead to a significant decrease in quality of life, may be the first and
only sign that the liver is being affected by the virus.
Following are answers to some frequently asked questions about hepatitis C and fatigue.
Q. Why is fatigue associated with hepatitis C?
A. Much of the fatigue a person with HCV experiences is due to an
activated immune system attempting to eliminate the virus. Despite the effective creation
of antibodies against it, the hepatitis C virus can undergo frequent mutation, allowing it
to avoid being eliminated from the body in 85 percent of those who contract it. In an
ongoing effort to rid the body of the virus, the immune system continues to create weapons
against the virus including antibodies, interleukins, and white blood cells.
At times, the immune response leads to the production of immune complexes, collections of
antibodies that course through the body. Immune complexes may deposit in the joints, the
blood vessels in the skin, or in the kidney, leading to arthritis, rashes or
glomerulonephritis (a form of kidney disease). These conditions are referred to as
"extra-hepatic manifestations" of hepatitis.
An immune system activated to fight a virus like HCV might also begin developing
antibodies against other tissues in the body, including the thyroid. The resulting
autoimmune illness, such as autoimmune thyroiditis, can result in still more symptoms of
fatigue.
Q. What underlying conditions might an HCV-infected patient have that
could contribute to his or her fatigue?
A. Fatigue in HCV-infected individuals is most likely due to the virus'
presence. However, a number of conditions that are readily diagnosed and treated may add
to the level of fatigue. Iron deficiency anemia and hypothyroidism are both common among
women and can certainly contribute to loss of energy.
Depression is also common and often manifests itself as excessive sleepiness and fatigue.
In fact, being diagnosed with a chronic condition can actually worsen an individual's
depression.
Q. How should conditions associated with HCV be treated?
A. In general, these conditions may be treated independently of the
hepatitis. Those that are clearly related to HCV may respond to treatment with interferon
alfa and ribivarin, approved therapy for HCV.
All medications ingested by a patient with HCV should be reviewed by his or her physician
because many drugs are metabolized by the liver, which may already be compromised by the
virus. Some medications, particularly some antidepressants, can lead to fatigue if serum
levels are too high. Therefore, in some cases, drug dosages may need to be reduced.
Q. What changes can a person make to ease the impact of the fatigue on
his or her life?
A. Most doctors recommend HCV patients eat a well-balanced diet, abstain
from drinking alcohol, and stop smoking.
In addition, coping with fatigue means balancing activity and rest. Some suggestions
include taking short naps between activities and crafting a schedule that balances
strenuous activities with ones that are less strenuous. For those with exhausting jobs,
devising a flexible work schedule or telecommuting from home may be good options.
Sources-
National Institutes of Health Consensus Statement Online 1997, March 24-26; 15(3): in
press.
"Hepatitis Alert," newsletter from the Hepatitis Foundation International
(800-891-0707), Summer 1997.
"Occurrence and Significance of Autoantibodies"