Hepatitis C Virus Infection as a Traumatic Experience

Objective The purpose of this study was to evaluate whether individuals consider their HCV infection to be a potentially traumatic experience. Additionally, we investigated its association with Post-Traumatic Stress Disorder (PTSD) and the impact of PTSD diagnosis on health-related quality of life (HRQoL) in HCV infected subjects. Methods We conducted a cross-sectional survey of 127 HCV-infected outpatients recruited at a University Hospital in Salvador, Brazil. All subjects answered an orally-administered questionnaire to gather clinical and socio-demographic data. We investigated traumatic experiences and the subject's perception of the disease using the Trauma History Questionnaire. PTSD and other psychiatric diagnoses were assessed through the Mini International Neuropsychiatric Interview-Brazilian Version 5.0.0 (M.I.N.I. PLUS). HRQoL was assessed using Short-Form 36 (SF-36). Results Approximately 38.6% of the patients considered hepatitis C to be a traumatic experience. Of these, 60.7% had a PTSD diagnosis. PTSD was associated with significant impairment in quality of life for individuals in seven SF-36 domains as shown bymultivariate analysis: Role-Physical (β: −24.85; 95% CI: −42.08; −7.61), Bodily Pain (β: −19.36; 95% CI: −31.28; −7.45), General Health (β: −20.79; 95% CI: −29.65; −11.92), Vitality (β: −11.92; 95% CI: −20.74; −3.1), Social Functioning (β: −34.73; 95% CI: −46.79; −22.68), Role-Emotional (β: −26.07; 95% CI: −44.61; −7.53), Mental Health (β: −17.46; 95% CI: −24.38; −10.54). Conclusion HCV is frequently a traumatic experience and it is strongly associated with PTSD diagnosis. PTSD significantly impaired HRQoL

Características comportamentais e psiquiátricas de pacientes em lista de espera para transplante hepático

O presente estudo objetivou investigar o impacto do diagnóstico psiquiátrico durante o prétransplante sobre o desfecho de morte no pós-transplante hepático. Para tanto, foi conduzido um estudo de coorte, ao avaliar longitudinalmente 93 indivíduos expostos e não expostos a transtornos mentais ainda no pré-transplante transplante e acompanhados por pelo menos dois anos após o transplante. Os instrumentos utilizados foram, além de entrevista semiestruturada, o M.I.N.I. PLUS (Mini International Neuropsychiatric Interview- BrazilianVersion5.0.0), Short-Form 36 e Bis 11 (Barrat Impulsiviness Scale). Todos os instrumentos foram aplicados em pacientes elegíveis para o transplante de fígado durante o período de 2010 a 2015 no Complexo Hospitalar Professor Edgard Santos (Com-HUPES)– Universidade Federal da Bahia (UFBA). Resultaram da presente tese, artigos que descreveram o perfil psiquiátrico destes sujeitos em lista de espera de transplante, comportamentos de risco de contágio do VHC e, o principal achado da tese, o papel dos transtornos mentais no prognóstico pós-transplante. Os trabalhos demonstraram alta prevalência de comorbidades psiquiátricas, evidências de comportamentos de risco como o compartilhamento de equipamentos de manicure, e a falta de diretriz para avaliação psiquiátrica nos pacientes em fila de espera. Prospectivamente observou-se que comorbidades psiquiátricas no prétransplante não conferiam risco para morte no pós-transplante. Conclui-se através dos trabalhos realizados que apesar da elevada prevalência de comorbidades psiquiátricas em pacientes em lista de espera esta prevalência não foi associada a desfecho negativo no póstransplante, além disso, ressalta a necessidade de diretrizes para avaliação e acompanhamento destes pacientes em todo o processo do transplante hepático

Impact of sustained virologic response on quality of life in chronic HVC carriers

Introduction. It is known that patients with chronic hepatitis C have a lower health-related quality of life (HRQOL) than the general population and evidence suggests that the hepatitis C virus (HCV) could exert direct neuropathic action on HRQOL. From this perspective, the virus clearance should be accompanied by improvement in HRQOL. Thus, we sought to review systematically the evidence in the literature and perform a meta-analysis of HRQOL changes caused by sustained virologic response (SVR).Material and Methods. The PubMed was searched using the keywords Hepatitis C, Quality of Life and Therapy. The reviewers came to a consensus on articles that were selected to full reading and those that should be included in the study and a meta-analysis was performed of mean change difference between responders and non-responders.Results. Eleven studies were included in the systematic review and four in the metaanalysis. Of these, nine studies showed more favorable outcome for responders, and they had a better outcome even in studies that evaluated only cirrhotic patients, previous non-responders, relapsers, patients in first treatment and patients unaware of treatment response. Moreover, the meta-analysis showed that the general health and vitality domains had statistically significant mean change difference between responders and non-responders, presenting a summary effect of 6.3 (CI 95% 2.5-10.0) and 7.8 (CI 95% 3.4-12.1) respectively.Conclusion. There is evidence indicating that SVR is accompanied by an improvement in HRQOL and patients reaching SVR have clinically relevant improvement in domains of general health and vitality

The Portuguese Version of the Immunosuppressant Therapy Adherence Scale (ITAS) among Liver Transplant Recipient Patients: Translation and Psychometric Properties

Introduction and aim. Transplant recipients are chronically ill patients who rely on medical treatment throughout life to achieve positive results. Despite that, medication nonadherence after liver transplantation is extremely common. The self-report, one of several methods for measuring adherence, is easy to apply and low cost. Thus, this study aims to translate and validate the Immunosuppressant Therapy Adherence Instrument (ITAS) in Brazilian Portuguese for liver transplant recipients.Material and methods. A total of 139 liver transplant recipients were selected from a general hospital, who were assessed by using the Portuguese version of ITAS. The scale was translated based on the model proposed by Wild, et al. and its psychometric properties were assessed.Results. The average Cronbach’s a coefficient was 0.830. ITAS and Basel Assessment of Adherence with Immunosuppressive Medications Scale (BAASIS) presented significant correlation, with a Spearman’s p coefficient = 0.300 (S = 309,580; p < 0.001). The area under the receiver operating characteristics (ROC) curve was 0.638 (95% CI: 0.557 – 0.715). Factor analysis results indicated that the carelessness factor model was the optimal model, and the factor “feeling worse” was the lowest.Conclusion. The Portuguese version of ITAS has adequate psychometric properties to measure adherence to immunosuppressant therapy

Comparative study of impulsiveness and risk behaviors among infected individuals with hepatitis C virus and human T-cell lymphotropic virus type 1

Introduction and objectives: Hepatitis C virus (HCV) and human T-cell lymphotropic virus type 1 (HTLV-1) infections have chronic courses. HCV is primarily transmitted via the hematogenous route, whereas HTLV-1 is primarily transmitted sexually, although it can also be transmitted by blood. Individuals chronically infected with either HTLV-1 or HCV can differ in terms of behavioral characteristics and personality traits. This study compared the occurrence of risk behaviors and impulsivity aspects between HCV and HTLV-1 carriers. Materials and methods: Observational, comparative and cross-sectional study that involved a sample of outpatients who had HCV or HLTV-1, by way of a sociodemographic and behavioral questionnaire and the Barratt Impulsiveness Scale – BIS-11. 143 individuals with HCV and 113 individuals with HTLV-1 were evaluated. Results: There was a difference with regards to gender among patients, with mostly males affected in the HCV group. Risk behaviors commonly mediated by impulsiveness were significantly more frequent in the HCV group. Similarly, overall impulsiveness and domain nonplanning were higher in the HCV group. Multivariate analysis showed that increased age, male gender, higher nonplanning scores and HCV infection were independent factors for the occurrence of risk behaviors. Both groups presented high rates of other sexually transmitted diseases and a low rate of condom use in sexual relations. Conclusions: This study confirms the higher rate of risk behaviors and the levels of impulsiveness commonly observed in patients with HCV, along with comparisons to patients with HTLV-1

The fatigue impact scale for daily use in patients with hepatitis B virus and hepatitis C virus chronic infections

Introduction. Fatigue is an important clinical finding in the hepatitis virus chronic infection. However, the absence of scales to measure fatigue, translated and validated for Brazilian Portuguese, prevents access to information essential in clarifying specific clinical conditions in this population.Aim. The aim of this study was to determine the psychometric properties of the fatigue impact scale for daily use (D-FIS), in Brazilian Portuguese, for patients with the hepatitis C virus (HCV) and hepatitis B virus (HBV) chronic infection.Material and methods. In this cross-sectional study, the authors evaluated the D-FIS in 101 outpatients, followed at the reference hospital. The Mini International Neuropsychiatry Interview Brazilian (MINI PLUS) was used to identify psychiatric disorders, and the Short Form Health Survey 36-item (SF-36) to evaluate the self-reported quality of life. We also examined the impact of fatigue on the quality of life of this group of patients.Results. Relevant psychometric D-FIS results were: floor effect proved to be 1%; skewness was 0.46; item homogeneity was 0.59 and SEM (SD = 8.51) was 2.4. The Cronbach’s alpha was 0.920 and item-total correlation yielded coefficients ranging from 0.65 (item 1) to 0.85 (item 3). In a linear regression model, fatigue and depression influenced the self-reported quality of life.Conclusion. This study presents that the fatigue scale for daily use in Brazilian Portuguese can be considered a useful tool to verify the presence of fatigue in patients with the hepatitis viruses B and C