Some people with hepatitis C (HCV) remain asymptomatic for years, and some folks even remain asymptomatic for life. However, others report experieicng consistent symptoms throughout the course of their infection, the most common of those reported symptoms being chronic fatigue.
Upwards of 60% of folks who are living with HCV have reported chronic fatigue symptoms. It’s also been suggested that awareness of one’s infection increases the likelihood that one will report symptoms of fatigue, which begs the question: do the psychological effects of the disease increase hepatitis C symptoms?
Fatigue caused by psychological effects
Interestingly, some research suggests that fatigue in individuals with chronic HCV is more closely related to psychological issues than the physiological effects of the disease. For example, two separate studies found that fatigue correlated weakly with the physical characteristics and symptoms of an HCV infection, such as level of fibrosis detected from a liver biopsy. Whereas, the same studies found that fatigue correlated strongly with psychological concerns, such as depression, anxiety, aggression, hostility, and interpersonal sensitivities.
Additional studies found that individuals with alcoholic liver disease, mixed liver disease, and chronic non-liver diseases also experienced significant fatigue correlated with psychological concerns, similar to findings in folks who are living with chronic HCV. Another recent study looking at the prevalence of fatigue in over 1,600 people living with HCV compared clinical and biological markers of disease to patient evaluations of fatigue and found that no significant correlations existed between reported fatigue symptoms and viral load, genotype, alcohol consumptions, or thyroid function. The factors that were associated with levels of fatigue included gender (higher in females), age (higher in older adults), presence of cirrhosis, small hemorrhages, and depression. From that study, fatigue was present in 53% of patients during their first visit, and 17% of those patients identified their symptoms of fatigue as either severe or impairing.
Interferon (IFN) therapy and fatigue
Not only do many folks experience fatigue, treatment with interferon (IFN) therapy often causes or further exacerbates fatigue symptoms. It’s been noted that of the patients treated with IFN, 70-100% experience fatigue (as compared to over 60% before treatment). Those who experience fatigue prior to being put on IFN treatment find that there fatigue it is often heightened during the first six months of treatment. Because fatigue is so pervasive among folks being treated with IFN therapy, if not managed closely, it may deter patients from completing their treatment regimen. Therefore, it’s extremely important providers assess patients psychologically before and during treatment while paying close attention to signs and symptoms of IFN-induced depression, which has been known to increase fatigue symptoms.
Managing Symptoms of Fatigue
The high prevalence of fatigue noted by individuals who have chronic HCV – both before and during treatment – means there is an express need to manage those symptoms with effective strategies and proactive approaches. Although, because clinicians often rely on subjective reports from patients, determining the severity of one’s symptoms and pairing them with an appropriate management strategy can be complicated.
Some research has suggested that antidepressants may be useful in reducing symptoms of fatigue in patients who also exhibit psychological concerns such as depression, but additional studies are necessary before widespread recommendations can be made for those who are also undergoing IFN therapy. Pharmacological interventions can be useful in reducing fatigue associated with IFN medications, but special care must be given before administering prescriptions to patients who have also had issues with substance abuse – particularly stimulants – because giving patients prescriptions for IFN-related depression and fatigue may increase underlying substance abuse concerns. Whereas some have found success in using methylphenidate to treat the side effects of IFN-related fatigue, it has not yet been established as a treatment for HCV-related fatigue.
Some holistic, non-pharmacological approaches to treating IFN-related fatigue in patients with HCV have also been proposed and include: aerobic exercise, replacing fluids and electrolytes, improved nutrition and diet, reduced IFN dosages, alternative times for taking IFN, and scheduling more strenuous activities during peak energy hours.
Others have begun trying Eastern medicinal approaches, like traditional Chinese medicine, which can include massage, herbal remedies, and acupuncture. Research indicating the efficacy of Traditional Chinese medicine as it applies to HCV fatigue is minimal, but in a preliminary report of 24 patients with chronic HCV and fatigue, in those who were using herbal treatments and who were receiving acupuncture, 4 out of 14 reported complete relief from their symptoms of fatigue, and 13 out of 17 reported an improvement.
When considering approaches for managing symptoms of HCV-related fatigue, one must also balance any additional concerns and treatments. Patients who are living with chronic HCV often have a number of factors to balance, such as: medications, exercise habits, intake of caffeine or alcohol, nutritional deficiencies, thyroid conditions, anemia, and psychological needs – all of which can impact a provider’s decision to treat fatigue.