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.

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"