Previous Western studies showed a consistent and marked reduction in health-related quality of life (HRQOL) in patients chronically infected with hepatitis C virus (HCV). However, these studies were conducted on patients whose knowledge of their serological status may have affected their HRQOL. This HRQOL survey conducted in the Egyptian rural population provides a unique opportunity to clarify this issue among a population whose serological status is unknown. HRQOL was assessed by an Arabic translation of the Short-Form 12, and a visual analog scale of the relative severity of one's health status. HCV chronic infection was defined by positive tests for anti-HCV antibody and HCV-RNA. HRQOL was compared according to HCV chronic infection status in linear mixed models adjusted for potential confounding factors, such as age, sex, education, and health care-related risk factors, and adjusted for interviewer as a random effect. One hundred forty-six Egyptians chronically infected with HCV had similar Short-Form 12 and visual analog scale scores, compared with 1,140 uninfected controls from the same rural community. In individuals chronically infected with HCV, serum aminotransferase levels did not correlate with HRQOL. In conclusion, this study did not find a significant reduction of HRQOL in patients chronically infected with HCV compared with uninfected, contemporaneous controls. This may be explained in part by a lower morbidity amongst patients chronically infected with HCV in rural Egypt and a higher morbidity amongst uninfected controls as compared with those of Western studies, as well as a lack of awareness of hepatitis C serological status. (HEPATOLOGY 2004;40:1434 -1441.)
A pproximately 15% of 59 million Egyptians in 1996 were estimated to have positive test results for anti-hepatitis C virus (HCV) antibody, and based on 60% viremia, more than five million Egyptians are chronically infected with HCV. 1 The treatment of chronic hepatitis C (CHC) patients is considered a public health priority in Egypt to reduce both the burden of liver disease and the transmission of HCV. However, dramatic health care budget constraints limit access to the costly treatment recommended in Western countries. [2][3][4] Decision to treat should depend on the expected benefits from treatment of CHC patients, who are mostly infected with the genotype 4, living in the Nile Delta rural areas, and generally unaware of their HCV serological status in the absence of systematic screening. 1 Previous Western studies have reported a consistent and marked reduction in health-related quality of life (HRQOL) among CHC patients as compared with nationally representative samples of adults, particularly in physical health-related domains. [5][6][7][8][9][10][11][12][13][14][15][16] The HRQOL of CHC patients declines even more during the 6 to 12 months of treatment, but it returns to the pretreatment level during the 6 months after treatment because of significant improvements in HRQOL of sustained virologi-