Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2019; 25(48): 6928-6938
Published online Dec 28, 2019. doi: 10.3748/wjg.v25.i48.6928
Hepatitis C virus eradication with directly acting antivirals improves health-related quality of life and psychological symptoms
Silvia Nardelli, Oliviero Riggio, Davide Rosati, Stefania Gioia, Alessio Farcomeni, Lorenzo Ridola
Silvia Nardelli, Oliviero Riggio, Davide Rosati, Stefania Gioia, Lorenzo Ridola, Department of Translational and Precision Medicine, “Sapienza” University of Rome, Rome 00185, Italy
Alessio Farcomeni, Department of Economics & Finance, University of Rome “Tor Vergata”, Rome 00185, Italy
Author contributions: Nardelli S and Ridola L drafted the article; Nardelli S, Riggio O and Ridola L contributed to critical revision of the article for important intellectual content; Gioia S and Rosati D contributed to acquisition of data; Nardelli S contributed to conception and design; Farcomeni A performed statistical analysis; Riggio O and Ridola L contributed to final approval of the article.
Institutional review board statement: This study protocol was reviewed and approved by the the Ethical and the Research Committees of the “Sapienza” University of Rome.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: S.N. was the winner of a competitive Gilead Fellowship Program 2017 for this project, all the other authors have nothing to disclose and no conflict of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lorenzo Ridola, MD, PhD, Doctor, Department of Translational and Precision Medicine, “Sapienza” University of Rome, viale dell’Università 37, Rome 00185, Italy. lorenzo.ridola@uniroma1.it
Telephone: +39-773-6556155
Received: October 21, 2019
Peer-review started: October 21, 2019
First decision: November 9, 2019
Revised: December 13, 2019
Accepted: December 22, 2019
Article in press: December 22, 2019
Published online: December 28, 2019

Alterations in health-related quality of life (HRQoL) and neuropsychological disorders were described in the hepatitis C virus (HCV) patients. Although several studies investigated the modifications of HRQoL after HCV eradication, no data exists on the modifications of neuropsychological symptoms.


To investigate the effect of directly acting antivirals (DAAs) treatment on HRQoL and neuropsychological symptoms.


Thirty nine patients with HCV infection underwent a neuropsychological assessment, including Zung-Self Depression-Rating-Scale, Spielberg State-Trait Anxiety Inventory Y1-Y2 and the Toronto-Alexithymia Scale-20 items before and after DAAs treatment. HRQoL was detected by Short-Form-36 (SF-36).


All HRQoL domains, but role limitation physical and bodily pain, significantly improved after treatment. Interestingly, after DAAs treatment, all domains of HRQoL returned similar to those of controls. Each neuropsychological test significantly improved after HCV eradication. A significant correlation was observed among each psychological test and the summary components of SF-36. At multiple linear regression analysis including each psychological test as possible covariates, Zung-Self Depression Rating Scale (Zung-SDS) score was independently and significantly related to summary components of the SF-36 in the basal state and the difference between Zung-SDS score before and after treatment was the only variable significantly and independently related to the modification of HRQoL induced by the treatment.


Neuropsychological symptoms strongly influenced HRQoL in HCV patients and there was a significant improvement of neuropsychological tests and HRQoL after DAAs treatment.

Keywords: Hepatitis C virus, Health related quality of life, Depression, State and trait anxiety, Alexithymia, Directly acting antivirals

Core tip: In patients with the hepatitis C virus (HCV) infection, alterations in health-related quality of life (HRQoL) and neuropsychological disturbances were described also in the absence of liver cirrhosis. During the last years, HCV therapy has evolved from interferon-based to directly acting antiviral (DAA)-based therapy, with excellent tolerability and efficacy. Until now, few data exist on the modifications of neuropsychological symptoms before and after DAAs treatment and on the relationship of these symptoms on HRQoL. With this study we demonstrated that HCV eradication with DDAs treatment significantly improves health-related quality of life and neuropsychological symptoms.