Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: The prevalence, risk factors and functional impact of joint pain are not well described in chronic hepatitis C virus (HCV)-infected patients, particularly in the setting of human immunodeficiency virus (HIV) coinfection. Our objectives were to determine if the prevalence of arthralgias was higher among chronic HCV-infected patients compared to HIV/HCV-coinfected persons and those with HIV alone, and to evaluate the risk factors and functional impact of joint pain in chronic HCV patients.
Methods: A cross-sectional study was performed among patients with chronic HCV infection aged 18-80 years followed at the infectious disease and hepatology clinics. Patients with HIV infection seen in the same clinics were enrolled as a comparison group. HIV was chosen as a comparison given that it is a chronic infection with similar risk factors. Joint pain was defined by patient self-report. Standardized interviews by trained personnel were conducted and the Multidimensional Health Assessment Questionnaire (MD-HAQ) was administered to assess the impact of joint pain on physical function and emotional well-being. The electronic medical records of all participants were reviewed up to the date of study visit to abstract relevant clinical data for hypothesized risk factors.
Results: Of the 210 patients enrolled, 178 had HCV infection (90 mono, 88 co-infected with HIV) and 32 had HIV only. Joint pain was reported by 63/90 (70%) of the HCV-mono-infected, 48/88 (54%) of the HCV-co-infected, and 17/32 (53%) of the HIV-mono-infected patients. The MD-HAQ results in the 178 HCV-infected patients demonstrated a mean pain score of 5.9/10, mean physical function score 2.5/10, mean global assessment of function 4.2/10, and mean RAPID3 12.7. No differences were observed between subjects with and without joint pain with regards to age (p=0.62), sex (p=0.53), race (p=0.32), and clinical site (p=0.32). Differences in clinical characteristics among those with and without joint pain among patients with chronic HCV infection are displayed in the table below.
Conclusion: Joint pain was common (62%) among patients with chronic HCV and was associated with diminished functional status and emotional well-being. HCV/HIV co-infected and HIV mono-infected have significantly lower rates of joint pain compared with HCV mono-infected patients, possibly due to T-cell moderation by HIV resulting in decreased effects of the hepatitis C virus or the intensive outpatient follow-up many HIV patients receive.
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Analysis of Potential Risk Factors Among Patients with Chronic HCV
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HCV (mono and co-infected) N= 178 (%)
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Joint pain N= 111 (%)
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No Joint pain N= 67 (%)
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P value
|
|
Current HCV treatment |
23 (13) |
15 (14) |
8 (12) |
NS* |
|
HIV |
88 (49) |
48 (43) |
40 (60) |
0.03 |
|
Genotype 1 2 3 |
135 (76) 6 (12) 6 (12) |
86 (77) 2 (2) 2 (2) |
49 (73) 4 (6) 4 (6) |
NS |
|
Smoking |
65 (37) |
52 (47) |
13 (19) |
<0.001 |
|
Alcohol |
5 (3) |
5 (5) |
0 |
0.07 |
|
Sleep Disturbance |
85 (48) |
74 (67) |
11 (16) |
<0.001 |
|
Dry eyes |
25 (14) |
24 (22) |
1 (2) |
<0.001 |
|
Dry mouth |
55 (31) |
50 (45) |
5 (8) |
<0.001 |
|
Peripheral neuropathy |
37 (21) |
37 (33) |
0 (0) |
<0.001 |
|
Myalgia |
36 (20) |
36 (32) |
0 (0) |
<0.001 |
|
Depression |
70 (39) |
60 (54) |
10 (15) |
<0.001 |
|
Anxiety |
79 (44) |
70 (63) |
9 (13) |
<0.001 |
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AST†, Mean (SD) |
63.8 (50.5) |
67.9 (5.5) |
57 (4.9) |
NS |
|
ALT†, Mean (SD) |
58.8 (48.7) |
59.8 (5.0) |
57.2 (5.6) |
NS |
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HCV viral load, Mean (SD) |
3.1 million (6.8) |
3.3 million (7.9) |
2.8 million (4.2) |
NS |
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*NS: p-value>0.05, †AST= alanine amino transferase and ALT= alanine amino transferase |
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Disclosure:
S. Bhangle,
None;
V. Lo Re,
None;
W. G. Pang,
None;
K. M. Chang,
None;
V. Amorosa,
None;
J. Kostman,
None;
H. R. Schumacher,
Takeda, Wyeth,
2,
Regeneron, Novartis, Ardea, Pfizer, Savient, Metabolex,
5;
A. Ogdie,
None.
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