For many people living with hepatitis C virus (HCV), fatigue is the most taxing everyday drag related to the disease. The symptoms can be sprawling, and may include sleepiness or drowsiness, low energy or stamina, difficulty concentrating, memory troubles, and what is known as “brain fog.”
Scientists don’t have the firmest grasp on what causes these physical and mental troubles. But the good news is that numerous studies have found that curing the virus does lead to marked improvements in fatigue as well as overall quality of life and work productivity. (One drawback of these studies, however, is their shorter follow-up time; the picture is less clear as to how much a cure affects fatigue far into the future.)
For most HCV-positive individuals, today’s available treatments mean a 90 percent-plus chance of a cure after an 8-, 12- or 24-week treatment, with treatment length depending on various factors such as the particular genotype (genetic variant) of hep C and how much the virus has already damaged the liver.
In its guidelines on who should be prioritized for hep C treatment, the American Association for the Study of Liver Diseases (AASLD) lists debilitating fatigue as a criterion for receiving high priority. Considering how fervently insurers have been restricting access to the astronomically expensive hep C drugs, the existence of severe fatigue symptoms may help convince payers to shell out for treatment. Other high priority criteria include moderate fibrosis (scarring) of the liver, HIV or hepatitis B virus (HBV) coinfection, other liver diseases, and type 2 diabetes. As for those who should receive the highest priority for treatment, the AASLD’s recommendations include people with advanced fibrosis or cirrhosis and those who have received an organ transplant.
Unfortunately, fatigue is also one of the top side effects of all the direct-acting antiviral medications used to treat the virus. But its severity pales in comparison to the devastating physical and emotional toll of the older interferon-based hep C treatments, which caused flu-like symptoms.
One recent study conducted by researchers at the University of California, Los Angeles, and other California health organizations, looked into the way that hep C may cause fatigue through its effects on the brain. They found that various neurological complications of hep C infection, including fatigue as well as cognitive problems, are related to changes in the frontal-subcortical structures of the organ.
Other potential causes of fatigue include cirrhosis, which is severe damage to the liver and a major potential long-term consequence of hep C, as well as the production of cytokines, which are an inflammatory immune response to the virus.
One of the reasons it can be hard to tease apart the root cause of fatigue among people with hep C is that there can be so many overlapping non-virus-related factors that are quite common among the population. So the virus may only be partially to blame for fatigue. Drug and alcohol abuse, depression and anxiety can all zap energy, as can the simple knowledge of having a serious disease.
Tips on dealing with fatigue
Talk to your doctor
- See your hepatologist (liver specialist) or primary care physician.
- Have a full medical exam in which you discuss your fatigue symptoms.
- Look at the medications you are taking; some may cause fatigue.
- Talk about your sleep patterns.
- Have an honest conversation about any drug or alcohol use.
See a specialist
- Your clinician may refer you to various specialists to look into other sources of fatigue.
- An internist or endocrinologist can test for thyroid disease, which can cause fatigue and is common among people living with hep C.
- A sleep specialist can see if problems such as sleep apnea are disrupting your rest.
- A psychotherapist, psychiatrist or both can provide treatment for depression and anxiety.
- Those with chronic pain may want to see a rheumatologist to test for fibromyalgia, which is also interrelated with fatigue and brain fog.
Make lifestyle changes
- A good diet and exercise regimen to keep a healthy weight may help with overall energy levels, considering that obesity is yet another cause of fatigue.
- Quit smoking. Both tobacco and marijuana can drain energy.
- Seek drug or alcohol treatment if necessary. Most clinicians advise people with hep C not to drink any alcohol at all, because of how it can accelerate liver damage. If you are unable to stop drinking entirely, experts recommend at least cutting back as much as possible.
- Getting about 30 to 45 minutes of aerobic exercise three or more times a week can help fight fatigue. One recent study found that people with hep C who walked about five cumulative miles three days a week found relief.
- Caffeine. Not only does java improve alertness, but research suggests it’s actually good for liver health. If you have sleeping troubles, however, you may want to be careful with caffeine use, particularly later in the day.
- Sleep hygiene. Various behavioral techniques may help you sleep better. These include going to bed and getting up at the same time each day, having a relaxing bedtime routine, avoiding the glare of computer, tablet and smartphone screens before bed, not eating before bed, refraining from late-day caffeine, and having a comfortable, dark, quiet, cool place to sleep.