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Open Access Research article

Long-term effects of treatment and response in patients with chronic hepatitis C on quality of life. An international, multicenter, randomized, controlled study

Geert Bezemer1, Arthur R Van Gool12, Elke Verheij-Hart1, Bettina E Hansen1, Yoav Lurie3, Juan I Esteban4, Martin Lagging5, Francesco Negro6, Stefan Zeuzem7, Carlo Ferrari8, Jean-Michel Pawlotsky9, Avidan U Neumann10, Solko W Schalm1, Robert J de Knegt1* and for the DITTO-HCV Study Group

Author Affiliations

1 Dpt. Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands

2 Yulius Academy, Yulius, Organization for Mental Health, Rotterdam, the Netherlands

3 Dpt. Gastroenterology, Sourasky Medical Center, Tel-Aviv, Israel

4 Dpt. Internal Medicine-Hepatology, Hospital General Vall d'Hebron, Barcelona, Spain

5 Dpt. Infectious Diseases, University of Gothenburg, Gothenborg, Sweden

6 Dpt. Gastroenterology & Hepatology, Hospital University of Genève, Genève, Switzerland

7 Dpt. Gastroenterology & Hepatology, Johann Wolfgang Goethe Hospital, Frankfurt, Germany

8 Dpt. Infectious Diseases and Hepatology, Azienda Ospedaliera di Parma, Parma, Italy

9 Dpt. Virology, Hopital Henri Mondor - Université Paris XII, Creteil, France

10 Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel

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BMC Gastroenterology 2012, 12:11  doi:10.1186/1471-230X-12-11

Published: 31 January 2012



Hepatitis C decreases health related quality of life (HRQL) which is further diminished by antiviral therapy. HRQL improves after successful treatment. This trial explores the course of and factors associated with HRQL in patients given individualized or standard treatment based on early treatment response (Ditto-study).


The Short Form (SF)-36 Health Survey was administered at baseline (n = 192) and 24 weeks after the end of therapy (n = 128).


At baseline HRQL was influenced by age, participating center, severity of liver disease and income. Exploring the course of HRQL (scores at follow up minus baseline), only the dimension general health increased. In this dimension patients with a relapse or sustained response differed from non-responders. Men and women differed in the dimension bodily pain. Treatment schedule did not influence the course of HRQL.


Main determinants of HRQL were severity of liver disease, age, gender, participating center and response to treatment. Our results do not exclude a more profound negative impact of individualized treatment compared to standard, possibly caused by higher doses and extended treatment duration in the individualized group. Antiviral therapy might have a more intense and more prolonged negative impact on females.

health related quality of life; hepatitis C; peginterferon