Improving Health-Related Quality of Life Assessment in Chronic Hepatitis C

Dear Editor, Alvarez, Urbina, and Tejada [1] comment on the importance of considering chronic hepatitis C patients with cognitive impairment in the evaluation of health-related quality of life (HRQoL) [2], bearing in mind that this is a usual comorbidity in this population. They argue that in patients with chronic disease and low cognitive status, the caregivers should be a valuable source of information of their quality of life, as demonstrated by studies with neurodegenerative disorders. They also propose the development of specific instruments for assessing quality of life in patients with both chronic diseases and cognitive impairment. We appreciate the contribution of Alvarez, Urbina, and Tejada [1] and agree on the relevance of evaluating quality of life in chronic hepatitis C patients regardless of the severity of extrahepatic manifestations. Recent evidence suggests that one third of patients with chronic hepatitis C virus (HCV) can experience cognitive impairment even in the absence of cirrhosis, although greater fibrosis correlates significantly with poorer cognitive functioning [3, 4]. Attention, concentration, working memory processes, and mental flexibility are the most frequently affected cognitive abilities early in the course of disease [4, 5]. These impairments are reported to affect quality of life and performance in professional and personal settings [4]. In our study, we considered cognitive impairment as an exclusion criteria if the patient demonstrated very severe limitations that precluded a reliable understanding of the questions, including extremely low literacy level or illiteracy. We believe that this selection did not imply a low representability of this population, because the most frequently reported cognitive impairments, especially in the early stage of disease, are executive functions that do