**5.1 Issues related to HRQOL in hepatitis C and hepatitis B**

Patients with chronic hepatitis C assessed by the SF-36 show diverse and non specific symptoms (fatigue, anorexia, weight loss, abdominal distress…) and usually have significant reductions in their SF-36 scores for all of the scales (both mental and physical components) (Dwigt, 1998; Foster, 2000; Strauss, 2006) .

Patients with chronic hepatitis B virus (HBV) infection show a reduction in the SF-36 scores that assessed mental functions, but they have no reduction in the scores that measured physical symptoms, indicating that the symptoms associated with chronic HCV infection are qualitatively different to those associated with chronic HBV infection (Curry, 2004; Spiegel, 2005; Lam, 2009).

Patients with chronic HCV infection who had used intravenous drugs in the past had the greatest impairment in QOL scores, but the reduction in QOL scores was still found in patients who had never used drugs (Weissman, 1980; Fowler 1980). The reduction in QOL could not be attributed to the degree of liver inflammation or to the mode of acquisition of the infection. Recent studies have demonstrated through cerebral magnetic resonance images of abnormal cerebral metabolism and cognitive impairments in patients with chronic hepatitis C ( Hilsabeck, 2002; Forton, 2008; Bokemeyer, 2011)
