Neurocognitive impairment with hepatitis C and HIV co-infection in Southern Brazil

Abstract

Although cognitive impairment has been well documented in human immunodeficiency virus (HIV) and hepatitis C virus (HCV) mono-infections, research on neurocognitive effects is limited in the context of HIV/HCV co-infection. The aims of this study were to explore the interplay between HIV and HCV infections in the expression of neurocognitive impairment (NCI), and to examine the differences in test performance between HIV/HCV co-infected and HIV or HCV mono-infected patients. A total of 128 participants from Southern Brazil underwent a comprehensive neuropsychological (NP) battery comprising 18 tests. Participants were grouped according to their serological status: HCV mono-infected (n = 20), HIV mono-infected (n = 48), HIV/HCV co-infected (n = 12), and HIV-/HCV-uninfected controls (n = 48). The frequencies of HIV subtypes B and C between the HIV mono-infected and HIV/HCV co-infected groups were comparable. There was greater prevalence of neuropsychological impairment among all three infection groups compared with the uninfected control group, but no statistically significant differences among mono- and co-infected groups were found. HCV infection was associated with cognitive deficits, independently of liver dysfunction. HCV infection did not show an additive effect on neurocognitive function among HIV+. NCI was independent of HCV RNA on peripheral blood, CSF, and hepatic injury. While we did not find additive global effect, in the present study, there was some evidence of additive HIV/HCV co-infection effects in speed of information processing, executive function, and verbal fluency domains when comparing the co-infected group with the other three groups. NP impairment was not dependent on HCV subtypes.

Keywords: HCV; HIV-1; HIV-associated neurocognitive disorders (HAND).

Figure 1. Frequency of global neuropsychological impairment based on global deficit score (GDS) > 0.5 in the HIV and HCV mono-infected, HIV/HCV co-infected and seronegative groups

All seropositive groups were significantly worse than the seronegative group p=0.0002, but not different from one another.

Figure 2. Global NP impairment in the HIV and HCV mono-infected, HIV/HCV co-infected and serum negative group

The global deficit scores in the HIV−/HCV+, HIV+/HCV− and HIV+/HCV+ groups were significantly higher than those in the HIV−/HCV− group (p=0.042, p<0.001, and p=0.001 respectively, after Benjamini-Hochberg correction). Differences between groups described above, assessed as Cohen’s d effect size (95% confidence interval), were −0.76(−1.31,−0.20), −1.13(−1.57,−0.69), and −1.27(−1.97,−0.57) respectively. The other comparisons were not significant. The line in the center of the box represents median; the superior and inferior borders of the box represents IQRs; the whiskers represent the least and greatest values, excluding outliers which are defined as the values falling below the first quartile − 1.5 IQR or above the third quartile + 1.5 IQR.