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. 2025 Feb 19;22(1):20.
doi: 10.1186/s12981-025-00707-x.

Neuropsychiatric and laboratory outcomes of hepatitis C treatment in an early-treated HIV cohort in Thailand

Ferron Ocampo  1 , Carlo Sacdalan  2   3 , Suteeraporn Pinyakorn  4   5 , Misti Paudel  4   5 , Tanyaporn Wansom  6 , Nathornsorn Poltubtim  2 , Somchai Sriplienchan  2 , Nittaya Phanuphak  7 , Robert Paul  8 , Denise Hsu  4   5 , Donn Colby  4   5 , Lydie Trautmann  4   5 , Serena Spudich  9   10 , Phillip Chan  9   10 ; RV254/SEARCH 010 Study Team
Affiliations

Neuropsychiatric and laboratory outcomes of hepatitis C treatment in an early-treated HIV cohort in Thailand

Ferron Ocampo et al. AIDS Res Ther. .

Abstract

Background: Hepatitis C virus (HCV) coinfection may further compromise immunological and cognitive function in people with HIV (PWH). This study compared laboratory and neuropsychiatric measures across the periods of HCV seroconversion and direct-acting antiviral (DAA) therapy with sustained virologic response (SVR) among PWH who initiated antiretroviral therapy (ART) during acute HIV infection (AHI) and acquired HCV after 24 weeks of ART.

Methods: Participants from the RV254 AHI cohort underwent paired laboratory and neuropsychiatric assessments during follow-up visits. The former included measurements of CD4 + and CD8 + T-cell counts, HIV RNA, liver enzymes, and lipid profiles. The latter included the Patient Health Questionnaire-9 (PHQ-9), Distress Thermometer (DT), and a 4-test cognitive battery that evaluated psychomotor speed, executive function, fine motor speed, and dexterity. The raw scores in the battery were standardized and averaged to create an aggregate performance (NPZ-4) score. Parameters of HCV-coinfected participants were compared across the periods of HCV seroconversion and DAA treatment.

Results: Between 2009 and 2022, 79 of 703 RV254 participants acquired HCV after ≥ 24 weeks of ART; 53 received DAA, and 50 (94%) achieved SVR. All participants were Thai males (median age: 30 years); 34 (68%) denied past intravenous drug use, and 41 (82%) had a history of other sexually transmitted infections during follow-up. Following SVR, aspartate transferase (AST) and alanine transaminase (ALT) decreased (p < 0.001), while total cholesterol, low-density lipoprotein, and triglycerides increased (p < 0.01). The median CD4 + /CD8 + ratio increased from 0.91 to 0.97 (p = 0.012). NPZ-4 improved from 0.75 to 0.91 (p = 0.004). The median DT score increased from 1.7 to 2.7 (p = 0.045), but the PHQ-9 score remained unchanged.

Conclusion: HCV coinfection is common in this group of high-risk PWH, highlighting the need for regular screening, early diagnosis, and treatment. The study participants exhibited a modest improvement in the CD4 + /CD8 + T-cell ratio and cognitive performance following DAA therapy and SVR. Future studies should examine potential neuropsychiatric impacts during early HCV infection as well as the longer-term neuropsychiatric outcomes after DAA treatment with SVR.

Keywords: Cognitive; Direct-acting antivirals; HIV; HIV/HCV coinfection; Hepatitis C; PWH; SVR.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol was approved by the institutional review boards of all relevant collaborating institutions. All participants provided written informed consent. Consent for publication: Not applicable. Competing interests: The RV254/SEARCH 010 study participants received antiretroviral drugs from the Thai Government Pharmaceutical Organization, Gilead Science, Merck, and ViiV Healthcare. SS reports grants from the NIH–NIMH and NINDS during the study and nonfinancial support from ViiV Healthcare, Inc., in the form of medications for a clinical trial; study medications were provided to the AIDS Clinical Trials Group for the clinical trial, outside the submitted work. RP and LT reports grants from the NIH–NIMH and NIAID. The other authors report no potential conflicts of interest.

Figures

Fig. 1
Fig. 1
Study participant identification and selection
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References

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