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The neuropsychological and neurological impact of hepatitis C virus co-infection in HIV-infected subjects

Clifford, David Ba; Evans, Scott Rb; Yang, Yijunb; Gulick, Roy Mc

Section II: Neurocognitive and neuropsychological studies

Objective: To evaluate the effect of hepatitis C virus (HCV)/HIV co-infection on neuropsychological performance and neurological status in HIV/HCV treatment-naive HIV-1-infected individuals we conducted a cross-sectional study using baseline data from an HIV therapy trial.

Methods: HCV status was determined by the presence of anti-HCV antibodies. Neuropsychological function was evaluated by Trailmaking tests, and the Digit Symbol Task. Depression was assessed using the Center for Epidemiologic Studies – Depression Scale. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index and anxiety by the State–Trait Anxiety Inventory for Adults. A questionnaire was designed grading the severity of a variety of symptoms.

Results: Of 264 patients with HCV status data, 30 were HCV positive and 234 were HCV negative. Both groups were comparable except that HCV-positive individuals had a higher prevalence of intravenous drug use and lower educational level. The HCV-positive group had a significantly lower neuropsychological performance overall. Multivariate modeling supported an association between HCV infection status with test performance in the Digit Symbol Task and mood parameters even when controlling for potentially confounding variables. Marginal differences were noted with respect to symptom questionnaire scores and global sleep. No differences were noted with respect to anxiety.

Conclusion: The findings suggest that HCV/HIV co-infection has an adverse impact on neuropsychological function. HCV may also be associated with depressed mood, particularly somatic depressive symptoms. Although confounding contributors to neuropsychological performance are difficult to exclude, exploratory modeling supports the association between HCV infection status and some impairment of neuropsychological performance and depressed mood.

aWashington University School of Medicine, St Louis, MO, USA

bHarvard School of Public Health, Boston, MA, USA

cWeill Medical College of Cornell University, New York, NY, USA.

Correspondence to David B. Clifford, MD, Department of Neurology, Washington University School of Medicine, C.B. 8111, 660 South Euclid Avenue, St Louis, MO 63110, USA. Tel: +1 314 747 8423; fax: +1 314 747 8427; e-mail: cliffordd@neuro.wustl.edu

© 2005 Lippincott Williams & Wilkins, Inc.