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Differential Cognitive Impairment in HCV Coinfected Men With Controlled HIV Compared to HCV Monoinfection

Sun, Bing MD, PhD*; Abadjian, Linda PhD; Rempel, Hans PhD*; Monto, Alexander MD; Pulliam, Lynn MS, PhD*,§

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 1st, 2013 - Volume 62 - Issue 2 - p 190–196
doi: 10.1097/QAI.0b013e31827b61f1
Clinicial Science

Background: Individuals infected with both HIV and hepatitis C virus (HCV) have shown impaired performance on different neuropsychological (NP) tests; however, whether coinfected individuals with controlled HIV and minimal liver damage in the era of antiretroviral therapy have impairment is understudied.

Methods: Nineteen HCV monoinfected, 17 HIV/HCV coinfected, and 17 control male participants were evaluated for depression, attention, executive function, information processing, fine motor speed, and verbal/visual learning/memory. Eleven controls and 14 HIV monoinfected participants with controlled viral load from a previous study were also included for comparison. At time of testing, participants were not using drugs or alcohol and did not have cirrhosis. A global deficit score (GDS) was calculated from 7 domains of NP tests and alterations in specific domains were determined.

Results: HIV/HCV subjects had a higher depression score (11.1 ± 7.5) than controls (5.4 ± 4.1, P = 0.010) and a higher GDS score (0.77 ± 0.47) than HCV (0.46 ± 0.34, P = 0.036), HIV (0.45 ± 0.36, P = 0.008), and controls (0.30 ± 0.29, P = 0.001). Coinfection was associated with worse scores in attention working memory (P =0.007), executive function (P = 0.01), fine motor function (P = 0.011), verbal learning/memory (P < 0.001), and visual learning/memory (P < 0.001) compared to controls. Within the HCV group, viral load was associated with lower attention, executive function, and information processing speed and positively with GDS.

Conclusions: Coinfection significantly increased the risk of cognitive impairment in subjects with controlled HIV viral loads. In HCV monoinfected but not coinfected subjects, HCV viral load correlated with worsening GDS, suggesting different pathways for NP impairment.

Departments of * Laboratory Medicine; and

Mental Health, Veterans Affairs Medical Center, San Francisco, CA

Department of Medicine, Division of Gastroenterology, Veterans Affairs Medical Center and University of California, San Francisco, CA

§Department of Laboratory Medicine, University of California, San Francisco, CA.

Correspondence to: Lynn Pulliam, MS, PhD, Department of Laboratory Medicine, Veterans Affairs Medical Center, 4150 Clement St (113A), San Francisco, CA 94121 (e-mail: lynn.pulliam@ucsf.edu).

Supported by National Institutes of Mental Health Grant RO1MH085538 (to L. Pulliam).

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal\x{2019}s Web site (www.jaids.com).

Received May 18, 2012

Accepted October 26, 2012

© 2013 Lippincott Williams & Wilkins, Inc.