Cognitive assessment in patients with Hepatitis C submitted to treatment with Sofosbuvir and Simeprevir or Daclatasvir

Abstract

<jats:p>ABSTRACT Background: Hepatitis C can be defined as an infectious disease that develops an inflammatory activity, which may cause an impairment in the central nervous system, may cause cognitive impairments and symptoms of depression. Objective: The objective of this study was to verify the cognitive performance of patients with chronic hepatitis C before and after treatment with simeprevir, sofosbuvir, and daclatasvir. Methods: A prospective study was carried out in three stages: before, right after treatment, and six months after. Fifty-eight patients under clinical follow-up were evaluated at the Emílio Ribas Infectology Institute, in São Paulo, Brazil. The following instruments were used: sociodemographic questionnaire, Lawton’s Scale, Beck’s Depression Inventory, and a battery of neuropsychological tests that evaluated: intellectual function, memory, attention, executive function, and motor and processing speed). For statistical analysis, the analyses described (mean, frequency, and standard deviation), chi-square, and ANOVA were used. Results: Most of the participants were male (n=30, 51.7%), with a mean of 58.23±8.79 years, mean schooling of 9.75±4.43 years. Comparing the results of neuropsychological evaluations (before, just after completion of drugs, and six months), a significant improvement was observed in relation to the acquisition of new knowledge (p=0.03), late visual memory (p=0.01), and tendency towards alternate attention (p=0.07). Conclusion: The treatment of the hepatitis C virus improved cognitive performance, especially in relation to memory.</jats:p>

High rate of depression in patients with chronic hepatitis C / Taxa elevada de depressão em pacientes com hepatite C crônica

“…The data from the pre-treatment evaluation are similar to those found in our population, that is, high rates of depression and neurocognitive alterations, however, the post-treatment analysis of the São Paulo group shows significant improvement of some neurocognitive symptoms in patients who achieved HCV eradication, but the frequency of depressive symptoms did not show a statistically significant decrease. 16 As the interface of psychic and cognitive symptoms is a frequent and relevant situation in clinical practice, the improvement of neurocognitive symptoms without improvement of depressive symptoms should be highlighted, because the evaluation of these symptoms with integrated tests is important and should be stimulated aiming at improving quality of life during and after HCV infection. 10,17 The average age found is as expected, since it follows the statistical data from Brazil and the world.…”

“…11,18 The analysis of viral characteristics showed that in this research, the absolute majority had genotype 1, the most prevalent in Brazil and worldwide, and similar to other studies, the cases of depression were not related to genotype. 1,2,16 The high viral load was expected in this population, because all patients were awaiting the release of DAAs by the Brazilian Ministry of Health, according to the national protocol. [1][2][20][21] The number of comorbidities and sedentary lifestyle are expected for the average age of the population.…”

Can we offer more for cognitive impairment in patients with chronic hepatitis C?

“…According to data from the study by Gascon et al 10 , cognitive impairment and its variations are not influenced by premorbid intellectual capacity (cognitive reserve). The cognitive reserve, however, is a complex construct 11 that deserves a thorough evaluation.…”

“…The work of Gascon et al 10 re-proposes the issue of cognitive impairment in patients with CHC and, notably, examines the benefits of DAAs on cognitive functioning: the effects of therapy with three DAAs on cognitive functioning and depression levels severity in a sample of 58 patients with CHC has been examined through three evaluations: before, immediately after and six months after treatment. Cognitive assessment was based on a large series of neuropsychological tests; depression and other aspects were also evaluated with standardized tools.…”

“…Other interesting perspectives are indicated by the work of Gascon et al 10 : Are there any predisposing or protective factors towards the possible cognitive impairment in patients with CHC (e.g., ApoE genotype) that are worth exploring? It would be interesting to follow CHC patients longitudinally, distinguishing responders from non-responders to DAAs, to assess the incidence of forms of dementia or other degenerative or inflammatory CNS diseases.…”