Direct antivirals and cognitive impairment in hepatitis C: a clinical-neurophysiologic study

Abstract

Cognition was assessed in hepatitis C virus (HCV) patients, who did not meet the criteria for a minimal hepatic encephalopathy. Their liver function was compensated. We then disentangled potential cognitive changes associated with a sustained virologic response at 12 weeks (SVR-12), following treatment with direct antiviral agents (DAAs). We studied 23 selected HCV patients with a battery of standard neuropsychological tests, and with recordings of the P300 wave, a cerebral potential of “cognitive” significance. There was a baseline evaluation (T0) and a second one 6 months later (T1). We had 2 control groups of comparable age and sex, i.e., 15 patients suffering from non-alcoholic fatty liver disease (NAFLD) and 15 healthy subjects. At T0, we detected a significant (p < 0.05) cognitive impairment in the HCV group, which involved episodic and working memory, attention, visuospatial and verbal abilities, executive functions, and logic reasoning. The P300 latency was significantly (p < 0.05) delayed in the group. At T1, we observed some significant (p < 0.05) HCV recovery in given test domains, e.g., memory, executive functions, and reasoning. Accordingly, the P300 latency shortened significantly (p < 0.05). HCV patients exhibited subtle cognitive defects, somehow independent of their liver condition, possibly linked to direct or indirect brain involvement by the virus. These defects partly recovered following the SVR-12, as achieved through DAAs. The P300 wave was a valid neurophysiologic counterpart of these changes. DAAs can have a role in the early preservation of cognition in HCVs.

A Review on Extrahepatic Manifestations of Chronic Hepatitis C Virus Infection and the Impact of Direct-Acting Antiviral Therapy

“…In a small population, elimination of HCV by DAAs has been shown to improve anxiety and de-pression [98], although another study could not find an impact on anxiety or depression during or after HCV treatment by DAA [99]. Other studies have evidenced the possibility of an improvement in cognitive functions after viral eradication by DAA [100,101]. A recent study evaluated various cognitive areas using psychometric tests comparing patients with treatment-naive HCV or HCV treated with DAA and heathy individuals found that HCVpositive patients performed significantly differently from healthy controls, but no difference was found between untreated HCV and DAA-treated patients.…”

Neurological and psychiatric effects of hepatitis C virus infection

“…In patients with suspected HCV-AND, tests that can be used to analyze the various cognitive domains are: Verbal learning and episodic memory: Rey auditory verbal learning test, Hopkins verbal learning test total recall, brief visual memory test revised total recall, digit forward span, verbal learning and memory test; Working memory: digit backward span, letter number sequencing, paced auditory serial addition task; Visuospatial skills and planning: Rey-Osterrieth complex figure test (ROCF) in the immediate trial; Lexical skills and executive functions: phonemic and the semantic verbal fluency tests, color-word-interference test (Stroop), trail making test part B, Wisconsin card sorting test, ROCF in the 10-min delayed recall trial; Logical thinking: verbal judgment test; Non-verbal intelligence: Horn’s performance test system[ 67 - 69 ].…”

Neuropsychological effects of direct‐acting antiviral treatment for Hepatitis C virus subjects: A systematic review

“…The direct-acting antiviral agents (DAAs) are a set of medications used to treat patients infected by the HCV. The summary of study characteristics and quality assessment of the 12 [29][30][31][32][33][34][35][36][37][38][39][40] included studies are presented in Table 2. Two of them were considered high quality, whilst the remaining ten others had ratings ranging from 4 to 6 stars, suggesting moderate quality.…”

“…Nine of the studies only evaluated it at the end of DAAs treatment. 29,[31][32][33][34][35][38][39][40] The other studies evaluated it twice-during, soon after the end, or after the end of DAAs treatment. 30,36,37 Amongst the results related to the cognitive effect of DAAs treatment, some studies had one or two control groups of healthy subjects, subjects coinfected with HIV and/or subjects with another clinical condition.…”

“…30,36,37 Amongst the results related to the cognitive effect of DAAs treatment, some studies had one or two control groups of healthy subjects, subjects coinfected with HIV and/or subjects with another clinical condition. 29,31,39,3438…”