Hepatitis C pretreatment profile and gender differences: Cognition and disease severity effects

Abstract

BACKGROUND The hepatitis C virus (HCV) is known to infect the brain, however findings on associated neuropsychiatric syndrome are controversial and the association itself remains unclear. Gender research in HCV infection is limited, failing to integrate the role of gender in neurocognitive syndrome. This study aimed to characterize psychological and neurocognitive profiles in HCV-infected patients before treatment and to describe gender differences in those profiles as well as the impact of disease severity. METHODS A total of 86 patients diagnosed with chronic hepatitis C were selected in the context of a multidisciplinary out-patient clinic. A semistructured interview was performed to collect social-demographic data and clinical characterization. Assessment was performed using the Hamilton anxiety scale (HAM-A), Hamilton depression scale (HAM-D), Beck depression inventory and a neuropsychological battery to measure attention, concentration, memory and executive functions components validated for the Portuguese population, before starting treatment. To identify the disease severity, platelet ratio index and FibroScan® were used. RESULTS A statistically significant gender effect was found on HAM-A (B = 0.64, confidence interval (CI): 0.17-1.11) and HAM-D, with women scoring higher (B = 0.62, CI: 0.14-1.09) compared to men. Regarding neuropsychological scores, significant differences between gender were identified in executive functions Trails Making Test (TMT)-B (B = 0.48, CI: 0.02-0.97), TMT B-A (B = 0.26, CI: -39.2 to -3.7) and in digit span total (B = -0.52, CI: -1.0 to -0.04), with women performing worse than men. Controlling for years of substance dependence, Digit Span Total was no longer significant; however, TMT-B and TMT B-A continued showing gender differences. Regarding the presence or absence of substance dependence, only HAM-A and HAM-D remained significant. For categorial variables, Digit Span Total was also influenced by gender, with women being more likely to be impaired (odds ratio (OR) = 7.07, CI: 2.04-24.45), and a trend was observed for Digit Span Backward (OR = 3.57, CI: 1.31-9.75). No significant differences were found between disease severity and neurocognitive performance. CONCLUSION Data suggest that gender has an influence on depression, anxiety and cognitive functions independently of the stage of infection. This effect seems influenced by substance dependence.