Neurocognitive impairment with hepatitis C and HIV co-infection in Southern Brazil

Abstract

Although cognitive impairment has been well documented in human immunodeficiency virus (HIV) and hepatitis C virus (HCV) mono-infections, research on neurocognitive effects is limited in the context of HIV/HCV co-infection. The aims of this study were to explore the interplay between HIV and HCV infections in the expression of neurocognitive impairment (NCI), and to examine the differences in test performance between HIV/HCV co-infected and HIV or HCV mono-infected patients. A total of 128 participants from Southern Brazil underwent a comprehensive neuropsychological (NP) battery comprising 18 tests. Participants were grouped according to their serological status: HCV mono-infected (n = 20), HIV mono-infected (n = 48), HIV/HCV co-infected (n = 12), and HIV-/HCV-uninfected controls (n = 48). The frequencies of HIV subtypes B and C between the HIV mono-infected and HIV/HCV co-infected groups were comparable. There was greater prevalence of neuropsychological impairment among all three infection groups compared with the uninfected control group, but no statistically significant differences among mono- and co-infected groups were found. HCV infection was associated with cognitive deficits, independently of liver dysfunction. HCV infection did not show an additive effect on neurocognitive function among HIV+. NCI was independent of HCV RNA on peripheral blood, CSF, and hepatic injury. While we did not find additive global effect, in the present study, there was some evidence of additive HIV/HCV co-infection effects in speed of information processing, executive function, and verbal fluency domains when comparing the co-infected group with the other three groups. NP impairment was not dependent on HCV subtypes.

Effects of HIV on executive function and verbal fluency in Cameroon

“…NP tests were also back-translated into English, and back-translated tests were similar to the original English version of the tests 84 . This battery has been shown to be sensitive in detecting HAND in several other settings, including in the USA 85,86 , India 87 , China 48,83 , Brazil 88,89 , Cameroon 84 , Nigeria 10,46,52,90 , Zambia 91–93 , and South Africa 51,94 . The NP tests were administered by trained psychometrists.…”

Neurological complications during HIV infection

“…Despite overall risks have significantly decreased during the ART era, common HIV co-infections include tuberculosis and hepatitis B and C. The types of cancer with higher incidence in the HIV positive population include Kaposi's sarcoma, Hodgkin's lymphoma, non-Hodgkin lymphoma, cervical cancer, anal cancer, liver cancer and lung cancer [79,80]. In terms of neurological impairment, hepatitis C virus (HCV) co-infection has been often associated with a greater risk for neurocognitive disorders in HIV infected individuals [81,82]. This may be related to enhanced HCV-related immune activation, both systemic and in the CNS.…”

Mechanisms of neuropathogenesis in HIV and HCV: similarities, differences, and unknowns

“…Some groups found that HCV likely further impairs cognition on a background of HIV infection (Cherner et al 2005; Hinkin et al 2008; Thiyagarajan et al 2010), while others have not (Clifford et al 2015). In a study in Southern Brazil, greater cognitive impairment was seen in HCV mono- and HCV-HIV co-infected groups as compared to healthy controls, but impairment was comparable between the mono- and co-infected groups (de Almeida et al 2018). Similarly, no clear additive effect was seen with HCV in HIV co-infected patients with regard to white matter microstructural integrity (Heaps-Woodruff et al 2016).…”