Influence of hepatitis C virus on neurocognitive function in patients free from other risk factors: validation from therapeutic outcomes

Authors

  • Venessa Pattullo,

    1. Department of Medicine, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
    2. Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
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  • Mary Pat McAndrews,

    1. Department of Psychology, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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  • Andrei Damyanovich,

    1. Department of Radiation Physics, University Health Network, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
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  • E. Jenny Heathcote

    1. Department of Medicine, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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Correspondence
Dr Jenny Heathcote, Toronto Western Hospital, 399 Bathurst St 6B Fell Rm 154, Toronto, ON, Canada M5T 2S8
Tel: +1 416 603 5800 x 2350
Fax: +1 416 603 6281
e-mail: jenny.heathcote@utoronto.ca

Abstract

Background and Aims: Mild neurocognitive dysfunction and altered cerebral proton magnetic resonance spectroscopy (1H-MRS) have been demonstrated in patients with chronic hepatitis C (CHC). This longitudinal study aimed to quantify these abnormalities in a cohort of patients free from correlated risk factors and determine whether treatment-induced viral clearance abolished these abnormalities.

Methods: Treatment-naïve, non-cirrhotic patients with CHC, rigorously screened and excluded for other causes of impaired neurocognition, underwent neurocognitive testing, 1H-MRS and evaluation for quality of life (QOL), mood and fatigue, before and 6 months after the completion of antiviral therapy. A comparison group of healthy controls was similarly assessed at baseline and 1 year later.

Results: Post-treatment results in 40 patients with CHC [31 sustained virological responders, hepatitis C virus (HCV)-R and 9 non-responders, HCV-NR] were compared with their pretreatment results, and with the baseline and follow-up assessments of 39 healthy controls. Before receiving treatment, patients had impaired learning efficiency, poorer QOL and higher fatigue scores compared with the controls. Viral clearance was associated with a significant albeit small improvement in the QOL score that did not reach control levels. Cerebral 1H-MRS demonstrated a lower N-acetyl aspartate/creatine (CRE) ratio in the globus pallidus (GP) of patients with hepatitis C, which was unchanged with viral clearance. The GP choline/CRE ratio increased in HCV-R following treatment, without a correlation with cognitive measures.

Conclusions: The hepatitis C virus has a measurable effect on CNS integrity in patients screened for other medical and/or psychiatric comorbidities. Viral clearance has not been demonstrated to abolish these abnormalities.

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