Influence of hepatitis C virus on neurocognitive function in patients free from other risk factors: validation from therapeutic outcomes
Article first published online: 25 MAY 2011
© 2011 John Wiley & Sons A/S
Volume 31, Issue 7, pages 1028–1038, August 2011
How to Cite
Pattullo, V., McAndrews, M. P., Damyanovich, A. and Heathcote, E. J. (2011), Influence of hepatitis C virus on neurocognitive function in patients free from other risk factors: validation from therapeutic outcomes. Liver International, 31: 1028–1038. doi: 10.1111/j.1478-3231.2011.02549.x
- Issue published online: 6 JUL 2011
- Article first published online: 25 MAY 2011
- Received 11 October 2010, Accepted 5 May 2011
- chronic hepatitis C;
- health-related quality of life;
- magnetic resonance spectroscopy;
- neurocognitive tests
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.