Hepatitis C virus influences neurocognitive function in patients free from other risk factors

Hepatitis C virus influences neurocognitive function in patients free from other risk factors

A study in the latest issue of Liver International examines the influence of hepatitis C virus on neurocognitive function in patients free from other risk factors.

Mild neurocognitive dysfunction and altered cerebral proton magnetic resonance spectroscopy (1H-MRS) have been demonstrated in patients with chronic hepatitis C.

Dr Jenny Heathcote and colleagues from Canada performed a longitudinal study to quantify these abnormalities in a cohort of patients free from correlated risk factors and determine whether treatment-induced viral clearance abolished these abnormalities.

Treatment-naïve, non-cirrhotic patients with chronic hepatitis C, rigorously screened and excluded for other causes of impaired neurocognition, underwent neurocognitive testing,
1H-MRS and evaluation for quality of life, mood and fatigue, before and 6 months after the completion of antiviral therapy.

Viral clearance was associated with an improvement in the quality of life score
Liver International

A comparison group of healthy controls was similarly assessed at baseline and 1 year later.
Post-treatment results in 40 patients with chronic hepatitis C were compared with their pretreatment results, and with the baseline and follow-up assessments of 39 healthy controls.
Before receiving treatment, the team noted that patients had impaired learning efficiency, poorer quality of life and higher fatigue scores compared with the controls.

The team observed that viral clearance was associated with a significant albeit small improvement in the quality of life score that did not reach control levels.

Cerebral 1H-MRS demonstrated a lower N-acetyl aspartate/creatine ratio in the globus pallidus of patients with hepatitis C, which was unchanged with viral clearance.

The research team found that the globus pallidus choline N-acetyl aspartate/creatine ratio increased in HCV-R following treatment, without a correlation with cognitive measures.
Dr Heathcote's team concludes, "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."

Liver International 2011: 31(7): 1028–1038

Influence of hepatitis C virus on neurocognitive function in patients free from other risk factors: validation from therapeutic outcomes.
Liver Int. 2011; 31(7):1028-38
(ISSN: 1478-3231)

Pattullo V; McAndrews MP; Damyanovich A; Heathcote EJDepartment of Medicine, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada Faculty of Medicine, University of Sydney, Sydney, NSW, Australia Department of Psychology, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada Department of Radiation Physics, University Health Network, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada.

Background and Aims:
Mild neurocognitive dysfunction and altered cerebral proton magnetic resonance spectroscopy ((1) H-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, (1) H-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 (1) H-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.
08 August 2011
PreMedline Identifier: 21733093