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Hepatitis C and Neuropsychological Function In Treatment Naive HIV-1-infected Subjects - A5097s Baseline Analysis
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Reported by Jules Levin
This study was reported this morning at Retrovirus. The study from the ACTG (AIDS Clinical Trials Group) used tests to evaluate neuropsychological performance and depression in HIV+ individuals with hepatitis C. Results of the tests found that individuals infected with both HCV and HIV performed worse on these tests than persons with only HIV. There was a trend for more HCV/HIV coinfected individuals had depression than HIV+ individuals (52% vs 33%). Coinfected patients performed worse on the nruopsychologucal tests compared to HIV+ persons. These results confirm findings in numerous previously conducted studies that HCV can be associated with depression and may result in cognitive impairment. Persons with HIV can suffer from more depression and cognitive impairment than healthy individuals without HIV. This current study in coinfected persons suggests that having HCV may increase depression and cognitive impairment for individuals with both HIV and HCV compared to those with only HIV. Studies show that successful treatment, resulting in sustained virologic suppression (undetectable HCV viral load), can relieve patients of these symptoms: depression and cognitive impairment improves.
Abstract 26. authors: Y Yang1, S Evans1, R Gulick2, D Clifford*3, and AIDS Clinical Trials Group A5097s Team 1Harvard Sch. of Publ. Hlth., Boston, MA, USA; 2Weill Med. Coll. of Cornell Univ., New York, NY, USA; and 3Washington Univ. Sch. of Med., St. Louis, MO, USA
HIV-1 and HCV cause neurologic complications but it is unclear whether HIV and HCV interact. We evaluate the effect of HCV/HIV co-infection on neuropsychological performance and depression in ARV- and anti-HCV treatment-naïve subjects.
A5097s is a substudy of A5095, a phase 3 antiretroviral treatment protocol for treatment-naïve HIV-infected subjects. We evaluated the populations at baseline before any therapy was initiated. Neuropsychological performance tests included Trailmaking Test (parts A and B) and the Digit Symbol task, which together assess attention, speed of information processing, and mental flexibility. Depression was assessed with the Center for Epidemiologic Studies-Depression Scale (CES-D). HCV status was determined by the presence of anti-HCV antibody at entry. For each subject, a baseline z-score was calculated for each subtest, representing the number of standard deviations away from an age-adjusted normative performance. The results were compared between the HCV/HIV-co-infected and the HIV-infected only groups.
Of patients enrolled in A5097s, 235 had HCV status data available at entry (25 HCV+ and 210 HCV-). The HCV+ and HCV- groups were comparable except that the HCV+ group had higher prevalence of history of IV drug use and lower educational level (p <0.05). The HCV+ group had significantly lower Z-scores in neuropsychological performance overall, (0.69 vs 0.13 SDs below the mean, p=0.012). Among 3 subtests, the HCV+ group performed less well than the HCV- group on the Digit Symbol task, (0.92 vs 0.21 SDs below the mean, p<0.001). Multivariate modeling suggests that there is a significant relationship between HCV-infection status and performance in the Digit Symbol task even when controlling for confounding variables (education, sex, IV drug use, CD4 count, HIV-1 RNA, depression, alcohol use, and hepatitis B status). Of the HCV+ subjects 52% and of HCV- subjects 33% had significant depression (p=0.055). Group differences resulted from significantly higher scores on the "somatic complaint" portion of the CES-D scale (p<0.001).
Our findings suggest that HCV/HIV co-infection adversely affected neuropsychological performance, particularly in the Digit Symbol task. HCV may also be associated with depressed mood particularly with somatic complaint. Despite a limited sample size and the difficulty of excluding all possible confounding factors, our results control for many potential confounds while still demonstrating a probable effect of hepatitis C on neuropsychological performance.
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