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Lower Cognitive Scores in Women With HCV/HIV Than With HIV Alone
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Third International Workshop on HIV and Women, January 14-15, 2013, Toronto
Mark Mascolini
Canadian women coinfected with hepatitis C virus (HCV) and HIV had a significantly lower cognitive composite index (CCI) than comparison groups of women infected only with HIV and women infected with neither virus.1 Cognitive scores did not differ significantly between the HIV-positive/HCV-negative group and the uninfected group.
Research has not assessed cognitive function in HIV-positive women as thoroughly as in HIV-positive men. Even less is known about the potential dual impact of HCV and HIV on cognitive function in women. To address these issues, researchers conducted this study in HIV-positive and negative women attending the Oak Tree Clinic in Vancouver, British Columbia.
The study involved 126 women participating in a larger study of neurocognition, including 81 women (64%) with HIV infection and 27 (21%) with HCV detectable by PCR. The researchers compared the CCI in three groups--20 women with HCV and HIV, 61 with only HIV infection, and 37 negative for both HIV and HCV.
All women underwent a comprehensive neuropsychologic battery including standard paper-and-pencil tests and subtests from a computerized battery (CANTAB). Altogether, 12 tests assessed four cognitive domains: fine motor speed and dexterity, learning and memory, processing speed, and executive function. The investigators generated z scores to control for the effects of age and education. They calculated a CCI by averaging z scores across cognitive domains, and they used analysis of covariance (ANCOVA) to compare data in the three groups.
The three groups were well matched in age (about 45 years), education (about 13 years), and proportion with depression (about 14%). Rates of heavy substance use were higher in HCV/HIV-coinfected women (80%) than in women with only HIV (46%) or women infected with neither virus (57%). At the time of neuropscyhologic testing, HIV-positive women had an average CD4 count of 516, and 76% of them had an undetectable viral load.
ANCOVA indicated a significant between-group difference in cognitive performance (F = 4.08, P = 0.02). Women coinfected with HCV and HIV had an average CCI score one-half standard deviation below the average of the other two groups. Average CCI in the coinfected group was significantly lower than in the HIV-infected group (P = 0.007) or the uninfected group (P = 0.013). But CCI did not differ significantly between the HIV-infected group and the uninfected group (P = 0.928).
Mean CCI by HIV and HCV status:
-- HIV+/HCV+: -0.51, standard deviation (SD) 1.17
-- HIV+/HCV-: +0.08, SD 0.97
-- HIV-/HCV-: +0.14, SD 0.89
When the researchers ran the same type of analysis on two individual areas of impairment--executive function and psychomotor/processing speed--they got similar results. In both cases, the average score for coinfected people was significantly lower than in either of the comparison groups. But the two comparison groups had similar average scores for these two areas of impairment.
The investigators noted that their analyses were limited by the small sample sizes. Still, they believe their findings "highlight the importance of assessing for other viral infections in HIV+ women and confirm [existing] literature suggesting the additional, detrimental impact HCV may have on neurocognitive performance."
Reference
1. Giesbrecht C, Thornton A, Hall-Patch C, et al. Poorer cognitive performance in HIV+ women coinfected with Hepatitis C (HCV) relative to control (uninfected) and monoinfected (HIV+) women. Third International Workshop on HIV and Women. January 14-15, 2013. Toronto. Abstract O_05.
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