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Acute Hepatitis C Affects Neurocognitive Functioning in People with HIV

Acute coinfection with hepatitis C virus (HCV) can contribute to neurocognitive impairment in people with HIV, according to a British study presented at the 44th Annual Meeting of the European Association for the Study of the Liver (EASL 2009) last month in Copenhagen.

L. Garvey from Imperial College London and colleagues evaluated neurological and cognitive changes in HIV positive individuals with acute HCV infection. Acute hepatitis C -- which is often asymptomatic -- may be identified in HIV patients undergoing routine liver function tests to monitor antiretroviral drug toxicity.

Central nervous system (CNS) manifestations of chronic hepatitis C and HIV have previously been described, including neurocognitive impairment, altered CNS metabolites, and evidence of HCV and/or HIV replication in the brain, the investigators noted as background. Some prior research indicated that chronic hepatitis C can contribute to cognitive impairment in people with HIV, but the impact of acute HCV infection on the CNS has not previously been studied.

The present analysis included 10 patients with stable chronic HIV infection and documented acute HCV infection (HCV RNA positive but HCV antibody negative). Matched groups of HIV positive individuals with no evidence of HCV infection and healthy participants with neither HIV nor HCV served as control subjects.

Participants underwent cerebral proton magnetic resonance spectroscopy (MRS) to quantify the myoinositol-to-creatine (mI/Cr) ratio in the right basal ganglia; levels of these metabolites are commonly used as a marker for neurological damage. The participants also completed computerized neurocognitive assessments (CogState).

Results

• Right basal ganglia mI/Cr ratio in the acute HCV group was significantly lower -- an indicator of impairment -- than it was in the HIV monoinfected and uninfected control groups (mean 2.90 vs 3.34 vs 3.43, respectively; P = 0.049).
• 50% of patients in the acute HCV group had a mI/Cr ratio below the lowest observed ratio in either of the control groups.
• Neurocognitive testing revealed significant defects in the monitoring domain in the acute HCV group compared with matched controls (P = 0.021).

"Acquisition of acute HCV in subjects with chronic HIV infection is associated with CNS involvement," the investigators concluded. "Reduced mI/Cr ratio is marker of infection and immune activation of microglial cells."

"Clinicians should be aware of early CNS involvement when assessing and treating subjects with acute HCV infection," they recommended.

Division of Medicine and Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College, London, UK.

5/22/09

Reference

L Garvey, A Winston, E Scotney, and others. Does Acute Hepatitis C Infection Affect the Central Nervous System in HIV Infected Individuals? 44th Annual Meeting of the European Association for the Study of the Liver (EASL 2009). Copenhagen, Denmark. April 22-26, 2009.