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Neurocognitive impairment is worse in HIV/HCV-coinfected individuals with liver dysfunction

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Abstract

Infections with HIV and hepatitis C virus (HCV) can individually and jointly contribute to neurocognitive impairment (NCI). Rates of NCI in HIV/HCV-coinfected persons range from 40 to 63% but its correlates have not been described. In this study, we examined HIV/HCV-coinfected adults on antiretroviral therapy (ART) with undetectable HIV RNA in blood (n = 412) who were assessed using a comprehensive neuropsychological test battery. Demographics, host and viral biomarkers, and markers of liver dysfunction were compared between impaired (n = 198) and unimpaired (n = 214) participants using logistic regression. The cohort was predominantly middle-aged men, half of whom (48%) had NCI. The odds of NCI increased by almost two-fold when serum albumin was < 4 g/dL, 1.7-fold when alanine aminotransferase (ALT) levels were > 50 IU/L, and 2.2-fold with every unit increase in log10 AST to Platelet Ratio Index (APRI). These readily available clinical biomarkers of NCI measure hepatic injury and/or dysfunction, suggesting a mechanism for the effects of HCV infection on NCI. They may identify patients at increased risk of NCI who could be prioritized for early initiation of HCV treatment to protect or improve cognition.

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Abbreviations

NCI:

Neurocognitive impairment

HIV:

Human immunodeficiency virus

HCV:

Hepatitis C virus

GDS:

Global deficit scores

HAND:

HIV-associated neurocognitive disorders

ART:

Highly active antiretroviral therapy

APRI:

AST to Platelet Ratio Index

FIB-4:

Fibrosis-4

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Acknowledgments

We thank all the participants for their invaluable contribution.

Funding

This work was supported by the National Institute on Drug Abuse of the National Institutes of Health under the award numbers R01 DA039775 (ARB) and R01 DA16015.

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Authors and Affiliations

  1. Department of Psychiatry, University of California, San Diego, CA, USA

    Jyoti Barokar, Reena Deutsch, Bin Tang & Mariana Cherner

  2. Division of Infectious Diseases, Department of Medicine, University of California, San Diego, CA, 92093, USA

    Allen McCutchan & Ajay R. Bharti

Authors
  1. Jyoti Barokar
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  2. Allen McCutchan
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  3. Reena Deutsch
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  4. Bin Tang
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  5. Mariana Cherner
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  6. Ajay R. Bharti
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Correspondence to Ajay R. Bharti.

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Summary

Readily available clinical biomarkers such as serum albumin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) to Platelet Ratio Index (APRI) may help identify patients at increased risk of neurocognitive impairment for interventions to protect or improve cognition.

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Barokar, J., McCutchan, A., Deutsch, R. et al. Neurocognitive impairment is worse in HIV/HCV-coinfected individuals with liver dysfunction. J. Neurovirol. 25, 792–799 (2019). https://doi.org/10.1007/s13365-019-00767-6

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  • DOI: https://doi.org/10.1007/s13365-019-00767-6

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