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Hepatitis C virus–related factors associated WITH cognitive performance in HIV-HCV-coinfected patients

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Abstract

The contribution of HCV-related variables to cognitive impairment in HIV-HCV-coinfected patients has been poorly investigated. We selected HIV-HCV-coinfected patients undergoing cognitive examination (exploring memory, language, speed of mental processing and fine motor function) at three clinical centres. Cognitive performance was evaluated using Z-transformed scores. Logistic regression analysis was used to investigate variables associated to cognitive impairment (defined as a composite Z-score ≤ − 1). Overall, 146 HIV-HCV-coinfected patients were enrolled. Median HCV-RNA was 6.2logU/mL. HCV genotype 1a/b was the most represented (53.4%). Liver fibrosis was mild (Fib4 ≤ 1.45) in the majority of patients (44.5%). Global cognitive impairment was diagnosed in 35 (24%) subjects. Exploring each domain, a higher proportion of impairment was observed for memory (37%) followed by speed of mental processing (32.2%), fine motor functioning (24%) and language (18.5%). Among HCV-related variables, the duration of HCV infection was independently associated with global cognitive impairment (aOR 1.13 per +1 year, p = 0.016) and abnormal speed of mental processing (aOR 1.16 per +1 year, p = 0.001), while higher HCV-RNA was independently associated to fine motor functioning impairment (aOR 1.98 per +1log, p = 0.037). HCV genotype, fibrosis stage, transaminases or bilirubin levels were not related to cognitive performance. Of note, integrase inhibitor (InSTI) use was independently associated to a pathological performance in fine motor functioning (aOR 3.34, p = 0.035) and memory (aOR 3.70, p = 0.014). In conclusion, the duration of HCV infection and HCV-RNA load showed an association with cognitive impairment, suggesting a role of hepatitis-related factors in the development of cognitive disorders in HIV-HCV-coinfected patients. The association between InSTI use and altered cognitive performance should prompt investigations about potential neurotoxicity of these drugs.

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Authors and Affiliations

  1. Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, viale Golgi 19, 27100, Pavia, Italy

    Massimiliano Fabbiani

  2. Department of Psychology, Catholic University, Largo Gemelli 1, 20123, Milan, Italy

    Nicoletta Ciccarelli

  3. Infectious Diseases Unit, S. Gerardo Hospital, via Pergolesi 33, 20900, Monza, Italy

    Valeria Castelli, Alessandro Soria, Elisa Colella, Manuela Valsecchi, Andrea Gori & Alessandra Bandera

  4. Institute of Clinical Infectious Diseases, Fondazione Gemelli, IRCCS, Catholic University, Largo Gemelli 8, 00168, Rome, Italy

    Alberto Borghetti, Davide Moschese, Arianna Emiliozzi & Simona Di Giambenedetto

  5. Department of Medical Biotechnologies, University of Siena, viale Bracci 16, 53100, Siena, Italy

    Andrea De Luca

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  1. Massimiliano Fabbiani
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  2. Nicoletta Ciccarelli
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  3. Valeria Castelli
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Correspondence to Massimiliano Fabbiani.

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All subjects had provided informed consent for participation to observational studies prior to enrolment.

Conflict of interest

MF received speakers’ honoraria and support for travel to meetings from Bristol-Myers Squibb (BMS), Gilead, Merck Sharp & Dohme (MSD), ViiV Healthcare, Janssen-Cilag, and fees for attending advisory boards from BMS and Gilead. AS consulted for AbbVie and received travel grants for meeting expenses from ViiV, Gilead, AbbVie, Merck, Janssen-Cilag. AB reports non-financial support from Bristol Myers Squibb, personal fees from Gilead Sciences, and non-financial support from ViiV Healthcare. AG received speaker’s honoraria and fees for attending advisory boards from ViiV Healthcare, Gilead, Janssen-Cilag, Merck Sharp & Dohme, Bristol-Myers Squibb, Pfizer, and Novartis and received research grants from ViiV, Bristol-Myers Squibb, and Gilead. ADL received speakers’ honoraria and fees for attending advisory boards from ViiV, Gilead, AbbVie, JC, MSD, and BMS and received unrestricted research grants (to his Institution) from ViiV Italy, Gilead Sciences (Fellowship Program), and MSD Italy. AB received grants from Gilead Fellowship Program (2011, 2013, 2016) and support for travel to meetings from AbbVie, MSD, ViiV, BMS, and Gilead. SDG received speakers’ honoraria and support for travel meetings from Gilead, Bristol-Myers Squibb (BMS), Abbott, Boehringer Ingelheim, Janssen-Cilag (JC), and GlaxoSmithKline. The remaining authors declare that they have no conflict of interest.

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Fabbiani, M., Ciccarelli, N., Castelli, V. et al. Hepatitis C virus–related factors associated WITH cognitive performance in HIV-HCV-coinfected patients. J. Neurovirol. 25, 866–873 (2019). https://doi.org/10.1007/s13365-019-00780-9

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