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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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