Acute
Hepatitis C Affects Neurocognitive Functioning in People with HIV By
Liz Highleyman 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. Central
nervous system and
peripheral nervous system |  |
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.
5/22/09 Division
of Medicine and Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial
College, London, UK. 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.
EASL
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