Improvement of Neurocognitive Function in Responders to an Antiviral Therapy for Chronic Hepatitis C

Abstract

Earlier studies have suggested neurocognitive impairment in patients with chronic hepatitis C virus (HCV) infection even before liver cirrhosis has developed. Since these deficits might be reversible after successful antiviral therapy, we analyzed the long‐term course of neurocognitive parameters in HCV patients with and without successful virus elimination by an interferon‐based antiviral treatment. In a multicenter study including 168 HCV patients receiving antiviral therapy (peginterferon alpha‐2b and ribavirin) we performed a long‐term follow‐up of neurocognitive performance before and after treatment. Neurocognitive function was psychometrically assessed using the computer‐aided TAP (Test Battery of Attentional Performance). When tested at least 12 months after termination of antiviral treatment, patients with sustained virologic response (SVR) had improved significantly as compared to their pretreatment performance in three of five TAP subtasks (vigilance, P < 0.001; shared attention: optical task, P < 0.001; working memory, P < 0.001). Patients who failed to eradicate the virus, however, showed no significant long‐term changes in neurocognitive performance in all five subtasks assessed (0.194 < P < 0.804). In the posttreatment evaluation, neurocognitive function was significantly better in responders to the antiviral therapy as compared to nonresponders. Conclusion: Successful eradication of HCV leads to a significant improvement of relevant aspects of attentional and neurocognitive performance, indicating that the neurocognitive impairment caused by chronic HCV infection is potentially reversible. This therefore suggests an added therapeutic benefit of antiviral treatment in HCV infection. Improvement of neurocognitive function may be an additional treatment indication in patients with HCV. (HEPATOLOGY 2013;58:497–504)

Extrahepatic comorbidities associated with hepatitis C virus in HIV-infected patients

“…Two studies have reported improvement of the neurocognitive function in patients with HCV after successful antiviral therapy, suggesting that benefits on the neurocognitive dysfunction may be an additional consideration for prescribing antiviral therapy in patients with chronic hepatitis C [77,78].…”

Eradication of hepatitis C virus and non‐liver‐related non–acquired immune deficiency syndrome–related events in human immunodeficiency virus/hepatitis C virus coinfection

“…Many of the manifestations of HCV‐related mixed cryoglobulinemia can resolve following successful HCV treatment, although patients with significant renal or neural injury may not recover fully after eradication of HCV infection . In the HCV‐monoinfected population, eradication of HCV following anti‐HCV therapy may reduce the risk of developing type II diabetes mellitus, renal and cardiovascular events, and neurocognitive dysfunction …”

HIV-1, HCV and Alcohol in the CNS: Potential Interactions and Effects on Neuroinflammation

“…A recent study regarding HCV viral clearance did not determine metabolite concentrations in SVR, but did measure neurocognitive performance in these patients [42]. Although previous studies yielded conflicting results regarding viral clearance and neurocognitive improvement, this study had a larger sample size and the neurocognitive tests were performed at least 12 months after therapy ended.…”