Neurocognition in Individuals Co-Infected with HIV and Hepatitis C

Abstract

Due to similar routes of viral transmission, many individuals infected with the human immunodeficiency virus (HIV) are also infected with the hepatitis C virus (HCV). Each virus can cause cognitive compromise among mono-infected individuals; evidence is accumulating that HIV/ HCV co-infection may have a particularly deleterious impact on cognition. We present neuropsychological data obtained from 118 HIV+ adults with advanced HIV disease, 35 of whom were co-infected with HCV, who completed a comprehensive neurocognitive evaluation. Rates of global cognitive impairment were higher among co-infected patients than among those with HIV alone (63% vs. 43%). Within the specific domains of learning and memory, co-infected individuals were significantly more likely to be impaired than were the HIV mono-infected participants. Finally, we discuss implications of these findings and potential future directions for research in this area. Keywords HIV infection; HCV infection; HIV/HCV co-infection; neurocognition© 2008 by The Haworth Press. All rights reserved. Address correspondence to: Charles H. Hinkin, PhD, David Geffen School of Medicine at University of California at Los Angeles, 760 Westwood Plaza, Room C8-747, Los Angeles, CA 90024 (chinkin@ucla.edu).. Publisher's Disclaimer: Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, reselling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material. NIH Public Access NEUROPSYCHOLOGICAL SEQUELAE OF HIV MONO-INFECTIONThe deleterious effects of HIV-infection on neuropsychological function are well established. 2 HIV-related neurocognitive dysfunction can range from subtle deficits in informationprocessing speed and efficiency to a pronounced dementia syndrome. Memory impairment, characterized especially by forgetfulness, motor and psychomotor slowing, attentional disruption, and executive systems dysfunction have all been repeatedly observed among HIVinfected individuals. This pattern of neurocognitive deficits is suggestive of disruption to the circuits that connect the prefrontal cortex with subcortical structures and is consistent with data from brain imaging and autopsy studies, which implicate preferential subcortical involvement. [3][4][5] While studies have found that cognitive deficits are more likely to be found in patients with more advanced immune sup...

Co-Morbidities in Persons Infected with HIV: Increased Burden with Older Age and Negative Effects on Health-Related Quality of Life

“…In fact, the new conceptual model of aging with HIV infection proposed by the HIV and Aging Working Group of the NIH Office of AIDS Research posits that medical co-morbidities are seen earlier and more frequently in older PLWH, which leads to frailty, neurocognitive and functional impairment, organ system failure, and increased hospitalization. 11 Across the lifespan, HIV is associated with increased rates of co-morbidities such as hepatitis C co-infection 12 and metabolic syndrome 13 that heighten risks of adverse cognitive 13,14 and health-related outcomes (e.g., chronic liver disease progression 12 ). As PLWH grow older, they also become more susceptible to developing the physical and mental diseases associated with so-called ''normal'' aging.…”

HIV/HCV Co-Infection—A Dual Neurocognitive Problem

“…According to these results, coexistence of HCV may be connected with the overall slowing of mental processes. Hinkin et al came to a similar conclusion [20]. The authors investigated 118 individuals, among whom 35 were also infected with HCV, using a comprehensive test battery measuring abstraction and executive functions, information processing, attention, learning, memory, verbal fluency, motor functions and global cognitive function.…”

“…Nevertheless, it can be assumed that HIV/HCV co-infected patients were in an overall worse medical condition, taking into account that 25 of them were in advanced stages of AIDS, while in the group of mono HIV-infected patients only 10 met these criteria. Moreover, as other authors who had not included patients with clinical diagnoses of hepatic encephalopathy to the study, we cannot exclude that some of the individuals might have had it at slight or sub-clinical level [20].…”

“…Only 3 of them were infected through heterosexual contact (Hxs), and one patient through illicit drug use (IDU). In the majority of patients (20) from the HIV/HCV co-infected group, HIV was transmitted by illicit drug use (IDU). Only 7 patients got infected through MSM risky behaviors and one patient through heterosexual contact (Hxs).…”

Depressive Symptoms and Neurocognitive Performance Among HIV-Infected Women

“…In fact, several demographic and HIV-related factors have been associated with neurocognitive impairment. These include: older age (Fazeli et al, 2011;Lopardo et al, 2009;4 Richarson et al, 2002), lower education (De Ronchi et al, 2002;Tozzi et al, 2007;Waldrop-Valverde et al, 2010), professional situation (Heaton et al, 2011;Woods et al, 2011), ethnicity (Durvasula et al, 2001;Manly et al, 2011), and HIV/HCV co-infection (Hinkin et al, 2008;Richardson et al, 2005). Although inconsistent, some studies have also found an association between neurocognitive impairment and lower CD4 count (De Ronchi et al, 2002;Fazeli et al, 2011;Njamnshi et al, 2009;Osowiecki et al, 2000), and higher plasma viral load (Marcotte et al, 2003;Tate et al, 2011).…”