Neuropsychiatric symptoms in hepatitis C patients resemble those of patients with autoimmune liver disease but are different from those in hepatitis B patients

Abstract

Chronic fatigue, mood alterations and cognitive impairment are frequent accessory symptoms of HCV-infection. Fatigue and mood alterations have also been observed in autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC), but not in hepatitis B virus (HBV)-infection, thus indicating an autoimmune response as possible cause of HCV-infection associated encephalopathy. Data, however, are sparse. This study aims to prove that HCV patients feature similar to those with autoimmune liver disease but contrary to HBV patients regarding neuropsychiatric symptoms. 132 non-cirrhotic patients (HCV: 46, HBV: 22, AIH: 27, PBC: 29, AIH/PBC: 8) completed questionnaires addressing the domains mentioned above. Eighty-eight underwent a comprehensive neuropsychological assessment. Patient groups were compared among each other and to 33 healthy controls. Fatigue, anxiety and depression scores were significantly increased, and the SF-36 mental score significantly decreased in all patient groups compared to controls. Fatigue was significantly more pronounced in HCV than in HBV patients. HCV patients scored significantly worse than HBV patients but not AIH and PBC patients in the SF-36. HCV, AIH and PBC but not HBV patients did significantly worse than controls in word learning. Recognition of words was impaired in HCV, AIH and PBC patients and recognition of figures in HCV patients, exclusively (p≤0.002). HCV patients did also worse than controls and HBV patients concerning alertness and working memory (p≤ 0.001). The neuropsychiatric profiles of HCV patients are similar to those of AIH and PBC patients but differ from those of HBV patients, suggesting an autoimmune response as a possible cause for these differences. This article is protected by copyright. All rights reserved.

Update on Hepatitis C Epidemiology: Unaware and Untreated Infected Population Could Be the Key to Elimination

“…Chronic HCV infection without cirrhosis is however associated with worse quality of life and symptoms (e.g. mood disorders and fatigue) than those who do not have this infection [ 3 ]. On large cohorts of patients, it is also widely demonstrated that chronic HCV infection is accompanied by extrahepatic manifestations including lymphoproliferative disorders (e.g.…”

Neuroimaging Findings in Chronic Hepatitis C Virus Infection: Correlation with Neurocognitive and Neuropsychiatric Manifestations

“…HCV-AND shows a profile of prevailing frontal lobe involvement characterized by disordered executive function, with impairment of working memory, processing speed, set-shifting, decision-making and verbal fluency [3][4][5][6], in association with apathy and disinhibition [7]. Dysfunction of the prefrontal cortex can also result in alexithymia, the inability to recognize and express one's feelings, thus affecting patient-reported symptoms [8].…”

“…The attentional function necessitates the complementary action of both frontal and parietal cortices, with the former involved in the targeting of a particular stimulus (selective attention), and the latter in maintaining that focus (sustained attention). In HCV-AND, sustained attention seems to be the more commonly affected subdomain [3], whereas episodic memory per se is relatively less affected, possibly owing to attentive disturbances and defective encoding strategies [3,9]. An uncommon feature is the impairment of cognitive domains related to posterior brain regions that affect constructional praxis, visuo-spatial and visuo-perceptual tasks.…”

Close Correlation between Frailty and Depressive State in Chronic Liver Diseases

“…Depressive state is often encountered in patients with CLDs [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Even in CLD patients with an earlier liver fibrosis stage, depressive manifestations can be frequently found compared with healthy individuals [ 17 ]. In patients with chronic hepatitis C, depressive state, anxiety, and fatigue were demonstrated to be major psychiatric abnormalities [ 19 ].…”