Epidemiology

Risk of cognitive impairment high in HCV-HIV coinfection and meth addiction

Last Updated: 2005-05-06 15:41:50 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Coinfection with hepatitis C virus (HCV) increases the neuropsychological deficits observed in patients with HIV infection and methamphetamine dependence, according to an article in the April 26th issue of Neurology.

After starting a study of the effects of HIV and meth addiction on cognitive function, Dr. M. Cherner and colleagues at the University of California San Diego found that many of the 430 study participants were also infected with HCV. They therefore investigated the effect of HCV comorbidity on outcomes of neuropsychological testing.

Included were 190 subjects with one of the three risk factors, 110 with two and 40 with three, along with 90 normal control subjects. HCV infection was most prevalent in those who were HIV-positive and methamphetamine-positive (37%) and lowest among those negative for both factors (2%).

The prevalence of global impairment increased with the number of risk factors (p < 0.0001). There were also additive effects on the individual domains of learning, motor speed and dexterity, delayed recall, and abstraction/problem solving.

Linear regression analysis adjusting for demographic factors, methamphetamine dependence and HIV serostatus showed that HCV remained a predictor of global impairment (p < 0.02), learning (p < 0.02), abstraction (p < 0.02), and motor skills (p < 0.04).

The ratio of aspartate aminotransferase to alanine aminotransferase -- a surrogate marker of liver dysfunction -- was not related to deficit scores.

"Because hepatitis C is potentially curable, its identification and treatment are likely to result in improved neurobehavioral outcomes among individuals with HIV infection and substance use disorders," Dr. Cherner's group advises.

"Because the majority of HCV-infected adults have additional risk factors for cognitive impairment such as drug or alcohol abuse or HIV infection, the prevalence of cognitive impairment among these persons may be disconcertingly high," Dr. Wilfred G. van Gorp, at Columbia University in New York, and Dr. Charles H. Hinkin, at the David Geffen School of Medicine at UCLA, point out in a related editorial.

Cognitive impairment can significantly affect employment status, medication adherence, and driving safety, so patients with multiple comorbidities should undergo careful assessment of cognitive function, psychiatric symptoms, and daily functioning, they add.

Neurology 2005;64:1328-1329,1343-1347.