11Memory and Aging Center, Sandler Neurosciences Center, 675 Nelson Rising Ln., Suite 190, University of California, San Francisco, CA 94158 USA 2Department of Psychiatry, University of Illinois at Chicago, 912 S. Wood St., M/C 913, Chicago, IL 60612, USA 3Department of Psychology, University of Illinois at Chicago, 1007 W. Harrison St., M/C 285, Chicago, IL 60607, USA 4Division of Gastroenterology, Department of Medicine, University of California San Francisco, 513 Parnassus Ave., San Francisco, CA 94143-0538, USA 5Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, Department of Medicine, Women's Interagency HIV Study, 3311 Bainbridge Ave., Bronx, NY 10467, USA 6Department of Neurology, SUNY Downstate, 450 Clarkson Ave., Brooklyn, NY 11203, USA 7Georgetown University Medical Center, 3700 Reservoir Rd., Washington, DC 20007, USA 8Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N Soto St., SSB 202Y, Los Angeles, CA 90033, USA 9Department of Medicine, Stroger Hospital and Rush Medical Center, 2225 W. Harrison St., Chicago, IL 60612, USA 10Department of Epidemiology, E7012, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA 11Department of Medicine, UNC School of Medicine, 321 South Columbia St., Chapel Hill, NC 27516, USA 12Department of Epidemiology, UNC Gillings School of Global Public Health, 135 Dauer Dr., Chapel Hill, NC 27599, USA 13Department of Medicine, University of California San Francisco, 350 Parnassus Ave., San Francisco, CA 94117, USA 14Department of Veterans Affairs Medical Center, Infectious Disease Section, 111W, 4150 Clement St., San Francisco, CA 94121, USA.
Since HIV impairs gut barriers to pathogens, HIV-infected adults may be vulnerable to Minimal Hepatic Encephalopathy (MHE) in the absence of cirrhosis.
Cognitive disorders persist in up to one-half of people living with HIV despite access to combination antiretroviral therapy (cART). MHE occurs in cirrhotic patients with or without HIV infection and may be associated with inflammation.
/Methods A cross-sectional investigation of liver fibrosis severity using the aspartate aminotransferase to platelet ratio index (APRI) and neuropsychological testing performance among women from the Women's Interagency HIV Study (WIHS). A subset underwent liver transient elastography (FibroScan, n=303).
We evaluated 1479 women (mean (SD) age of 46 (9.3) years): 770 (52%) only HIV-infected, 73 (5%) only HCV-infected, 235 (16%) HIV/HCV co-infected, and 401 (27%) uninfected. Of these, 1221 (83%) exhibited APRI ≤0.5 (no or only mild fibrosis), 206 (14%) exhibited APRI >0.5 and ≤1.5 (moderate fibrosis), and 52 (3%) exhibited APRI >1.5 (severe fibrosis). Having moderate or severe fibrosis (APRI >0.5) was associated with worse performance in learning, executive function, memory, psychomotor speed, fluency, and fine motor skills. In these models that adjusted for fibrosis, smaller associations were found for HIV (learning and memory) and HCV (executive functioning and attention). The severity of fibrosis, measured by FibroScan, was associated with worse performance in attention, executive functioning, and fluency.
Liver fibrosis had a contribution to cognitive performance independent of HCV and HIV; however, the pattern of neuropsychological deficit associated with fibrosis was not typical of MHE.