Neuropsychiatric impact of hepatitis C on advanced HIV.
OBJECTIVE
To determine whether hepatitis C (HCV) contributes to CNS dysfunction among HIV-infected individuals.


METHODS
Using a cross-sectional design, the neuropsychiatric profile of individuals with advanced HIV coinfected with hepatitis C (HIV+/HCV+) was compared to similarly advanced HIV patients without HCV coinfection (HIV+/HCV-). Participants were derived from the Manhattan HIV Brain Bank and underwent neurocognitive testing and semistructured psychiatric interviews. Evidence of HCV infection was determined by serology performed prior to study entry. Hepatic function was determined by serum chemistries (bilirubin, creatinine, and international normalized ratio) at the time of the cognitive assessments.


RESULTS
Coinfected (HIV+/HCV+) individuals were significantly more likely to have had past opiate or cocaine or stimulant dependence. HIV+/HCV+ participants also had significantly greater rates of past substance-induced major depression. There were no significant differences in rates of primary mental disorders. Forty-two percent of both the HIV+/HCV+ and HIV+/HCV- participants met criteria for current major depression. There was a trend for HIV+/HCV+ patients to perform worse neurocognitively. On tests of executive functioning, HIV+/HCV+ individuals exhibited a greater rate of impairment and had significantly more perseveration. Differences in cognitive functioning were associated with serology but did not correlate with indices of liver disease severity. The HCV+ patients were also more likely to be diagnosed with HIV-associated dementia.


CONCLUSIONS
There appears to be a neuropsychiatric impact of HCV that is detectable even among an advanced HIV cohort.
Ryan
E L
EL
Departments of Psychiatry, The Mount Sinai Medical Center, New York, NY, USA. elizabeth.ryan@mssm.edu
Morgello
S
S
Isaacs
K
K
Naseer
M
M
Gerits
P
P
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002908:Chronic Disease; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D008875:Middle Aged; D009483:Neuropsychological Tests; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology