title: Influence of hepatitis C virus on neurocognitive function in patients free from other risk factors: validation from therapeutic outcomes.
abstract: OBJECTIVE
  Mild neurocognitive dysfunction and altered cerebral proton magnetic resonance spectroscopy ((1) H-MRS) have been demonstrated in patients with chronic hepatitis C (CHC). This longitudinal study aimed to quantify these abnormalities in a cohort of patients free from correlated risk factors and determine whether treatment-induced viral clearance abolished these abnormalities.
  
  
  METHODS
  Treatment-naïve, non-cirrhotic patients with CHC, rigorously screened and excluded for other causes of impaired neurocognition, underwent neurocognitive testing, (1) H-MRS and evaluation for quality of life (QOL), mood and fatigue, before and 6 months after the completion of antiviral therapy. A comparison group of healthy controls was similarly assessed at baseline and 1 year later.
  
  
  RESULTS
  Post-treatment results in 40 patients with CHC [31 sustained virological responders, hepatitis C virus (HCV)-R and 9 non-responders, HCV-NR] were compared with their pretreatment results, and with the baseline and follow-up assessments of 39 healthy controls. Before receiving treatment, patients had impaired learning efficiency, poorer QOL and higher fatigue scores compared with the controls. Viral clearance was associated with a significant albeit small improvement in the QOL score that did not reach control levels. Cerebral (1) H-MRS demonstrated a lower N-acetyl aspartate/creatine (CRE) ratio in the globus pallidus (GP) of patients with hepatitis C, which was unchanged with viral clearance. The GP choline/CRE ratio increased in HCV-R following treatment, without a correlation with cognitive measures.
  
  
  CONCLUSIONS
  The hepatitis C virus has a measurable effect on CNS integrity in patients screened for other medical and/or psychiatric comorbidities. Viral clearance has not been demonstrated to abolish these abnormalities.
authors: Department of Medicine, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
authors: Venessa
authors: V
authors: Pattullo
authors: Mary Pat
authors: MP
authors: McAndrews
authors: Andrei
authors: A
authors: Damyanovich
authors: E Jenny
authors: EJ
authors: Heathcote
mesh_terms: D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001921:Brain / Q000378:metabolism*; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology* / Q000821:virology; D015331:Cohort Studies; D003401:Creatine / Q000378:metabolism; D005221:Fatigue / Q000209:etiology / Q000473:pathology; D005260:Female; D005917:Globus Pallidus / Q000378:metabolism; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000821:virology; D006801:Humans; D008137:Longitudinal Studies; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D009483:Neuropsychological Tests; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine