Neuropsychological Symptoms in HIV-HCV Coinfected and HCV Monoinfected Individuals

Neuropsychological side effects such as depression and anxiety are common in hepatitis C patients treated with interferon-based therapy, and lead to treatment discontinuation in some 20%-40% of cases.

Some studies have found that pre-existing psychiatric conditions or a history of substance abuse predict a greater likelihood of adverse events during interferon treatment, though others have not observed this association.

In a study presented at the 8th International Congress on Drug Therapy in HIV Infection last month in Glasgow, investigators aimed to compare the neuropsychological symptoms of HIV-HCV coinfected and HCV monoinfected subjects at the time of initiation of treatment with pegylated interferon plus ribavirin.

The study enrolled 131 patients (39 HIV-HCV coinfected, 92 HCV monoinfected); 93 were men and the median age was 43 years. 97% of coinfected and 33% of HCV monoinfected subjects had a history of injection drug use; 13 coinfected and 3 monoinfected patients had cirrhosis. At baseline, each participant had a clinical interview with a psychologist and completed a battery of neuropsychological tests (SCID-1, ZUNG-depression scale, STAI-X1, chronic fatigue liver disease, and WHOQoL); coinfected patients also received the MMPI-2 test.

Results

38.5% of coinfected patients and 33.7% of HCV monoinfected patients experienced depression.

28.2% and 20.7%, respectively, experienced anxiety.

41.0% and 50.0%, respectively experienced moderate fatigue.

The psychosomatic impact of liver disease was mild in about half the subjects (47.3%), and was similar in the 2 groups.

63.4% of patients overall reported a fairly good quality of life.

15.4% of coinfected and 29.3% of HCV monoinfected subjects reported very good quality of life (P = 0.09).

The median number of neuropsychological symptoms was 4 (range 0-5) in HIV-HCV coinfected and 2 (range 0-5) in HCV monoinfected patients (P = 0.003).

85% of coinfected patients had at least 1 "fragile" psychic aspect on the MMPI-2 test.

Conclusion

"The median number of neuropsychological symptoms are significantly greater in HIV-HCV [coinfected] patients than HCV monoinfected," the researchers concluded. They recommended a multidisciplinary approach to managing coinfected patients, as well as trials of preventive use of antidepressants in this population.

12/08/06

Reference
P Nasta, S Antonelli, A Matti, and others. Neuro-psychological disturbances in HIV/HCV co-infected and HCV mono-infected patients eligible to receive PegIFN alpha. 8th Congress on Drug Therapy in HIV Infection (HIV8). Glasgow. November 12-16, 2006. Abstract P322.