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Cognitive Function in Hepatitis C Patients with Advanced Fibrosis
Enrolled in the HALT-C Trial
Prior studies have demonstrated neuropsychological
abnormalities in chronic hepatitis C (CHC) patients
even with mild fibrosis. The aim of this study was to determine the frequency, type,
and severity of cognitive
impairment
in a large group of CHC patients with advanced fibrosis.
The
Hepatitis C Antiviral Long-term Treatment against Cirrhosis
(HALT-C) Trial was designed to determine whether maintenance interferon
therapy could slow disease progression in patients
who had failed to eradicate hepatitis C virus (HCV) during
prior interferon treatment (nonresponders). The investigators incorporated
a Lead-in period of treatment with long-acting pegylated interferon alfa-2a (Pegasys)
plus ribavirin into the
study design.
Ten
validated neuropsychological tests were administered to 201
CHC patients. Standard scores for individual tests were calculated
using normative population data that controlled for age, gender,
and/or education.
Lifetime
psychiatric history, alcohol
consumption,
and mood status were also determined.
Results
33% of patients met criteria for cognitive impairment (i.e.
standard score <40 on at least 4 tests).
Mild impairment in verbal recall and working memory were noted
with other domains remaining intact. Liver disease severity and lifetime psychiatric/substance
abuse history did not correlate with group mean cognitive
test results or the presence of cognitive impairment.
In contrast, IQ and depression
scores were significant and independent predictors of
cognitive impairment (ROC = 0.84).
The
authors conclude, “33% of patients entering the HALT-C trial
have evidence of a mild, non-focal subcortical
processing deficit which was highly correlated with IQ, education,
and occupation.”
“Future
studies of cognitive function in CHC patients should control
for general cognitive ability.”
Division of Gastroenterology, Department
of Internal Medicine, University of Michigan Medical Center,
Ann Arbor, MI 48109-0362, USA.
10/24/05
Reference
R
J Fontana and others (the HALT-C Trial Group).
Cognitive function in hepatitis C patients with advanced
fibrosis enrolled in the HALT-C trial. Journal of Hepatology 43(4): 614-622. October 2005.
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