| Publication Abstract Display | | Type: Published Abstract | | Title: Neuropsychiatric changes during hepatitis C treatment in patients with HIV and substance use comorbidities. | | Authors: Cherner M, Woods S, Vigil O, Barakat F, Perry W, Atkinson JH, Letendre S, Heaton R, Hassanein T, Grant I | | Year: 2009 | | Publication: Journal of NeuroVirology | | Volume: 15 Issue: S1 Pages: 16 | | Abstract:Introduction: Patients receiving treatment for hepatitis C virus (HCV) infection often complain of neuropsychiatric symptoms, including depressed mood, fatigue, and cognitive dysfunction. At the HIV Neurobehavioral Research Center, we are following the course of neuropsychiatric changes in a group of HCV+ patients receiving treatment with pegylated interferon and Ribavirin at the UCSD Liver Center, San Diego, CA, USA.
Method: Of 88 patients enrolled to date, 34 have reached 6 months on treatment and have complete neuropsychological and psychiatric assessments. Patients were 16 men and 18 women, with a mean (SD) age of 48.5 (8.7) and 12.6 (2.0) years of education. All had detectable HCV viral load at baseline, 79% are genotype 1, and 24% had fibrosis scores of 3 or 4. Ten (30%) were HIV+ and most (85%) had a lifetime history of substance abuse or dependence, including 50% for alcohol and 35% for cocaine, as well as 17% meeting dependence criteria for methamphetamine with use within the last 18 months. None met current criteria for substance use disorders. History of major depressive disorder was present in 44% of the sample. In addition to their routine HCV care, participants received a comprehensive neuropsychological assessment, a neurologically focused medical exam, and assessment of mood status and fatigue.
Results: Mean current depressive symptoms as measured by the Beck Depression Inventory (BDI) increased from 10.2 (6.4) at the pre-treatment baseline, to 14.0 (9.4) (p<.05) at 6 months on treatment. The proportion of patients meeting current criteria for MDD increased from 9% to 13% (p, not significant (NS)). Overall levels of fatigue measured by the Multi-Symptom Fatigue Inventory also tended to increase [15.6 (22.4) to 22.4 (25.9), (p, NS)]. Concurrently 24% of patients exhibited global neuropsychological impairment at baseline, compared to 35% at the 6-month time point. Neuropsychological decline was not associated with HIV status, prior history of substance use disorders, or current depressive symptoms. Those with neuropsychological decline (n = 15) reported greater overall fatigue at follow-up [32.0 (24.3)] compared to those who improved or had no change (n = 18) [14.5 (25.2)] (p=.03). This included worsening general complaints of fatigue [11.5 (8.0) vs. 6.8 (8.1), (p=.05)], physical fatigue [9.1 (6.7) vs. 4.5 (1.5), (p=.03), mental fatigue [7.9 (5.9) vs. 4.8 (6.8), (p=.090], and psychological distress [3.5 (5.9) vs. −1.6 (6.9), (p=.02)].
Discussion: Although only change in current depressive symptoms and fatigue reached statistical significance in this small sample, there was a trend toward worsening neuropsychological and neuropsychiatric status at 6 months on HCV treatment. Findings corroborate patient reports and clinician observations of mood, stamina, and cognitive changes during HCV treatment. |
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