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Neurocognitive effects of HIV, hepatitis C, and substance use history

Kathryn N Devlin1, Assawin Gongvatana, Uraina S Clark

  • 1Centers for Behavioral and Preventive Medicine, The Miriam Hospital, One Hoppin Street, Providence, RI 02903, USA.

Journal of the International Neuropsychological Society : JINS
|December 3, 2011
PubMed

Insights

Neurocognitive impairment in HIV persists despite HAART, especially with Hepatitis C virus (HCV) coinfection. Poor HIV viral control, not just HIV status, significantly impacts cognitive function.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Virology
  • Public Health

Background:

  • HIV-associated neurocognitive dysfunction (HAND) remains a significant clinical challenge even during the highly active antiretroviral therapy (HAART) era.
  • Comorbidities such as Hepatitis C Virus (HCV) infection and substance use are prevalent in people with HIV and may worsen cognitive outcomes.
  • The precise impact of HIV, HCV, and substance use on neurocognition within the HAART era requires further elucidation.

Purpose of the Study:

  • To investigate the neurocognitive effects of HIV infection, HCV coinfection, and substance use history in individuals receiving HAART.
  • To examine the relationship between specific HIV disease markers (CD4 counts, HIV RNA levels, infection duration) and cognitive performance.
  • To understand the interplay of these factors on neurocognitive functioning in a well-characterized cohort.

Main Methods:

  • A comprehensive neuropsychological assessment was administered to 115 HIV-infected and 72 HIV-seronegative participants.
  • Participants had high rates of lifetime substance dependence and HCV infection.
  • Statistical analyses explored the influence of HIV serostatus, HCV infection, substance use history, and HIV disease measures on cognitive functioning.

Main Results:

  • Approximately 50% of HIV-infected participants demonstrated neurocognitive impairment.
  • Detectable HIV RNA levels were significantly associated with poorer cognitive functioning, whereas HIV serostatus alone was not.
  • Hepatitis C Virus (HCV) infection was strongly and consistently linked to reduced neurocognitive performance across multiple domains; substance use showed a weaker association.

Conclusions:

  • Neurocognitive impairment continues to be a prevalent issue for individuals with HIV, even with effective HAART.
  • Poor viral control (detectable HIV RNA) and comorbidities, particularly HCV coinfection, are key contributors to cognitive deficits.
  • These findings underscore the importance of managing viral load and addressing coinfections to mitigate HAND.

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