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Liver Fibrosis Linked to Cognitive Performance in HIV and Hepatitis C
Victor G Valcour1, Leah H Rubin, Mary U Obasi
1*Department of Neurology, Memory and Aging Center, Sandler Neurosciences Center, University of California, San Francisco, CA; Departments of †Psychiatry; ‡Psychology, University of Illinois at Chicago, Chicago, IL; §Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA; ‖Department of Medicine, Montefiore Medical Center, The University Hospital for the Albert Einstein College of Medicine, Women's Interagency HIV Study, Bronx, NY; ¶Department of Neurology, SUNY Downstate, Brooklyn, NY; #Department of Medicine, Georgetown University Medical Center, Washington, DC; **Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA; ††Department of Medicine, Stroger Hospital and Rush Medical Center, Chicago, IL; ‡‡Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; §§Department of Medicine, UNC School of Medicine, Chapel Hill, NC; ‖‖Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC; ¶¶Department of Medicine, University of California San Francisco, San Francisco, CA; and ##Department of Veterans Affairs, Medical Center, Infectious Disease Section, San Francisco, CA.
Objective:
Because HIV impairs gut barriers to pathogens, HIV-infected adults may be vulnerable to minimal hepatic encephalopathy in the absence of cirrhosis.
Background:
Cognitive disorders persist in up to one-half of people living with HIV despite access to combination antiretroviral therapy. Minimal hepatic encephalopathy occurs in cirrhotic patients with or without HIV infection and may be associated with inflammation.
Design/Methods:
A cross-sectional investigation of liver fibrosis severity using the aspartate aminotransferase to platelet ratio index (APRI) and neuropsychological testing performance among women from the Women's Interagency HIV Study. A subset underwent liver transient elastography (FibroScan, n = 303).
Results:
We evaluated 1479 women [mean (SD) age of 46 (9.3) years]: 770 (52%) only HIV infected, 73 (5%) only hepatitis C virus (HCV) infected, 235 (16%) HIV/HCV coinfected, and 401 (27%) uninfected. Of these, 1221 (83%) exhibited APRI ≤0.5 (no or only mild fibrosis), 206 (14%) exhibited APRI >0.5 and ≤1.5 (moderate fibrosis), and 52 (3%) exhibited APRI >1.5 (severe fibrosis). Having moderate or severe fibrosis (APRI >0.5) was associated with worse performance in learning, executive function, memory, psychomotor speed, fluency, and fine motor skills. In these models that adjusted for fibrosis, smaller associations were found for HIV (learning and memory) and HCV (executive functioning and attention). The severity of fibrosis, measured by FibroScan, was associated with worse performance in attention, executive functioning, and fluency.
Conclusions:
Liver fibrosis had a contribution to cognitive performance independent of HCV and HIV; however, the pattern of neuropsychological deficit associated with fibrosis was not typical of minimal hepatic encephalopathy.
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