Abstract
Previous studies have reported that hepatitis C virus (HCV) co-infection worsens neurocognitive
status among individuals with human immunodeficiency virus (HIV)-1 infection. We assessed
the prevalence of neurologic disorders and the severity of HIV-associated neurocognitive
impairment among HIV-infected individuals in two centralized HIV clinics in Alberta,
Canada from 1998 to 2010 based on their HCV serostatus. Of 456 HIV-infected persons
without concurrent substance abuse, 91 (20.0%) were HCV seropositive. Of 58 neurologic
disorders identified in the cohort, HIV/HCV co-infected individuals exhibited a higher
prevalence of multiple neurologic disorders compared to HIV-infected individuals (60.4%
vs. 46.6%, p<0.05) and a higher frequency of seizures (28.6% vs. 17.8%, p<0.05). Unlike HIV mono-infected persons, the risk of seizures was independent of immune
status in HIV/HCV co-infected individuals (p<0.05). Symptomatic HIV-associated neurocognitive disorders (sHAND) were more severe
among HIV/HCV co-infected persons (p<0.05). HCV co-infection was associated with an increased mortality rate (24.2% vs.
14.5%, p<0.05) with a mortality hazard ratio of 2.38 after adjusting for demographic and clinical
variables. Our results indicate that the presence of HCV co-infection among HIV-infected
individuals increased neurologic disease burden and risk of death, underscoring HCV's
capacity to affect the nervous system and survival of HIV-infected persons.
Abbreviations:
cART (Combination antiretroviral therapy), CI (Confidence interval), CNS OI (Opportunistic infection of central nervous system), DSP (Distal sensory polyneuropathy), HCV (Hepatitis C virus), HIV (Human immunodeficiency virus), HR (Hazard ratio), IQR (Interquartile range), IDU (Intravenous drug use), MDS (Mean deficit score), MSK (Memorial Sloan-Kettering), NCI (Neurocognitive impairment), NP (Neuropsychological), sHAND (Symptomatic HIV-associated neurocognitive disorders), WNV (West Nile virus)Keywords
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References
- Decline in the AIDS and death rates in the EuroSIDA study: an observational study.Lancet. 2003; 362: 22-29
- Neurologic disease burden in treated HIV/AIDS predicts survival: a population-based study.Neurology. 2010; 75: 1150-1158
- Clinical confirmation of the American Academy of Neurology algorithm for HIV-1-associated cognitive/motor disorder. The Dana Consortium on Therapy for HIV Dementia and Related Cognitive Disorders.Neurology. 1996; 47: 1247-1253
- Updated research nosology for HIV-associated neurocognitive disorders.Neurology. 2007; 69: 1789-1799
- Epidemiology of hepatitis C virus infection.World J Gastroenterol. 2007; 13: 2436-2441
- Clinical progression, survival, and immune recovery during antiretroviral therapy in patients with HIV-1 and hepatitis C virus coinfection: the Swiss HIV Cohort Study.Lancet. 2000; 356: 1800-1805
- Hepatitis C virus coinfection increases mortality in HIV-infected patients in the highly active antiretroviral therapy era: data from the HIV Atlanta VA Cohort Study.Clin Infect Dis. 2004; 39: 1507-1513
- Neurologic consequences of hepatitis C and human immunodeficiency virus coinfection.J Neurovirol. 2005; 11: 67-71
- Pathogenesis of hepatitis C virus coinfection in the brains of patients infected with HIV.J Infect Dis. 2007; 196: 361-370
- Search for hepatitis C virus negative-strand RNA sequences and analysis of viral sequences in the central nervous system: evidence of replication.J Virol. 2002; 76: 600-608
- Hepatitis C virus neuroinvasion: identification of infected cells.J Virol. 2009; 83: 1312-1319
- Detection and analysis of hepatitis C virus sequences in cerebrospinal fluid.J Virol. 2002; 76: 10064-10068
- Detection of genomic viral RNA in nerve and muscle of patients with HCV neuropathy.Neurology. 2003; 60: 808-812
- Hepatitis C virus core protein induces neuroimmune activation and potentiates Human Immunodeficiency Virus-1 neurotoxicity.PLoS One. 2010; 5: e12856
- The neuropsychological and neurological impact of hepatitis C virus co-infection in HIV-infected subjects.AIDS. 2005; 19: S64-S71
- Neuropsychiatric impact of hepatitis C on advanced HIV.Neurology. 2004; 62: 957-962
- Hepatitis C augments cognitive deficits associated with HIV infection and methamphetamine.Neurology. 2005; 64: 1343-1347
- Neuropsychological functioning in a cohort of HIV- and hepatitis C virus-infected women.AIDS. 2005; 19: 1659-1667
- Cognitive function, mood and health-related quality of life in hepatitis C virus (HCV)-monoinfected and HIV/HCV-coinfected individuals commencing HCV treatment.HIV Med. 2007; 8: 192-202
- Neurobehavioral effects of human immunodeficiency virus infection among former plasma donors in rural China.J Neurovirol. 2008; 14: 536-549
- A review of cognitive impairment and cerebral metabolite abnormalities in patients with hepatitis C infection.AIDS. 2005; 19: S53-S63
- Evidence for neuroinflammation and neuroprotection in HCV infection-associated encephalopathy.Gut. 2011; 60: 370-377
- Clinical factors related to brain structure in HIV: the CHARTER study.J Neurovirol. 2011; 17: 248-257
- Hepatitis C virus infection affects the brain-evidence from psychometric studies and magnetic resonance spectroscopy.J Hepatol. 2004; 41: 845-851
- Hepatitis C seropositivity is not a risk factor for sensory neuropathy among patients with HIV.Neurology. 2010; 74: 1538-1542
- Effects of active HCV replication on neurologic status in HIV RNA virally suppressed patients.Neurology. 2009; 73: 309-314
- Variable impact on mortality of AIDS-defining events diagnosed during combination antiretroviral therapy: not all AIDS-defining conditions are created equal.Clin Infect Dis. 2009; 48: 1138-1151
- Neurocognitive impairment and survival in a cohort of HIV-infected patients treated with HAART.AIDS Res Hum Retroviruses. 2005; 21: 706-713
- Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus-type 1 (HIV-1) infection. Report of a Working Group of the American Academy of Neurology AIDS Task Force.Neurology. 1991; 41: 778-785
- The AIDS dementia complex.J Infect Dis. 1988; 158: 1079-1083
- Normative data for a brief neuropsychological screening battery. Multicenter AIDS Cohort Study.Percept Mot Skills. 1991; 73: 539-550
- Neurocognitive symptoms and impairment in an HIV community clinic.Can J Neurol Sci. 2001; 28: 228-231
- New-onset seizures associated with HIV infection.Neurology. 2000; 55: 1558-1561
- Neurologic disease burden in treated HIV/AIDS predicts survival. A population-based study.Neurology. 2010; 75: 1150-1158
- Viruses and the immune system: their roles in seizure cascade development.J Neurochem. 2008; 104: 1167-1176
- Electroencephalography findings in adult patients with West Nile virus—associated meningitis and meningoencephalitis.Clin Infect Dis. 2003; 37: 1573-1578
- Microglial activation and TNFalpha production mediate altered CNS excitability following peripheral inflammation.Proc Natl Acad Sci USA. 2008; 105: 17151-17156
- Elevation of interleukin 6 levels in patients with chronic hepatitis due to hepatitis C virus.J Gastroenterol. 1997; 32: 211-215
- Soluble tumor necrosis factor receptors in chronic hepatitis C: a correlation with histological fibrosis and activity.J Hepatol. 1999; 30: 185-191
- Antidepressants and seizures: emphasis on newer agents and clinical implications.Int J Clin Pract. 2005; 59: 1435-1440
- Illicit drug use and the risk of new-onset seizures.Am J Epidemiol. 1990; 132: 47-57
- Effects of hepatic function and hepatitis C virus on the nervous system assessment of advanced-stage HIV-infected individuals.AIDS. 2005; 19: S116-S122
- Neurobehavioural consequences of substance abuse and HIV infection.J Psychopharmacol. 2000; 14: 228-237
- Risk factors for cognitive impairment in HIV-1-infected persons with different risk behaviors.Arch Neurol. 2002; 59: 812-818
- Natural history of hepatitis C virus infection in HIV-infected individuals and the impact of HIV in the era of highly active antiretroviral therapy: a meta-analysis.AIDS. 2008; 22: 1979-1991
Article info
Publication history
Published online: September 19, 2011
Accepted:
August 16,
2011
Received in revised form:
June 17,
2011
Received:
January 27,
2011
Identification
Copyright
© 2011 Published by Elsevier Inc.
