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Liver fibrosis decreases cognitive function in women, independent of HIV or HCV

BOSTON — Liver fibrosis negatively influenced cognitive performance in women, independently of whether or not they had hepatitis C virus infection and HIV, according to research presented at CROI 2016.

Researchers conducted a cross-sectional study of 1,479 women enrolled in the Women’s Interagency HIV Study and sought to determine associations between liver fibrosis severity using the aspartate aminotransferase to platelet ratio index (APRI) and neuropsychological testing performance with the thought that some of the mild cognitive impairment in this population could be similar to that described in minimal hepatic encephalopathy (MHE). In addition, a subset of patients (n = 303) underwent liver transient elastography (TE) and were evaluated for associations via neuropsychological testing performance on a one-hour testing battery.

Victor Valcour

“Minimal hepatic encephalopathy occurs in cirrhotic patients with or without HIV infection and is thought to be associated with inflammation. Since HIV impairs gut barriers to pathogens, we hypothesized that HIV-infected adults are vulnerable to [minimal hepatic encephalopathy] in the absence of cirrhosis,” Victor Valcour, MD, PhD, professor of medicine, division of geriatric medicine and department of neurology, University of California San Francisco, and colleagues wrote.

Among the patients, 52% had HIV mono-infection, 5% had HCV mono-infection, 16% had HIV/HCV co-infection and 27% had neither.

Overall, 83% of women had an APRI less than 0.5 (n = 1,221), 14% had an APRI greater than 0.5 and less than 1.5 (n = 206) and 3% had an APRI greater than 1.5 (n = 52). Analysis showed an APRI greater than 0.5, or moderate to severe fibrosis, was associated with deficits in learning, executive function, memory, psychomotor speed, fluency and fine motor skills, according to the abstract.

After adjusting for fibrosis, models showed a smaller association between HIV and decreased learning and memory, but only smaller association between HCV and decreased performance on two isolated tests that evaluate executive functioning and attention. The severity of fibrosis measured by liver TE was also found to be associated with deficits in attention, executive functioning and fluency.

“These findings are unique as they identify fibrosis as an important potential modulator of HCV’s effects on cognition,” Valcour told Healio.com/Hepatology. “Unexpectedly, the pattern of cognitive deficit did not perfectly mirror that of MHE, suggestive that other mechanisms might be at play. Nevertheless, these findings open up a new window of exploration to improve cognitive quality of life for our patients”

“Independent of HCV and HIV, liver fibrosis has distinct contributions to cognitive performance in the era of [combination antiretroviral therapy],” the researchers concluded. “These data highlight the heterogeneous contributions to cognitive impairment in the era of combination antiretroviral therapy.” – by Melinda Stevens

Reference:

Valcour V, et al. Abstract #422. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 22-25, 2016; Boston.

Disclosure: Valcour reports consulting for Merck and ViiV Healthcare.