Women coinfected with HIV/HCV have worse brain impairment

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Women coinfected with HIV/HCV have worse brain impairment

     , Tuesday, September 27, 2005

Women coinfected with HIV and hepatitis C virus had worse neuropsychological

function than women who are infected with only one or these viruses, or who

are negative for both infections, according to US research published in the

October 14th edition of AIDS. The investigators, from the Women's

Interagency HIV Study (WIHS), suggest that brain impairment is likely to be

a concern in " the optimal management of patients with hepatitis C virus and

HIV disease. "

Brain impairment is a well recognised manifestation of HIV disease,

particularly in individuals with severe immune damage. Neuropsychological

damage caused by hepatitis C virus has also been observed, with evidence of

the virus found in the brains of infected individuals.

Earlier studies have suggested an increased rate of brain impairment in

patients coinfected with HIV and hepatitis C. To take this research further,

investigators from WIHS compared the neuropsychological function of 220

women who were either coinfected with HIV and hepatitis C virus; infected

with either HIV or hepatitis C virus; or were negative for both infections.

None of the women had HIV-related neurological conditions or a history of

mental illness such as bipolar disorder or schizophrenia, and had no

evidence of intoxication caused by drugs or alcohol at the time of

neuropsychological testing.

Of the 220 women in the study, 70 were coinfected with HIV and hepatitis C

virus, 102 had one infection (27, hepatitis C virus; 75, HIV), and 48 were

negative for both HIV and hepatitis C virus.

Anti-HIV therapy was being taken by 53% of the HIV-positive women. None of

the hepatitis C virus-infected women were taking pegylated interferon and

ribavirin as this was not the standard of care for the infection at the time

the study was conducted.

A total of 49% of women infected with hepatitis C virus had abnormal

neuropsychological test results compared to 32% of hepatitis C

virus-uninfected women. This difference was statistically significant (p <

0.01).

Using the women who were uninfected with either virus as a control group,

the investigators found that the risks of brain impairment were

significantly greater in women coinfected with HIV and hepatitis C (odds

ratio 3.77). However, the investigators failed to find any interaction

between HIV and hepatitis C virus but suggest that the two viruses had an

additive effect.

In further analysis, the investigators found that coinfected women with a

CD4 cell count below 200 cells/mm3 had an increased risk of brain impairment

(odds ratio 5.38) compared to coinfected women with a CD4 cell count above

this level (odds ratio 3.48). In addition, HIV-positive women who were not

taking anti-HIV therapy were much more likely to have abnormal brain

functioning (odds ratio 7.03) than women negative for both infections.

Multivariate analysis controlling for factors including HIV disease status,

HIV treatment history, education, IQ, history of substance abuse and history

of head injury indicated that the risk of brain impairment was over three

times greater in coinfected women (odds ratio 3.07). However, when age was

included in this model, the odds ratio for neuropsychological impairment

fell (odds ratio 1.97). The role of age was then examined further. Women

under 40 who had HIV, either with (odds ratio 4.67) or without hepatitis C

virus coinfection (odds ratio 3.93), had an increased risk of brain

impairment than women negative for both HIV and hepatitis C virus. There

were no significant differences in neuropsychological function according to

infection status for women over 40, however the investigators note that the

sample size was small.

" Hepatitis C virus in combination with HIV results in substantially

increased odds of neuropsychological impairment " , observe the investigators.

Reference

JL et al. Neuropsychological functioning in a cohort of HIV- and

hepatitis C virus-infected women. AIDS 19: 1659 - 1667, 2005.

http://www.aidsmap.com/en/news/699A5262-BCE0-4A99-87C6-C7F77E9988C9.asp