Direct antivirals and cognitive impairment in hepatitis C: a clinical-neurophysiologic study
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Direct antivirals and cognitive impairment in hepatitis C: a clinical-neurophysiologic study Gloria Vaghi 1 & Benedetta Gori 2 & Gionata Strigaro 2 & Michela Burlone 1 & Rosalba Minisini 1 & Matteo N. Barbaglia 1 & Elena Brigatti 2 & Claudia Varrasi 2 & Mario Pirisi 1 & Roberto Cantello 2 Received: 19 May 2020 / Revised: 5 August 2020 / Accepted: 26 August 2020 # The Author(s) 2020
Abstract Cognition was assessed in hepatitis C virus (HCV) patients, who did not meet the criteria for a minimal hepatic encephalopathy. Their liver function was compensated. We then disentangled potential cognitive changes associated with a sustained virologic response at 12 weeks (SVR-12), following treatment with direct antiviral agents (DAAs). We studied 23 selected HCV patients with a battery of standard neuropsychological tests, and with recordings of the P300 wave, a cerebral potential of “cognitive” significance. There was a baseline evaluation (T0) and a second one 6 months later (T1). We had 2 control groups of comparable age and sex, i.e., 15 patients suffering from non-alcoholic fatty liver disease (NAFLD) and 15 healthy subjects. At T0, we detected a significant (p < 0.05) cognitive impairment in the HCV group, which involved episodic and working memory, attention, visuospatial and verbal abilities, executive functions, and logic reasoning. The P300 latency was significantly (p < 0.05) delayed in the group. At T1, we observed some significant (p < 0.05) HCV recovery in given test domains, e.g., memory, executive functions, and reasoning. Accordingly, the P300 latency shortened significantly (p < 0.05). HCV patients exhibited subtle cognitive defects, somehow independent of their liver condition, possibly linked to direct or indirect brain involvement by the virus. These defects partly recovered following the SVR-12, as achieved through DAAs. The P300 wave was a valid neurophysiologic counterpart of these changes. DAAs can have a role in the early preservation of cognition in HCVs. Keywords Hepatitis C . Cognitive impairment . Neuropsychology . P300 wave . Direct antiviral agents
Introduction Hepatic encephalopathy (HE) and its mildest expression (minimal HE) are a neuropsychiatric syndrome related to liver failure, with a wide range of severity (Wijdicks 2016). However, hepatitis C virus (HCV) patients not even meeting the definition(s) of minimal HE (Weissenborn 2015) can show a subtle cognitive impairment. This picture, also termed HCVassociated neurocognitive disorder (HCV-AND) affects for instance attention, executive functions, learning/visuospatial Gloria Vaghi and Benedetta Gori contributed equally to this work. * Gionata Strigaro [email protected]; [email protected] 1
Internal Medicine Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
2
Neurology Unit Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
abilities, and verbal recall. Its features are indeed different from minimal HE (Monaco et al. 2015). HCV infect
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