Women coinfected with HIV/HCV have worse brain impairment

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 14^th 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

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.