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Background:  Co-infection with HIV and hepatitis C virus (HCV) has been associated with an increased risk of liver cirrhosis and more rapid progression to end-stage liver disease. Cognitive changes associated with HIV/HCV co-infection have not been adequately evaluated.

Methods:  In this study, 32 HIV⁺/HCV^– (mono-infected) and 14 HIV⁺/HCV⁺ (co-infected) patients underwent neuropsychological evaluation before and after 6 months of treatment with HAART. We hypothesized that co-infected patients would demonstrate worse neuropsychological performance than mono-infected patients. Furthermore, we expected the test scores of both the mono-infected and co-infected groups to improve with HAART. Repeated measures multivariate analysis of variance (MANOVA) was used to evaluate group differences and treatment effects. The dependent variables were six cognitive domains derived from neuropsychological test scores (attention, psychomotor speed, executive functioning, verbal memory, visual memory, and fine motor functioning).

Results:  Overall, there was a significant difference in cognitive functioning related to HCV status (p < 0.03). In contrast, neither treatment time (pre- vs post-treatment) nor the interaction between HCV status and treatment time contributed significantly to cognitive functioning. Further examination of the significant finding with follow up tests showed that HCV status was significantly related to visual memory (p < 0.03) and fine motor speed (p < 0.002), with worse performance found in the co-infected group relative to the mono-infected group. Of the 6 cognitive domains, 4 and the summary score fell within the impaired range in the co-infected group, whereas, none of the cognitive domains, nor the summary score, were impaired in the mono-infected group at baseline.

Conclusions:  The results suggested HCV/HIV co-infection is associated with impaired visual memory and manual dexterity. Thus, it cannot be assumed that HIV fully accounts for these types of cognitive deficits in co-infected patients. Studies with larger sample sizes are needed to determine whether other cognitive deficits and improvement following treatment would become apparent in co-infected groups, since there was a non-significant trend for co-infected patients to perform worse than mono-infected patients on other cognitive domains and to improve following treatment with HAART.   

Keywords: HIV; HCV; Cognitive deficits