Liver Fibrosis Linked to Cognitive Performance in HIV and Hepatitis C

for the Women's Interagency HIV Study Protocol Team

Research output: Contribution to journalArticle

Abstract

Objective: Because HIV impairs gut barriers to pathogens, HIV-infected adults may be vulnerable to minimal hepatic encephalopathy in the absence of cirrhosis. Background: Cognitive disorders persist in up to one-half of people living with HIV despite access to combination antiretroviral therapy. Minimal hepatic encephalopathy occurs in cirrhotic patients with or without HIV infection and may be associated with inflammation. Design/Methods: A cross-sectional investigation of liver fibrosis severity using the aspartate aminotransferase to platelet ratio index (APRI) and neuropsychological testing performance among women from the Women's Interagency HIV Study. A subset underwent liver transient elastography (FibroScan, n 303). Results: We evaluated 1479 women [mean (SD) age of 46 (9.3) years]: 770 (52%) only HIV infected, 73 (5%) only hepatitis C virus (HCV) infected, 235 (16%) HIV/HCV coinfected, and 401 (27%) uninfected. Of these, 1221 (83%) exhibited APRI ≤0.5 (no or only mild fibrosis), 206 (14%) exhibited APRI >0.5 and ≤1.5 (moderate fibrosis), and 52 (3%) exhibited APRI >1.5 (severe fibrosis). Having moderate or severe fibrosis (APRI >0.5) was associated with worse performance in learning, executive function, memory, psychomotor speed, fluency, and fine motor skills. In these models that adjusted for fibrosis, smaller associations were found for HIV (learning and memory) and HCV (executive functioning and attention). The severity of fibrosis, measured by FibroScan, was associated with worse performance in attention, executive functioning, and fluency. Conclusions: Liver fibrosis had a contribution to cognitive performance independent of HCV and HIV; however, the pattern of neuropsychological deficit associated with fibrosis was not typical of minimal hepatic encephalopathy.

Original languageEnglish (US)
Pages (from-to)266-273
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume72
Issue number3
DOIs
StatePublished - Jul 1 2016

Fingerprint

Hepatitis C
Liver Cirrhosis
Fibrosis
HIV
Transaminases
Blood Platelets
Hepacivirus
Hepatic Encephalopathy
Learning
Elasticity Imaging Techniques
Motor Skills
Executive Function
Aspartate Aminotransferases
HIV Infections
Inflammation
Liver

Keywords

  • AIDS dementia complex
  • cirrhosis
  • cognition
  • HIV
  • liver diseases
  • minimal hepatic encephalopathy

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Liver Fibrosis Linked to Cognitive Performance in HIV and Hepatitis C. / for the Women's Interagency HIV Study Protocol Team.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 72, No. 3, 01.07.2016, p. 266-273.

Research output: Contribution to journalArticle

for the Women's Interagency HIV Study Protocol Team. / Liver Fibrosis Linked to Cognitive Performance in HIV and Hepatitis C. In: Journal of Acquired Immune Deficiency Syndromes. 2016 ; Vol. 72, No. 3. pp. 266-273.
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abstract = "Objective: Because HIV impairs gut barriers to pathogens, HIV-infected adults may be vulnerable to minimal hepatic encephalopathy in the absence of cirrhosis. Background: Cognitive disorders persist in up to one-half of people living with HIV despite access to combination antiretroviral therapy. Minimal hepatic encephalopathy occurs in cirrhotic patients with or without HIV infection and may be associated with inflammation. Design/Methods: A cross-sectional investigation of liver fibrosis severity using the aspartate aminotransferase to platelet ratio index (APRI) and neuropsychological testing performance among women from the Women's Interagency HIV Study. A subset underwent liver transient elastography (FibroScan, n 303). Results: We evaluated 1479 women [mean (SD) age of 46 (9.3) years]: 770 (52{\%}) only HIV infected, 73 (5{\%}) only hepatitis C virus (HCV) infected, 235 (16{\%}) HIV/HCV coinfected, and 401 (27{\%}) uninfected. Of these, 1221 (83{\%}) exhibited APRI ≤0.5 (no or only mild fibrosis), 206 (14{\%}) exhibited APRI >0.5 and ≤1.5 (moderate fibrosis), and 52 (3{\%}) exhibited APRI >1.5 (severe fibrosis). Having moderate or severe fibrosis (APRI >0.5) was associated with worse performance in learning, executive function, memory, psychomotor speed, fluency, and fine motor skills. In these models that adjusted for fibrosis, smaller associations were found for HIV (learning and memory) and HCV (executive functioning and attention). The severity of fibrosis, measured by FibroScan, was associated with worse performance in attention, executive functioning, and fluency. Conclusions: Liver fibrosis had a contribution to cognitive performance independent of HCV and HIV; however, the pattern of neuropsychological deficit associated with fibrosis was not typical of minimal hepatic encephalopathy.",
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AU - for the Women's Interagency HIV Study Protocol Team

AU - Valcour, Victor G.

AU - Rubin, Leah H.

AU - Obasi, Mary U.

AU - Maki, Pauline M.

AU - Peters, Marion G.

AU - Levin, Susanna

AU - Crystal, Howard A.

AU - Young, Mary A.

AU - Mack, Wendy J.

AU - Cohen, Mardge H.

AU - Pierce, Christopher B.

AU - Adimora, Adaora A.

AU - Tien, Phyllis C.

AU - Anastos, Kathryn

AU - Minkoff, Howard

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AU - Greenblatt, Ruth

AU - Aouizerat, Bradley

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AU - Golub, Elizabeth

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N2 - Objective: Because HIV impairs gut barriers to pathogens, HIV-infected adults may be vulnerable to minimal hepatic encephalopathy in the absence of cirrhosis. Background: Cognitive disorders persist in up to one-half of people living with HIV despite access to combination antiretroviral therapy. Minimal hepatic encephalopathy occurs in cirrhotic patients with or without HIV infection and may be associated with inflammation. Design/Methods: A cross-sectional investigation of liver fibrosis severity using the aspartate aminotransferase to platelet ratio index (APRI) and neuropsychological testing performance among women from the Women's Interagency HIV Study. A subset underwent liver transient elastography (FibroScan, n 303). Results: We evaluated 1479 women [mean (SD) age of 46 (9.3) years]: 770 (52%) only HIV infected, 73 (5%) only hepatitis C virus (HCV) infected, 235 (16%) HIV/HCV coinfected, and 401 (27%) uninfected. Of these, 1221 (83%) exhibited APRI ≤0.5 (no or only mild fibrosis), 206 (14%) exhibited APRI >0.5 and ≤1.5 (moderate fibrosis), and 52 (3%) exhibited APRI >1.5 (severe fibrosis). Having moderate or severe fibrosis (APRI >0.5) was associated with worse performance in learning, executive function, memory, psychomotor speed, fluency, and fine motor skills. In these models that adjusted for fibrosis, smaller associations were found for HIV (learning and memory) and HCV (executive functioning and attention). The severity of fibrosis, measured by FibroScan, was associated with worse performance in attention, executive functioning, and fluency. Conclusions: Liver fibrosis had a contribution to cognitive performance independent of HCV and HIV; however, the pattern of neuropsychological deficit associated with fibrosis was not typical of minimal hepatic encephalopathy.

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