Cognitive function in hepatitis C patients with advanced fibrosis enrolled in the HALT-C trial

Fontana, Robert J.; Bieliauskas, Linas A.; Back-Madruga, Carla; Lindsay, Karen L.; Kronfol, Ziad; Lok, Anna S.; Padmanabhan, Latha; the HALT-C Trial Group,

doi:10.1016/j.jhep.2005.04.006

« Previous Next »Journal of Hepatology
Volume 43, Issue 4 , Pages 614-622, October 2005

Cognitive function in hepatitis C patients with advanced fibrosis enrolled in the HALT-C trial

Robert J. Fontana
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical Center, 3912 Taubman Center, Ann Arbor, MI 48109-0362, USA
- Corresponding author. Tel.: +1 734 936 4780; fax: +1 734 936 7392.
Linas A. Bieliauskas
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI, USA
Carla Back-Madruga
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
Karen L. Lindsay
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
Ziad Kronfol
- Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI, USA
Anna S. Lok
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical Center, 3912 Taubman Center, Ann Arbor, MI 48109-0362, USA
Latha Padmanabhan
- New England Research Institutes, Watertown, MA, USA
the HALT-C Trial Group
- This is publication number 5 from the HALT-C Trial Group.

Received 29 November 2004; received in revised form 26 April 2005; accepted 27 April 2005. published online 31 May 2005.

Background/Aims

Prior studies have demonstrated neuropsychological abnormalities in chronic hepatitis C (CHC) patients even with mild fibrosis. The aim of this study was to determine the frequency, type, and severity of cognitive impairment in a large group of CHC patients with advanced fibrosis.

Methods

Ten validated neuropsychological tests were administered to 201 CHC patients. Standard scores for individual tests were calculated using normative population data that controlled for age, gender, and/or education. Lifetime psychiatric history, alcohol consumption, and mood status were also determined.

Results

33% of patients met criteria for cognitive impairment (i.e. standard score <40 on at least 4 tests). Mild impairment in verbal recall and working memory were noted with other domains remaining intact. Liver disease severity and lifetime psychiatric/substance abuse history did not correlate with group mean cognitive test results or the presence of cognitive impairment. In contrast, IQ and depression scores were significant and independent predictors of cognitive impairment (ROC=0.84).

Conclusions

33% of patients entering the HALT-C trial have evidence of a mild, non-focal subcortical processing deficit which was highly correlated with IQ, education, and occupation. Future studies of cognitive function in CHC patients should control for general cognitive ability.

Keywords: Hepatitis C, Cognitive function, Neuropsychological testing, Hepatic fibrosis

Abbreviations: BDI, beck depression inventory, BSI, brief symptom inventory, CHC, chronic hepatitis C, CIDI-LT, composite international diagnostic interview lifetime, HALT-C, hepatitis C antiviral long-term treatment against cirrhosis, HCV, hepatitis C virus, HIV, human immunodeficiency virus, INR, international normalized ratio, IQ, intelligence quotient, ROC, receiver operating curve, SSRI, selective serotonin reuptake inhibitor