Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Hepatology, AIG Hospitals, Hyderabad, India.
J Viral Hepat. 2022 May;29(5):395-406. doi: 10.1111/jvh.13668. Epub 2022 Mar 17.
Chronic hepatitis C virus (HCV) infection is associated with neuropsychiatric changes. Also, patients with cirrhosis may develop overt or minimal hepatic encephalopathy. Sustained virological response (SVR) with direct-acting antiviral agents (DAAs) may improve the neuropsychiatric manifestations and quality of life (QoL). Consecutive patients (with and without cirrhosis, all genders and aged 18-65 years) with hepatitis C were assessed at enrolment and at 12 weeks after therapy completion for mood (Beck's Depression Inventory [BDI]), anxiety (generalized anxiety disorder [GAD-7]), QoL (SF-36 ver.2) and computer-based tests for number connection (NCT), visual memory, Stroop test and reaction times. We recruited 385 viraemic chronic HCV patients (76.1% male, 21.0% cirrhotic, mean age 39.4 ± 14.2 years, 59.3% genotype 3, mean HCV RNA load 5.8 log). Overall SVR-12 rates were 90.6%, with cure rates 87.6% and 91.4% in patients with and without cirrhosis, respectively. Patients who achieved SVR-12 had mean percentage reduction in BDI (11.3%, p = .000), GAD (8.6%, p = .001) and Stroop test (58.4%, p = .001), with improved NCT (1.7%, p = .001), visual memory (13.7%, p = .001) and digit span (23.8%, p = .002). On multivariate logistic regression, adherence (OR, 17.5 [95% CI 2.80-110.50], p = .000), high ALT (OR 1.02 [95% CI 1.00-1.05]), and BDI score (OR 1.73 [95% CI 1.42-3.26] p = .039) predicted cure. SVR-12 was associated with improved visual memory ≥5.5 (AUC-0.708; sensitivity 62.5%, specificity 63%, p = .000) and % correct Stroop test responses >26.6% (AUC-0.918, sensitivity 94.4% specificity 80.4%, p = .000). In conclusion, given the cumulative evidence of the safety of DAAs and efficacy of improving cognitive and neuropsychological and quality-of-life outcomes irrespective of age and gender, as shown in our study, future recommendations should focus on integrated universal HCV care to enable HCV elimination.
慢性丙型肝炎病毒（HCV）感染与神经精神变化有关。此外，肝硬化患者可能会出现显性或轻微肝性脑病。直接作用抗病毒药物（DAA）的持续病毒学应答（SVR）可能改善神经精神表现和生活质量（QoL）。连续入组（有和无肝硬化，所有性别和年龄 18-65 岁）的丙型肝炎患者在治疗结束后 12 周进行情绪（贝克抑郁量表[BDI]）、焦虑（广泛性焦虑障碍[GAD-7]）、生活质量（SF-36 ver.2）和计算机连线测试（NCT）、视觉记忆、Stroop 测试和反应时间评估。我们招募了 385 名病毒血症慢性 HCV 患者（76.1%为男性，21.0%为肝硬化，平均年龄 39.4±14.2 岁，59.3%为基因型 3，平均 HCV RNA 载量 5.8log）。总的 SVR-12 率为 90.6%，有肝硬化和无肝硬化患者的治愈率分别为 87.6%和 91.4%。达到 SVR-12 的患者 BDI（11.3%，p=0.000）、GAD（8.6%，p=0.001）和 Stroop 测试（58.4%，p=0.001）的平均百分比降低，NCT（1.7%，p=0.001）、视觉记忆（13.7%，p=0.001）和数字跨度（23.8%，p=0.002）得到改善。多变量逻辑回归显示，依从性（OR，17.5[95%CI 2.80-110.50]，p=0.000）、高 ALT（OR 1.02[95%CI 1.00-1.05]）和 BDI 评分（OR 1.73[95%CI 1.42-3.26]，p=0.039）可预测治愈率。SVR-12 与视觉记忆改善≥5.5（AUC-0.708；灵敏度 62.5%，特异性 63%，p=0.000）和 Stroop 测试正确反应百分比>26.6%（AUC-0.918，灵敏度 94.4%，特异性 80.4%，p=0.000）相关。总之，鉴于 DAA 的安全性和改善认知、神经心理和生活质量结局的疗效的累积证据，无论年龄和性别如何，如我们的研究所示，未来的建议应侧重于综合的丙型肝炎病毒全面护理，以实现丙型肝炎病毒的消除。
