J Hepatol. 2011 Oct 22. [Epub ahead of print]
Effects of Anti-Viral Therapy and HCV Clearance on Cerebral Metabolism and Cognition.
Byrnes V, Miller A, Lowry D, Hill E, Weinstein C, Alsop D, Lenkinski R, Afdhal NH.
Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Chronic hepatitis C virus (HCV) infection is associated with altered cerebral metabolism and cognitive dysfunction. We aimed to evaluate the effect of pegylated interferon/ribavirin (PIFN/R) and HCV clearance on cerebral metabolism and neuropsychological performance.
Fifteen non-cirrhotic HCV positive subjects underwent (1)H MR spectroscopy (MRS) before, during, and after treatment with PIFN/R. The metabolites of interest namely, N-acetylaspartate (NAA), choline (Cho), myo-inositol (MI), and the control metabolite creatine (Cr), were acquired from 3 different brain regions; left basal ganglia, left frontal cortex and left dorso-lateral pre-frontal cortex. Coinciding with this, subjects also underwent a battery of neuropsychological tests to evaluate the domains of verbal learning, memory, attention, language, executive functioning and motor skills. Seven HCV positive controls (not receiving anti-viral therapy) underwent MRS and neuropsychological testing at two time points, 12 weeks apart, to examine for variation in cerebral metabolites over time and the practice effect of repeat neuropsychological testing.
Significant reductions in basal ganglia Cho/Cr (p=0.03) and basal ganglia MI/Cr (p=0.03) were observed in sustained virological responders (SVRs, n=8), but not non-responders/relapsers (NR/R, n=6), indicative of reduced cerebral infection and/or immune activation in those who cleared virus. SVRs demonstrated significant improvements in verbal learning, memory and visuospatial memory. A small but significant improvement in neurocognitive function secondary to the practice effect was seen in both HCV controls and HCV subjects during treatment.
HCV eradication has a beneficial effect on cerebral metabolism and selective aspects of neurocognitive function, and is, an important factor when contemplating anti-viral therapy in HCV, especially in those with mild disease.
Thanks for posting that article. Wow! The more I learn about Hep C the more I realize I have been suffering from its ill effects for years even though I never knew I had it and my liver enzymes were not that elevated (and sometimes normal). It seems just about all of my heath problems over the last few years (systemic vasculitis, muscle and joint aches, fatigue, slight but noticeable to me memory slowing, general malaise, etc.) are most likely due to Hep C doing it dirty work. Had I known earlier, like the early 90s, and had there been treatment then (which there really was not), I would have jumped at the chance to treat earlier in this disease cycle. It seems that every year that has gone by, this virus has been silently chipping away at the health and well being of my entire body and mind, and in addition to the health of my liver.
I agree. All the more reason to treat and to treat early before the virus ravages the body and mind.
Thanks for posting that article. Makes me even more positive my symptoms are from the Hep C virus and, as I said beore, had treatment been available and had I known I had Hep C, I definitely would have treated in the early 90s, before I developed all of these related problems from Hep C.
It's good to know that someone is studying these things. Makes me even more glad about my SVR. Although it has taken a while to recover from the effects of tx, I do feel a cognitive improvement 2 years later.
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