Differential Cognitive Impairment in HCV Coinfected Men With Controlled HIV Compared to HCV Monoinfection

Background: Individuals infected with both HIV and hepatitis C virus (HCV) have shown impaired performance on different neuropsychological (NP) tests; however, whether coinfected individuals with controlled HIV and minimal liver damage in the era of antiretroviral therapy have impairment is understudied. Methods: Nineteen HCV monoinfected, 17 HIV/HCV coinfected, and 17 control male participants were evaluated for depression, attention, executive function, information processing, fine motor speed, and verbal/visual learning/memory. Eleven controls and 14 HIV monoinfected participants with controlled viral load from a previous study were also included for comparison. At time of testing, participants were not using drugs or alcohol and did not have cirrhosis. A global deficit score (GDS) was calculated from 7 domains of NP tests and alterations in specific domains were determined. Results: HIV/HCV subjects had a higher depression score (11.1 +/- 7.5) than controls (5.4 +/- 4.1, P = 0.010) and a higher GDS score (0.77 +/- 0.47) than HCV (0.46 +/- 0.34, P = 0.036), HIV (0.45 +/- 0.36, P = 0.008), and controls (0.30 +/- 0.29, P = 0.001). Coinfection was associated with worse scores in attention working memory (P = 0.007), executive function (P = 0.01), fine motor function (P = 0.011), verbal learning/memory (P < 0.001), and visual learning/memory (P < 0.001) compared to controls. Within the HCV group, viral load was associated with lower attention, executive function, and information processing speed and positively with GDS. Conclusions: Coinfection significantly increased the risk of cognitive impairment in subjects with controlled HIV viral loads. In HCV monoinfected but not coinfected subjects, HCV viral load correlated with worsening GDS, suggesting different pathways for NP impairment.