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From the Departments of Psychiatry (Dr. Ryan and K. Isaacs) and Pathology (Dr. Morgello, and M. Naseer and P. Gerits), The Mount Sinai Medical Center, New York, NY.
Address correspondence and reprint requests to Dr. Elizabeth Ryan, Mount Sinai School of Medicine, Box 1134-MHBB, One Gustave Levy Place, New York, NY 10029-6574; e-mail: Elizabeth.ryan{at}mssm.edu
Objective: To determine whether hepatitis C (HCV) contributes to CNS dysfunction among HIV-infected individuals.
Methods: Using a cross-sectional design, the neuropsychiatric profile of individuals with advanced HIV coinfected with hepatitis C (HIV+/HCV+) was compared to similarly advanced HIV patients without HCV coinfection (HIV+/HCV-). Participants were derived from the Manhattan HIV Brain Bank and underwent neurocognitive testing and semistructured psychiatric interviews. Evidence of HCV infection was determined by serology performed prior to study entry. Hepatic function was determined by serum chemistries (bilirubin, creatinine, and international normalized ratio) at the time of the cognitive assessments.
Results: Coinfected (HIV+/HCV+) individuals were significantly more likely to have had past opiate or cocaine or stimulant dependence. HIV+/HCV+ participants also had significantly greater rates of past substance-induced major depression. There were no significant differences in rates of primary mental disorders. Forty-two percent of both the HIV+/HCV+ and HIV+/HCV- participants met criteria for current major depression. There was a trend for HIV+/HCV+ patients to perform worse neurocognitively. On tests of executive functioning, HIV+/HCV+ individuals exhibited a greater rate of impairment and had significantly more perseveration. Differences in cognitive functioning were associated with serology but did not correlate with indices of liver disease severity. The HCV+ patients were also more likely to be diagnosed with HIV-associated dementia.
Conclusions: There appears to be a neuropsychiatric impact of HCV that is detectable even among an advanced HIV cohort.
Received March 26, 2003. Accepted in final form October 19, 2003.
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