The role of HCV as an independent risk factor for HIV-associated neurocognitive impairment (NCI) is still controversial. VACS Index, a composite marker of disease severity, has been associated with increased risk for mortality and with concurrent risk for NCI. Aim was to evaluate changes over time after DAA treatment on neurocognitive performance and VACS index in HIV/HCV co-infected (HIV/HCV) patients (pts).
HIV/HCV pts starting DAA treatment were enrolled in a prospective study. All patients underwent neuropsychological assessment (NPA) before starting DAA (T1) and 12-24 weeks after (T2) end of treatment (EOT). NPA was carried out through a standardized battery of 14 tests on 5 different domains. We used NPZ-8 as a summary measure of z-scores of neuropsychological testing performance. Pts were classified as having NCI if they scored >1 standard deviation (SD) below the normal mean in at least 2 tests, or >2 SD in 1 test. HAND was classified according to Frascati’s criteria. VACS Index was calculated through standard methods at T1 and 6 months after EOT. Paired Wilcoxon and Mc Nemar test were used for statistical comparisons.
A total of 62 patients included: male 74.2%, median age 54 years (IQR 51-56); injection drug users (IDUs) 85.4%; on cART 100%; median CD4 563 cell/mmc (IQR 340-761); HIV-RNA not detectable 83.3%; baseline log10 HCV RNA 5.8 (IQR 5.3-6.3). Fibrosis was F1/F2 in 11, F3 in 12, F4 in 39 pts. Half of the patients was HCV treatment experienced. DAA regimen was SOF-based for 32 pts and non-SOF-based for 30 pts. At baseline 23/62 were neurocognitively impaired. HAND criteria were limited by high frequency of confounding comorbid conditions (substance use). No significant changes over time in NPA was observed after DAA (Table). Similarly, when considering only pts achieving SVR12, neurocognitive performance did not improve. For 51 pts, VACS index was calculated at T1 and 6 month after EOT: at month 6 compared to T1, median values were significantly lower after DAA treatment (Table).
In our experience, DAA treatment strongly improved VACS Index, but did not impact on neurocognitive performance in HIV/HCV co-infected. These results could be explained by a poor contribution of HCV to neurocognitive impairment in HIV co-infected population, even though the elevated frequency of confounding factors in this highly vulnerable population may have masked benefit effect of DAA on neurocognition.