Cognitive disorders persist in up to one-half of people living with HIV despite access to combination antiretroviral therapy (cART). Minimal Hepatic Encephalopathy (MHE) occurs in cirrhotic patients with or without HIV infection and is thought to be associated with inflammation. Since HIV impairs gut barriers to pathogens, we hypothesized that HIV-infected adults are vulnerable to MHE in the absence of cirrhosis.
We completed a cross-sectional investigation of associations between liver fibrosis severity, using the aspartate aminotransferase to platelet ratio index (APRI), and neuropsychological testing performance in 1,479 women from the Women’s Interagency HIV Study (WIHS). A subset underwent liver transient elastography (n=303). We evaluated associations to neuropsychological testing performance on a one-hour testing battery.
We evaluated 1479 women (mean (SD) age of 46 (9.3) years): 770 (52%) only HIV-infected, 73 (5%) only HCV-infected, 235 (16%) HIV and HCV co-infected and 401 (27%) HIV- and HCV uninfected. 1221 (83%) had an APRI ≤0·5 (no or only mild fibrosis), 206 (14%) had an APRI >0·5 and ≤1·5 (moderate fibrosis) and 52 (3%) had an APRI >1·5 (severe fibrosis). Having moderate or severe fibrosis (APRI >0.5) was associated with deficits in learning, executive function, memory, psychomotor speed, fluency, and fine motor skills. In these models that adjusted for fibrosis, smaller associations were found for HIV (learning and memory) and HCV (executive functioning and attention). Similarly, the severity of fibrosis, measured by liver transient elastography, was associated with deficits in attention, executive functioning, and fluency.
Independent of HCV and HIV, liver fibrosis has distinct contributions to cognitive performance in the era of cART. In adjusted models, HCV and HIV had only limited associations when fibrosis is included. These data highlight the heterogeneous contributions to cognitive impairment in the era of combination antiretroviral therapy.