P20
Evaluation of mild cognitive dysfunction by Montreal Cognitive Assessment test
in co-infected HIV HCV patients treated with the new direct acting antivirals (DAAs)
F. Pes 1, S. Onali1, C. Balestrieri2, F. Figorilli1, G. Serra2, C. Pasetto1, L. Chessa1,2
1 Department
of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
2 Liver Unit, Department of Internal Medicine, Azienda Ospedaliera-Universitaria di Cagliari, Cagliari, Italy
Background and aim
§  There are 37 million of people with HIV and 140
million with antibodies to the hepatitis C virus in the
world and about 2,300,000 are co- Infected HIV-HCV
[1].
§  Transmission of HCV in HIV infected is primary
through IDU, followed by the exchange of infected
blood or bloodstream, and finally unprotected sex,
both homosexual and heterosexual[2-3].
§  Liver disease caused by chronic HCV infection are an
increasingly important cause of morbidity and mortality
among HIV+ patients[4-5]. Progression of liver fibrosis
to cirrhosis and the end stage liver are more rapid in
co-infected HIV-HCV than in mono-infected .patients.
§  Both HIV and HCV replicate in the brain and
cerebrospinal fluid and are implicated in the
development of neuro-cognitive alterations[6] and
peripheral neuropathic syndromes.
§  Co-infection is associated with an increase in neurocognitive impairment[7-10]. The evidence of HCV
replication in the brain [11-12] and the immunocytochemical detection of the virus C in astrocytes and
microglia suggests a possible additional role of HCV in
the development of this deficit[6].
§  DAAs modified the sustained virological response
rates even in patients with co-infection that attests
over 95% even among patients with cirrhosis, or
experienced previous treatment.
§ 
We have evaluated several cognitive domains: visuoconstructional skills, executive functions, attention
and concentration, memory, language and
orientation.
§  The
result of MoCA was the sum of the scores in
each area for a maximum of 30 points. We
considered normal a score ≥26/30.
Figure n.1
§  The average score at MoCA post treatment was 26,5
whereas at the baseline was 23,9 (p<0,0088). (Figure
n.2)
Figure n.2
§  10
patients (66,7%) improved their score in MoCA
post treatment compared to baseline (p< 0,0369), and
a high number of patients (66,7% vs 26,7%) has
equalized or exceeded the minimum score of test,
compared to baseline (p <0,0001).
§  The average score was improved in almost all areas,
except for the one that evaluates the visuoconstructional skills, in which there was a slight
decline in the results obtained in the second test
(from 3.4 to 3.2).
§  The aim of the study was to investigated changes in
neuro-cognitive status of HIV-HCV patients
undergoing antiviral treatment using the Montreal
Cognitive Assessment (MoCA) test. (Figure n.1)
Methods
Results
§  Memory was the most affected area in both tests. The
average score obtained in this exercise in the first test
was 2.2 points, while in the second was 3.5; 74% of
patients obtained a score of at least 3/5 after SVR, vs
53% at baseline. (figure n.3)
Table n.1
§  In this single centre prospective study we included
32
co-infected HIV-HCV patients treated with DAAs
between 2016-2017 in the Liver Unit of University
Hospital of Monserrato (Cagliari, Italy). (Table n.1)
Figure n.3
§  Twenty
one patients (65.6%) were cirrhotic, without
signs of encephalopathy. Nineteen patients (59.4%)
were naive to antiviral therapy.
§  At the baseline of DAAs therapy, all patients were on
antiretroviral treatment with HIV RNA under 37 copies/
ml.
§  Patients
were evaluated at baseline and 16/32 at 6
months after end of therapy. All of them achieved SVR.
§  To examine changes in
neuro-cognitive status of HIVHCV co-infected patients treated with DAAs we used
MoCA Test. It was carried out at baseline (before
starting therapy) and 6 months after the end of
treatment.
§  In two exercises (naming and Backward Digit Span)
100% of patients achieved the highest score in post
treatment tests, compared to 80-85% of baseline.
Conclusion
§  The results of our study suggest that co-infected HCV-HIV patients who achieved SVR improve neurocognitive functions, such as execution and
memory, emphasizing the importance of treatment with antivirals direct acting not only for the eradication of HCV (SVR 100% in our treated
patients), but also in the improving of neuro-cognitive disorders.
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