RT Journal Article
SR Electronic
T1 Neuropsychiatric performance and treatment of hepatitis C with direct-acting antivirals: a prospective study
JF BMJ Open Gastroenterology
FD BMJ Publishing Group Ltd
SP e000183
DO 10.1136/bmjgast-2017-000183
VO 4
IS 1
A1 Sofia Volpato
A1 Sara Montagnese
A1 Alberto Zanetto
A1 Matteo Turco
A1 Michele De Rui
A1 Alberto Ferrarese
A1 Piero Amodio
A1 Giacomo Germani
A1 Marco Senzolo
A1 Martina Gambato
A1 Francesco Paolo Russo
A1 Patrizia Burra
YR 2017
UL http://bmjopengastro.bmj.com//content/4/1/e000183.abstract
AB Background Since direct-acting antivirals (DAAs) have been approved for the treatment of hepatitis C virus (HCV) infection, a small series of patients with new-onset neuropsychiatric alterations have been referred to us. We therefore set out to study neuropsychiatric function in relation to DAAs prospectively.Methods Ten patients with cirrhosis and 12 post-liver transplant (post-LT) patients were enrolled. All underwent wake electroencephalography (EEG) and a neuropsychological evaluation (paper and pencil battery, simple/choice reaction times, working memory task) at baseline, at the end of treatment with DAAs and after 6 months. At the same time points, full blood count, liver/kidney function tests, quantitative HCV RNA, ammonia and immunosuppressant drug levels were obtained, as appropriate.Results Patients with cirrhosis were significantly older than post-LT patients (65±12 vs 55±7 years; P<0.05). Neuropsychological performance and wake EEG were comparable in the two groups at baseline. At the end of a course of treatment with DAAs, a significant slowing in choice reaction times and in the EEG (increased relative delta power) was observed in patients with cirrhosis, which resolved after 6 months. In contrast, no significant changes over time were observed in the neuropsychiatric performance of post-LT patients. No significant associations were observed between neuropsychiatric performance and stand-alone/combined laboratory variables.Conclusion Some degree of neuropsychiatric impairment was observed in relation to treatment with DAAs in patients with cirrhosis, but not in post-LT patients, suggesting that the former may be sensitive to mild DAA neurotoxicity.