LAUSR

Chronic hepatitis C virus (HCV) infection is associated with neuropsychiatric changes. Also patients with cirrhosis may develop overt or minimal hepatic encephalopathy. Sustained virological response (SVR) with direct-acting antiviral agents (DAAs) may improve the neuropsychiatric manifestations and quality of life (QoL). Consecutive patients (with and without cirrhosis, all genders, aged 18-65 years) with hepatitis C were assessed at enrolment and at 12 weeks after therapy completion for mood [Beck's Depression Inventory (BDI)], anxiety [generalized anxiety disorder (GAD-7)], QoL (SF-36 ver.2) and computer based-tests for number connection (NCT), visual memory, Stroop test and reaction times. We recruited 385 viremic chronic HCV patients (76.1% male, 21.0% cirrhotic, mean age 39.4 ± 14.2 years, 59.3% genotype 3, mean HCV RNA load 5.8 log). Overall SVR-12 rates were 90.6%, with cure rates 87.6% and 91.4% in patients with and without cirrhosis, respectively. Patients who achieved SVR-12 had mean percentage reduction in BDI (11.3%, P=0.000), GAD (8.6%,P=0.001) and Stroop test (58.4%, P=0.001), with improved NCT (1.7%, P=0.001) visual memory (13.7%, P=0.001) and digit span (23.8%, P =0.002). On multivariate logistic regression, adherence [OR, 17.5 (95% CI 2.80 -110.50), P=0.000], high ALT [OR 1.02(95%CI 1.00 - 1.05)], BDI score [OR 1.73(95%CI 1.42 - 3.26) P=0.039] predicted cure. SVR-12 was associated with improved visual memory ≥ 5.5(AUC-0.708; sensitivity 62.5%, specificity 63%, P=0.000), and % correct Stroop test responses >26.6% (AUC-0.918, sensitivity 94.4% specificity 80.4%, P=0.000). In conclusion, given the cumulative evidence of the safety of DAAs and efficacy of improving cognitive and neuropsychological and quality of life outcomes irrespective of age and gender, as shown in our study, future recommendations should focus on the integrated universal HCV care to enable HCV elimination.