Implications of hepatitis C virus infection for behavioral symptoms and activities of daily living

Abstract

Hepatitis C virus (HCV) is neurovirulent and has been shown to be associated with neuropsychological (NP) deficits in a subset of infected individuals. Despite these previous findings, little work has been done to examine neurobehavioral symptoms associated with HCV infection. We examined 34 HCV seropositive (HCV+) individuals and 35 healthy comparison participants (HCV–) with the self-rating form of the Frontal Systems Behavior Scale (FrSBe). Results showed that at the group level, only the FrSBe apathy subscale mean was clinically elevated (T score >65) among HCV+ persons; executive dysfunction, disinhibition, and total subscale means were not clinically elevated. At the individual level, a significantly higher proportion of HCV+ individuals than of HCV– individuals reported clinically elevated FrSBe T scores . Moreover, HCV+ individuals were nearly 3 times as likely to report clinically elevated FrSBe T scores of apathy, executive dysfunction, and disinhibition as compared to HCV– participants. A multiple regression that included substance use disorders, neuropsychological impairment, and age indicated that HCV status was an independent predictor of self-reported FrSBe total T scores. Across all participants, small, yet significant, correlations were found between elevated self-reported FrsBe T scores and dependence in activities of daily living. These results show that a subset of HCV-infected individuals report clinically elevated behavioral symptoms. Clinical implications for the assessment and management of elevated behavioral symptoms in HCV are discussed.

Keywords:

• Hepatitis
• Executive functions
• Prefrontal cortex
• Apathy
• Neuropsychology
• Substance abuse

This research was partially supported by National Institutes of Health/National Institute on Drug Abuse (NIH/NIDA) Grant P01 DA12065–08. The HIV Neurobehavioral Research Center (HNRC) is supported by Center Award MH 62512–07 from National Institute of Mental Health (NIMH). The San Diego HIV Neurobehavioral Research Center (HNRC) group is affiliated with the University of California, San Diego, the Naval Hospital, San Diego, and the Veterans Affairs San Diego Healthcare System, and it includes: Director: Igor Grant, MD; Codirectors: J. Hampton Atkinson, MD, Ronald J. Ellis, MD, PhD, and J. Allen McCutchan, MD; Center Manager: Thomas D. Marcotte, PhD; Melanie Sherman; Naval Hospital San Diego: Braden R. Hale, MD, MPH (PI); Neuromedical Component: Ronald J. Ellis, MD, PhD (PI), J. Allen McCutchan, MD, Scott Letendre, MD, Edmund Capparelli, Pharm.D., Rachel Schrier, PhD; Jennifer Marquie-Beck; Terry Alexander, RN; Neurobehavioral Component: Robert K. Heaton, PhD (PI), Mariana Cherner, PhD, Steven Paul Woods, Psy.D., David J. Moore, PhD; Matthew Dawson; Neuroimaging Component: Terry Jernigan, PhD (PI), Christine Fennema-Notestine, PhD, Sarah L. Archibald, MA, John Hesselink, MD, Jacopo Annese, PhD, Michael J. Taylor, PhD, Brian Schweinsburg, PhD; Neurobiology Component: Eliezer Masliah, MD (PI), Ian Everall, FRCPsych., FRCPath., PhD, Cristian Achim, MD, PhD; Neurovirology Component: Douglas Richman, MD (PI), David M. Smith, MD; International Component: J. Allen McCutchan, MD (PI); Developmental Component: Ian Everall, FRCPsych., FRCPath., PhD (PI), Stuart Lipton, MD, PhD; Clinical Trials Component: J. Allen McCutchan, MD, J. Hampton Atkinson, MD, Ronald J. Ellis, MD, PhD, Scott Letendre, MD; Participant Accrual and Retention Unit: J. Hampton Atkinson, MD (PI), Rodney von Jaeger, MPH; Data Management Unit: Anthony C. Gamst, PhD (PI), Clint Cushman (Data Systems Manager), Daniel R. Masys, MD (Senior Consultant); Statistics Unit: Ian Abramson, PhD (PI), Florin Vaida, PhD, Christopher Ake, PhD.