P0697 - Chronic Hepatitis C Infection Is Associated With Depression, Anxiety, and Impaired Neurocognitive Performance, Which Improves After Achieving SVR-12 With Direct-Acting Antivirals: A Prospective Study

Madhumita Premkumar, MD, DM, MACG¹, Harmanpreet Kaur, MSc¹, Harpreet Kaur, MSc¹, Sandeep Grover, MD¹, Gagandeep Grover, MD², Radha Dhiman, MD, DM, FACG, FRCP¹, Ajay Duseja, MD, DM, FACG, FRCP¹, Rohit Mehtani, MD^3
1Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India; ²Punjab Government, Chandigarh, Chandigarh, India; ³Post Graduate Institute of Medical Education and Research, Chandigarh, Delhi, India

Introduction: Chronic hepatitis C virus (HCV) infection is associated with cognitive impairment, anxiety and mood changes attributable to HCV per se. In addition, patients with cirrhosis may develop overt or minimal hepatic encephalopathy (MHE). With direct acting antiviral agents (DAAs), the high sustained virological response (SVR) rate may improve neuropsychiatric manifestations in HCV.

Methods: Consecutive patients, (with and without cirrhosis, all genders, aged 18-65 years) with viremic hepatitis C were assessed at presentation with Beck’s Depression Inventory (BDI-II), Generalized Anxiety Disorder (GAD-7), and for cognition using a combination of paper-based [Montreal Cognitive Assessment (MoCA)] and computer based-tests for number connection (NCT), visual memory, digit span, vigilance, Stroop test and reaction times. The neurocognitive battery was custom designed using Psychology Experiment Building Language (PEBL) version 2.1. All tests were repeated at 12 weeks after completion of DAA therapy and changes in depression, anxiety and cognitive scores were assessed.

Results: We recruited 402 viremic chronic HCV patients (65% male, 20.1% cirrhotic, mean age 39.2± 14years, 90.3% genotype 3, mean RNA load 5.8 log). In addition, 32.0% , 6.2% and 15 % persons consumed alcohol, opium, and tobacco, respectively. SVR-12 rates were 90.5% overall, including 87.5% and 91.2% in patients with and without cirrhosis, respectively. Patients who achieved SVR-12 had mean percentage reduction in BDI (11.3%, p=0.001), GAD (18.4%, p=0.001), and Stroop test (58.4% p=0.001), with improved MoCA score (7.6%, p=0.001), NCT (1.7%, p=0.001) visual memory (13.7%, p=0.001), digit span (23.8%, p=0.002) and correct replies on the Stroop test (12.2%,p=0.001). On Cox proportional hazards analysis, age, gender, viral load, and presence of cirrhosis did not predict SVR-12. Improvement in MoCA (HR 1.4 95% CI 1.1-2.0) was the best predictor of SVR-12. Achievement of SVR-12 was associated with percentage improvement in MoCA (AUC 0.874, sensitivity 73.4%, specificity 85%, p=0.000), increased recalled visual memory targets (AUC 0.901; sensitivity 79%, specificity 85% p=0.000), and increased digit span (AUC 0.770, sensitivity 65.4% specificity 84.7%, p=0.000).

Discussion: This prospective cohort of chronic HCV patients showed significant improvement of neurocognitive scores after treatment with DAAs. Computerized tests provide validated and cost-effective screening for cognitive impairment in liver disease


Figure: Figure 1A Changes in Depression (Beck’s Depression Inventory) , 1B Cognitive score (MoCA score) , 1C Generalized Anxiety Disorder Score as Conventional tests; 1D Visual Memory Score 1E Number Connection Test and 1F Stroop test using the Best Card Sort method.

	Total (N=402)	Cured (N=364)	Treatment Failure (N=364)	p Value
Number Connection Test
At Day 0 (ms)	1680.0 ± 458	1708.9 ± 788	1403.97± 289	0.250
At 12 weeks post therapy (ms)	1347.4 ± 904	1198.68 ± 488	2772.57 ± 1333	0.000
Visual Memory (Objects Recalled)
At Day 0	5.06 ± 1.0	4.98 ± 1.0	5.78 ± 0.91	0.000
12 weeks post therapy	5.37 ± 0.9	5.48 ± 0.91	4.31 ±0.62	0.000
Digit Span (Number of Digits recalled)
At Day 0	5.11 ± 1.17	5.07± 1.1	5.47± 1.1	0.048
12 weeks post therapy	5.90 ± 1.01	6.00 ± 0.9	4.94 ± 0.83
Stroop Test ( Best Card Sort test) (ms)
At Day 0	4124.10 ± 2365	4193.51 ± 2110	3459.23 ± 1695	0.069
12 weeks post therapy	1751.05 ± 788	1264± 434	6430.18 ± 2811	0.000
Percentage Correct Responses on Stroop Test
At Day 0	47.0 ± 11.0	52.63 ± 10.3	54.6 ± 11.6	0.003
12 weeks post therapy	50.0 ± 11.0	55.6 ± 11.4	45 ± 8.6	0.000

Table: Table shows the changes in the neurocognitive battery in persons who achieved SVR-12 vs. Treatment Failures


Disclosures:
Madhumita Premkumar indicated no relevant financial relationships.
Harmanpreet Kaur indicated no relevant financial relationships.
Harpreet Kaur indicated no relevant financial relationships.
Sandeep Grover indicated no relevant financial relationships.
Gagandeep Grover indicated no relevant financial relationships.
Radha Dhiman indicated no relevant financial relationships.
Ajay Duseja indicated no relevant financial relationships.
Rohit Mehtani indicated no relevant financial relationships.


Madhumita Premkumar, MD, DM, MACG¹, Harmanpreet Kaur, MSc¹, Harpreet Kaur, MSc¹, Sandeep Grover, MD¹, Gagandeep Grover, MD², Radha Dhiman, MD, DM, FACG, FRCP¹, Ajay Duseja, MD, DM, FACG, FRCP¹, Rohit Mehtani, MD³. P0697 - Chronic Hepatitis C Infection Is Associated With Depression, Anxiety, and Impaired Neurocognitive Performance, Which Improves After Achieving SVR-12 With Direct-Acting Antivirals: A Prospective Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.