S1083 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
Bibliographic record
Abstract
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). Conclusion: 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 1.: A 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.Table 1.: Changes in the neurocognitive battery in persons who achieved SVR-12 vs. Treatment Failures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".