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Viral Hepatitis C Associated Neurocognitive Dysfunction in Ireland in the DAA era

Approximately 30,000-50,000 people in Ireland are chronically infected with HCV. Studies estimate that one third of infected persons demonstrate neurocognitive dysfunction characterised by amnesia, and dysexecutive syndrome, unrelated to stage of liver disease. Evidence supports the theory that direct viral invasion of the brain with associated immune mediated inflammation is the likely main cause of cognitive change. Cognitive impairment leads to disengagement with healthcare services, reduced quality of life, increased mortality and high healthcare costs.
The first aim of this study is to determine the prevalence and pattern of neurocognitive function in HCV-infected patients. The second aim is to determine if cognitive impairment can be stabilised or ameliorated through two differing interventions to include viral eradication with DAA antiviral therapy (DAA treatment intervention study) and a formal exercise programme to investigate the effects of exercise on cognitive function in this cohort (Exercise intervention study)
Methods: A validated brief cognitive screen will be used to determine the prevalence of cognitive impairment in 3000 HCV infected patients attending St James’s Hospital. Subsequently 260 of those with cognitive impairment will be recruited to undergo detailed neuropsychological assessments before and after two differing interventions: 130 patients will receive DAA antiviral drug intervention to eradicate HCV. Of the remaining 130 patients, 65 will be randomised to a 12-week exercise intervention and the remaining 65 will receive routine care (control group). Fifty patients randomised to the antiviral drug group will also undergo brain imaging before and after the intervention.
Results: this study will determine the prevalence of cognitive impairment in chronic HCV infection, the effectiveness of antiviral drug treatment in improving or stabilising cognitive impairment, and the potential effect of exercise therapy as an ancillary intervention.