Association between hepatitis C virus infection and cognitive decline in seniors: further evidence from Taiwan.

OBJECTIVES

To assess the association between hepatitis C virus (HCV) infection and cognitive impairment among seniors in Taiwan, building on our previous findings from a cross-sectional study.

DESIGN

Retrospective cohort study.

SETTING

Taiwan Biobank.

PARTICIPANTS

326 participants with positive serum anti-HCV and a control group of 8753 with negative HCV free of cognitive impairment were assessed by the Mini-Mental State Examination at baseline.

MEASUREMENTS: The association between HCV infection and cognitive impairment was evaluated using Cox proportional hazard models. The analysis was adjusted for age, sex, education, BMI, hypertension, cirrhosis, depression, estimated glomerular filtration rate, APOE genotype, and recruitment periods.

RESULTS

Anti-HCV positive patients showed a significantly higher incidence of cognitive impairment compared to anti-HCV negative individuals (14.28 vs. 7.21 per 1000 person-years, P = 0.004). After adjusting for covariates, HCV infection was significantly associated with an increased risk of developing cognitive impairment (adjusted HR [aHR]: 1.80, 95% confidence interval [CI]: 1.12-2.90). Subgroup analyses for individuals diagnosed prior to the public direct-acting antivirals reimbursement in 2017 and with high antibody titres (sample/cutoff ratio ≥ 5), the elevated risk of cognitive impairment remained statistically significant, with aHRs of 1.69 (95% CI: 1.04-2.75) and 1.81 (95% CI: 1.11-2.96) respectively. Additionally, HCV patients carrying the APOE ɛ4 allele had a marginally higher risk (aHR: 2.60, 95% CI: 0.96-7.08, P = 0.06).

CONCLUSIONS

In Taiwan, our findings strengthen evidence that individuals above the age of 60 with HCV infections are at a greater risk of developing cognitive impairment than their counterparts, who were HCV negative.