BACKGROUND: HCV chronic infection may affect Patient-Reported Outcomes (PROs) and HCV related neuroinflammation might correlate with neurocognitive performances (NCP) dysfunction.

PATIENTS AND METHODS: A prospective observational study on HCV infected patients treated with direct-acting antivirals (DAA) was conducted at the University Department of Infectious and Tropical Diseases of Brescia, ASST Spedali Civili General Hospital (Italy) from October 2017 to June 2018. Data were collected at baseline (BL), end of treatment (EOT) and 12 weeks after EOT (FU12W). PROs were evaluated with Chronic Liver Disease Questionnaire (CLDQ), Fatigue Severity Scale (FSS), Visual Analogue Fatigue Scale (VAFS) and Work Productivity and Activity Impairment Questionnaire: General Health (WPAI:GH). Montreal Cognitive Assessment (MoCA) test evaluated NCP. Exclusion criteria were: HIV infection with CD4+ nadir <200 cell/μL or encephalopathy, current alcohol or drug abuse and severe psychiatric disorders. Population features were analysed to identify factors related to PROs and NCP. Statistical significance was considered with p-value<0.05.

RESULTS: 76 patients (60.5% males) were analysed: mean age was 60.7, 29 (38.1%) had advanced fibrosis, 6 (7.9%) were HIV/HCV co-infected, 18 (23.6%) took polytherapy (≥5 drugs), ribavirin (RBV) was added in 10 cases (13.1%). Improvements were registered in all questionnaires at FU12W, with significant changes in CLDQ, VAFS and MoCA. Quality of life (QoL) was lower in women and the elderly. RBV assumption temporarily affected QoL and fatigue. Female sex, age and polytherapy were related to worse NCP. HIV/HCV co-infection and fibrosis did not affect scores.

CONCLUSIONS: DAA seem to be associated with improvement in PROs and NCP, regardless of fibrosis and HIV/HCV co-infection. These aspects must be considered in real settings, particularly in specific populations including women, the elderly or those assuming polytherapy.