Liver fibrosis is associated with cognitive impairment in HIV-positive patients

Introduction: The aim of our study was to investigate the potential relationship between liver fibrosis (LF) and cognitive performance in HIV patients. Materials and Methods: We performed a cross-sectional cohort study by consecutively enrolling HIV patients during routine outpatient visits at two clinical centres in Italy. Subjects with decompensated liver disease were excluded. All subjects underwent a comprehensive neuropsychological battery exploring memory, attention, psychomotor speed and language; cognitive impairment was defined as at least two abnormal [1.5 SD below the mean for appropriate norms] cognitive domains. LF was explored by calculating FIB4 index; in a subgroup of patients, LF was also assessed by transient elastography. Factors associated with cognitive impairment were investigated by logistic regression models. Results: A total of 413 patients [77% males, median age 46 (IQR 39 52), 17% with past AIDS-defining events, 19% past IDU, 3% with diabetes, 94% on cART, 90% with HIV RNA B50 copies/mL, 18% co-infected with HCV] were enrolled. Seventeen patients (4%) had FIB4 3.25 and 14/129 (3%) had liver stiffness 14KPa. Forty-seven patients (11%) were diagnosed with cognitive impairment. At multivariate analyses patients with FIB4 1.45 showed a higher risk of cognitive impairment in comparison with those with lower values (OR 2.19, 95% CI 1.02 4.72; p 0.044) after adjusting for education (OR 0.79, 95% CI 0.71 0.88; pB0.001), past IDU (OR 1.69, 95% CI 0.67 4.23; p 0.264), diabetes (OR 2.35, 95% CI 0.62 8.86; p 0.207), HIV RNA B50 copies/mL (OR 0.47, 95% CI 0.19 1.14; p 0.095) and HCV co-infection (OR 0.88, 95% CI 0.33 2.39; p 0.807). Analyzing any single cognitive domain, a higher risk of abnormal psychomotor speed was associated with fibroscan score 14KPa in comparison with fibroscan score B7KPa (OR 285.07; 95% CI 2.42 33574.06; p 0.020) after adjusting for education (OR 0.54, 95% CI 0.31 0.92; p 0.024), age (for 10 years increase) (OR 2.03, 95% CI 0.55 7.53; p 0.288), past IDU (OR 4.43, 95% CI 0.35 7.57; p 0.526), HIV RNA B50 copies/mL (OR 0.01, 95% CI 0.00 0.18; p 0.003), HIV history (for 1 year increase) (OR 0.96, 95% CI 0.83 1.12; p 0.641), CD4 cells count at nadir (OR 1.10, 95% CI 0.56 2.16; p 0.779), and HCV co-infection (OR 0.06; 95% CI 0.00 1.93; p 0.113). Conclusions: In HIV-infected patients higher LF, estimated through non-invasive methods, is associated to a higher risk of cognitive impairment.