Study of Cerebral Function in Patients With Chronic Hepatitis C Infection (HCV/CNS)
Study of Cerebral Function in Patients With Chronic Hepatitis C Infection (HCV/CNS)
Patients with HCV infection often suffer from chronic fatigue, depression and reduced
 cognition, even before evolving severe liver fibrosis, liver cirrhosis and hepatic
 encephalopathy.

 It is currently unclear to what extent the symptoms er due to a direct pathological effects
 of the virus itself, or due to pre-existing psychiatric disease. There is a complex
 relationship between prior or existing drug abuse, psychiatric disease and HCV infection,
 that makes it difficult to establish cause-effect relationships.

 A biological mechanism has been suggested to contribute to development of cerebral
 dysfunction in the patients. According to the prevailing Trojan Horses hypothesis circulating
 lymphocytes cross the blood brain barrier carrying HCV to the central nervous system and
 virus is subsequently replicated in the macrophages and the microglia in brain as a separate
 compartment. As part of the immunological response to viral replication, neurodegenerative
 processes takes place with a harmful effect on the neural circuit and cerebral function.
 Identification of HCV RNA negative strand, a replication product, in brain tissue from HCV
 patients, as part of autopsy studies, supports the hypothesis. Moreover, HCV patients have
 also been observed with abnormal metabolic concentrations in the frontal white substance and
 the basal ganglia by MRI spectroscopy compared to control groups.

 The overall study objective is to assess cerebral function with particular emphasis on
 cognitive functions in HCV patients (genotypes 1,2,3 and 4) by use of a neuropsychiatric test
 battery. Furthermore, the patients will be examined by MRI, including magnetization transfer,
 diffusion tensor and contrast perfusion, in order to perform measurements of cerebral
 volumetric and microstructure. Finally, HCV analysis, including viral sequences and cytokine
 profiles, in serum and cerebrospinal fluid will be carried out in the study population.
Inclusion Criteria:

 -  Chronic HCV infection with genotype 1, 2, 3 or 4.

 -  Age > 18 and <60

 -  Liver biopsy or fibroscan performed within last 5 years

 -  Signed informed consent form.

 Exclusion Criteria:

 -  Liver biopsy showing liver pathology not due to HCV infection.

 -  Liver cirrhosis or severe liver fibrosis

 -  Former antiviral HCV treatment (for included HCV patients).

 -  HIV and/or Hepatitis B virus infection.

 -  Alcohol or drug abuse within the last 2 years.

 -  Neutropenia, anemia or thrombocytopenia.

 -  Clinical signs of non-compensated liver pathology.

 -  Moderate to severe cardiopulmonary disease (NYHA score 1 or above)

 -  Creatinine clearance < 80mL/min.

 -  Pregnancy.

 -  Ferromagnetic implants

 -  Significant somatic disease affecting the central nervous system (somatic/neurologic
 disease)

 -  Head trauma resulting in unconsciousness > 5min

 -  Schizophrenia or other psychotic disorders