The neuropsychiatric manifestations of hepatitis C virus (HCV)—chronic fatigue, mood alterations and cognitive impairment—may be driven by an autoimmune response to the virus.

Publishing their findings in the Journal of Viral Hepatitis, researchers studied 132 people without cirrhosis, including 46 people with HCV, 22 with hepatitis B virus (HBV), 27 with autoimmune hepatitis (AIH), 29 with primary biliary cholangitis (PBC, a chronic liver disease resulting from destruction of the bile ducts) and eight with AIH and PBC.

The participants completed questionnaires, including the Short-Form-36 (SF-36, to assess quality of life), the Fatigue Impact Scale (FIS) and the Hospital Anxiety and Depression Scale (HADS). Eighty-eight of the participants received a neurological exam and neuropsychological testing that focused on memory and attention.

The study also included 33 healthy control subjects. Compared with that group, all the other study groups had greater fatigue, anxiety and depression scores and lower scores on the mental health portion of the SF-36.

Those with HCV had greater fatigue than those with HBV and worse scores on the SF-36 than those with HBV but not those with AIH and PBC. Compared with the controls, those with HCV, AIH and PBC but not those with HBV performed worse at word learning. Also compared with controls, those with HCV, AIH and PBV had poorer recognition of words while only those with HCV had poorer recognition of figures. Compared with both the controls and those with HBV, those with HCV performed more poorly on measures of alertness and working memory.

“The neuropsychiatric profiles of HCV patients,” the study authors concluded, “are similar to those of AIH and PBC patients but differ from those of HBV patients, suggesting an autoimmune response as a possible cause for these differences.”

To read the study abstract, click here.