Hepatitis C virus (HCV) affects 71 million people worldwide, causing both hepatic and extrahepatic issues, including neurological and psychiatric symptoms. Neurological issues in patients with HCV, even without liver cirrhosis, can result from mechanisms like neuroinvasion, immune-mediated damage, and cryoglobulinemia. Central nervous system disorders include cerebral vasculopathy and encephalopathy, while peripheral neuropathies can affect sensation and strength in the legs. Cognitive decline and psychological disorders, such as depression and fatigue, affect up to 50% of HCV patients. New antiviral therapies improve extrahepatic symptoms, though some neurological symptoms may be irreversible if there’s significant liver damage.

HCV-associated neurocognitive disorder and minimal hepatic encephalopathy are distinct cognitive impairments in patients with HCV, requiring different diagnostic approaches. Neuropsychological tests and imaging help diagnose these conditions. Direct-acting antivirals have improved the treatment landscape for HCV, with better sustained virological response and tolerance than interferon-based therapies. These treatments also improve cognitive and psychiatric symptoms, although some deficits may persist if the virus remains in immune-privileged sites. Further studies are needed to evaluate the long-term effects of HCV eradication on neuropsychological health.

Reference: Faccioli J, Nardelli S, Gioia S, Riggio O, Ridola L. Neurological and psychiatric effects of hepatitis C virus infection. World J Gastroenterol. 2021 Aug 7;27(29):4846-4861. doi: 10.3748/wjg.v27.i29.4846. PMID: 34447230; PMCID: PMC8371503.