Neuropsychological Effects of Direct-acting Antiviral Treatment for Hepatitis C Virus Subjects

A Systematic Review

Cassio Santos-Lima, Breno Souza-Marques, Flávia Vieira, Maria Isabel Schinoni, Lucas C. Quarantini and Neander Abreu


J Viral Hepat. 2021;28(12):1672-1682. 

In This Article

Materials and Methods

Systematic Review

Preliminary searches for similar reviews were searched for in the Cochrane Database of Systematic Reviews and International Prospective Register of Systematic Reviews (PROSPERO). As no ongoing study was found, this systematic review was registered in PROSPERO (CRD42020205233) and conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—PRISMA.[26]

Search Strategy

Systematic searches were conducted in the following databases: PubMed/Medline, Embase, Scopus and LILACS. Search terms were 'Hepatitis C', 'direct acting antiviral' and 'cognition' (Figure 1). For the composition of the search strategy, synonyms and terms of Medical Subject Headings Terms (MeSH), when available, were also used. Searching took place between 1 September 2020 and 30 March 2021 and only included studies from 1999 and onwards. Search results were independently assessed by two reviewers (CSL and BSM), first by title and then by abstract, at which point any divergence was settled by consensus. Then, the selected articles were read in full, independently.

Figure 1.

PRISMA Flow Diagram of included studies: An overview of search strategy

Eligibility Criteria, Data Extraction and Quality Assessment

Selected studies had to meet the following criteria to be included.

  1. Randomized controlled trials, open-label studies, case series and letters to the editors or correspondence.

  2. Included patients with Hepatitis C being treated with any DAA.

  3. Assessed at least one neuropsychological function with a validated instrument or an experimental task.

Studies were excluded from the systematic review if the following was presented in the study sample:

  1. Patients with a history of convulsions without clear aetiology or with any other serious neurological or general medical conditions.

Data from the selected studies were independently extracted by two reviewers (CSL and BSM) and compared for consistency, with any discrepancy being settled by consensus. The Newcastle-Ottawa Quality Assessment Scale (NOS)[27] for Cohort Studies and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Series[28] were used to assess the methodological quality of the articles included. Studies with NOS scores between 1 and 3, 4 and 6, and greater than or equal to 7 were defined as low, moderate and high quality, respectively (Table 1).