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In this issue of Neurology, Cherner et al.1 discuss both the negative impact of hepatitis C (HCV) infection upon cognitive functioning and, equally importantly, the additive effect of methamphetamine abuse, HIV infection, and HCV infection upon cognition. Not only does each appear to represent an independent risk factor for neuropsychological impairment, but when they are combined in the same individual, the risk for more severe neuropsychological impairment is greatly increased. Cherner et al. also demonstrate that these effects are not only seen at a global cognitive level, but also differentially target specific neuropsychological domains.
Before commenting on the importance of this research, several methodologic concerns bear mention. First, the prevalence of substantial alcohol use was high in their sample. The noninfected participants drank an average of 3.3 …
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