A history of alcohol dependence augments HIV-associated neurocognitive deficits in persons aged 60 and older

Abstract

Background Excessive alcohol use is common among people living with HIV. Given the growing prevalence of older HIV+ adults, and observations indicating higher risk for neurocognitive impairment in older adults with either HIV infection or alcoholism, an increased understanding of their combined impact in the context of this increasingly aged population is crucial. Methods We conducted comprehensive neurocognitive assessment in 112 older HIV+ individuals aged 50 to 69 years. Regression analyses were conducted to examine the interaction between age and the presence of lifetime alcohol dependence on neurocognitive measures, controlling for years of education, hepatitis C serostatus, and lifetime non-alcohol substance use disorder. Results Significant interactions of age and alcohol dependence history were found for global neurocognitive function, which was driven by the domains of executive function, processing speed, and semantic memory. Follow-up analyses indicated adverse effects of alcohol use history on neurocognitive measures that were evident only in HIV+ individuals 60 years and older. Conclusions While mounting evidence in younger cohorts indicates adverse synergistic HIV/alcohol effects on neurocognitive function, our novel preliminary findings in this elderly HIV+ cohort demonstrated the importance of even a relatively distant alcohol use history on the expression of HIV-associated neurocognitive disorders that may not become apparent until much later in life.

Accelerated and accentuated neurocognitive aging in HIV infection

“…A limitation of the current study is the cross-sectional design, which precluded us from examining possible accelerated neurocognitive aging processes over time, as well as relatively small samples (n range 40–48), which should be increased for future studies of accelerated aging in HIV. While the alcohol and substance dependence histories were unrelated to any neuropsychological outcome variables, lifetime non-alcohol substance dependence, since higher rates were observed in the O− and O+ groups compared to the OO− groups, should be examined by future studies as a possible contributor to an overall effect of accelerated aging (Gongvatana et al 2014; Iudicello et al 2012). One notable characteristic of our HIV+ sample is the rates of individuals prescribed ARV regimens (92.5%), which is comparable to rates reported by Centers for Disease Control (2013) for patients under care, but nevertheless may not be generalizable to persons not engaged or retained in care, who may be at even higher risk for impairment.…”

Impairments in Component Processes of Executive Function and Episodic Memory in Alcoholism, HIV Infection, and HIV Infection with Alcoholism Comorbidity

“…Chronic alcoholism (ALC) is a common co‐occurrence in HIV infection (HIV) (Conigliaro et al., ; Gongvatana et al., ), with the rate of alcoholism in this group being twice as high as that reported in the general population (Justice et al., ). Each condition is associated with a specific profile of cognitive impairments, involving component processes of executive functioning (ALC: Beatty et al., ; Bernardin et al., ; Nixon and Parsons, ; Noel et al., ; Oscar‐Berman and Marinkovic, ; HIV: Giesbrecht et al., ; Heaton et al., ; Woods et al., ) and episodic memory (ALC: Becker et al., ; Parsons and Prigatano, ; Pitel et al., ; Riege et al., ; Sullivan et al., ; HIV: Maki et al., ; Stout et al., ).…”

The Role of IL-17 Signaling in Regulation of the Liver–Brain Axis and Intestinal Permeability in Alcoholic Liver Disease

“…Although the numbers of Th17 cells in the peripheral blood often vary in AIDS patients, Th17 cells are substantially depleted from the gastrointestinal tract, leading to a loss of mucosal integrity, increased microbial translocation, and further impairment of systemic immune responses 103 . Furthermore, excessive alcohol use is common among AIDS patients, and greatly augments HIV-associated neurocognitive deficits 104 . However, the role of IL-17 signaling in HIV progression complicated by chronic alcohol abuse has not been evaluated.…”