Contributors to neuropsychological impairment in HIV-infected and HIV-uninfected opiate-dependent patients

Abstract

Neuropsychological (NP) impairment is multiply determined among HIV-infected and HIV-uninfected individuals who are also dually diagnosed with depression and who use illicit substances. The purpose of the present study was to assess the impact of HIV status, depression, and problematic substance use on NP performance. A total of 160 opiate-dependent outpatients undergoing methadone maintenance (80 HIV-infected, 80 HIV-uninfected) completed diagnostic and NP evaluations. Raw scores from individual NP tests were converted to Z scores relative to standard norms and were averaged to form a composite score. HIV-infected participants had significantly lower overall NP performance—as well as lower performance on tests of attention, motor speed, and verbal memory—than HIV-uninfected participants. In multiple regression analyses considering the role of depression and substance use, only HIV status emerged as a significant predictor of NP impairment. These findings confirm NP impairment in HIV-infected substance abusing patients independent of comorbid depression and severity of substance use.

Neurocognitive impairment and medication adherence in HIV patients with and without cocaine dependence

“…This method is commonly used as an indicator of overall neurocognitive functioning in HIV patients (Applebaum, Otto, Richardson, & Safren, 2009; Brew et al, 2007; Clifford et al, 2002; Schifitto et al, 2007). …”

Neurocognitive Impairment and HIV Risk Factors: A Reciprocal Relationship

“…Recent studies, however, have begun to disentangle the independent contribution of HIV infection itself from treatment for opioid dependence. Among HIV-infected and uninfected subjects prescribed methadone, HIV infection, but not addiction severity or comorbid depression, predicted neuropsychological impairment, though the prevalence of mild depressive symptoms and active drug use was extremely high in the sample [10]. …”

Substance abuse, hepatitis C, and aging in HIV: common cofactors that contribute to neurobehavioral disturbances

“…44-46 HIV+ opioid users have also evidenced specific neurocognitive deficits, most reliably noted in the domains of attention, information processing, problem solving, working memory, and psychomotor speed. 47-49 These deficits appear to persist even among HIV+ individuals who are asymptomatic 50-52 and among those in methadone maintenance therapy. 53,54 Margolin et al 55 carefully controlled for numerous potential confounds (sociodemographics, medical and psychiatric illnesses), and still found evidence to suggest that long- and short-term heroin and other drug use variables (eg, severity of drug use problems, current methadone use, positive urine toxicology) accounted for variance in neuropsychiatric impairment.…”