Exploring Substance Use and HIV Treatment Factors Associated with Neurocognitive Impairment among People Living with HIV/AIDS

Abstract

Neurocognitive (NC) impairment remains prevalent among people living with HIV (PLWH) and may be exacerbated by alcohol and drug use. This cross-sectional study assesses the degree to which alcohol and other drug use, time from HIV diagnosis to treatment, and years living with HIV affect three areas of NC functioning among HIV-seropositive adults. NC functioning in 370 PLWH living in Miami, FL was assessed using the Auditory Verbal Learning Test, the Short Category Test, Booklet Format, and the Color Trails Test 2 (CTT2). Participants reported the number of days using alcohol, marijuana, and cocaine over the previous 3 months, the number of known years living with HIV and length of time from HIV diagnosis to seeking care. Bivariate linear regression and multivariate linear regression were used to test associations between independent and dependent variables. Mean scores on NC measures were significantly lower than published norms; 39% of participants scored ≥1 standard deviation below normative sample means on >2 NC tests. No significant associations were found between alcohol or cocaine use and any NC measure. Years living with HIV was associated with CTT2 in the bivariate analysis (β = 1.031; p = 0.007). In multivariate analysis, each day of marijuana use and years living with HIV were associated with a 0.32 (p = 0.05) point and 1.18 (p = 0.03) points poorer performance score on the CTT2, respectively. Results suggest that both marijuana use and duration of HIV infection may affect cognitive functioning among PLWH in ways that may impair their ability to follow important treatment guidance.

Correlates of willingness to initiate pre-exposure prophylaxis and anticipation of practicing safer drug- and sex-related behaviors among high-risk drug users on methadone treatment

“…In prior studies (Anderson et al, 2015; Attonito et al, 2014; Becker et al, 2011), cognitive deficits have been associated with risky behaviors, poor medication adherence, and treatment disengagement (Anand et al, 2010; Shrestha et al, 2015; Verdejo-Garcia and Perez-Garcia, 2007; Vo et al, 2014). Given the relationship between NCI and higher HIV risk behaviors, this is an important group of PWUD who might benefit from PrEP.…”

Treatment Engagement Moderates the Effect of Neurocognitive Impairment on Antiretroviral Therapy Adherence in HIV-Infected Drug Users in Treatment

“…Prior evidence has demonstrated that HIV-infected PWUDs display a wide range of cognitive deficits including problems with executive function, attention, memory, new learning, information-processing speed, and visual-spatial perception, that have significant impact on HIV risk behaviors and risk-reduction intervention outcomes. Furthermore, the presence of cognitive impairment may be associated with the disease process (AIDS-related dementia), drug use history, or relatively poor lifestyle (Anand, Springer, Copenhaver, & Altice, 2010; Anderson, Higgins, Ownby, & Waldrop-Valverde, 2015; Attonito, Devieux, Lerner, Hospital, & Rosenberg, 2014; Becker, Thames, Woo, Castellon, & Hinkin, 2011; Byrd et al, 2011; Ezeabogu, Copenhaver, & Potrepka, 2012; Heaton et al, 2011; Meade, Conn, Skalski, & Safren, 2011; Schouten, Cinque, Gisslen, Reiss, & Portegies, 2011; Shrestha, Weikum, Copenhaver, & Altice, 2016; Thaler, Sayegh, Kim, Castellon, & Hinkin, 2015; Woods, Moore, Weber, & Grant, 2009; Zhou &Saksena, 2013) and may be disruptive to participation in treatment services, including HIV prevention, treatment engagement, and medication adherence, which must be accounted for during behavioral intervention development and adaptation (Bates, Pawlak, Tonigan, & Buckman, 2006; Fishbein et al, 2007; Huedo-Medina, Shrestha, &Copenhaver, 2016; Shrestha & Copenhaver, 2016; Shrestha, Huedo-Medina, & Copenhaver, 2015; Verdejo-Garcia & Perez-Garcia, 2007; Vo, Schacht, Mintzer, & Fishman, 2014). …”

Obesity, Cytokines and Cognition across the Lifespan among People Living with HIV

“…Our data confirms that central obesity is associated with impaired verbal and auditory working memory, and reduced capacity for decision-making. These cognitive functions are associated with the higher-order thinking required to conduct safer sex practices and health management behaviors, such as ART adherence [29]. There are now many associations that may link increased obesity to changes in cognitive performance; however the mechanisms remain highly speculative.…”