Neuropsychological Consequences of HIV and Substance Abuse: A Literature Review and Implications for Treatment and Future Research

Abstract

Neuropsychological dysfunction, ranging from mild cognitive symptoms to dementia has been a consistent part of the clinical picture of HIV/AIDS. However, advances in clinical management, particularly antiretroviral (ARV) treatment, have mitigated the neuropsychological effects of HIV and revised the pattern and nature of cognitive deficits, which are observed in HIV-infected individuals. The attendant improvements in mortality and morbidity have led to a need for programs and interventions that sustain healthy behavior and prevent a resurgence of HIV transmission risk. Psychiatric risk factors, particularly substance use, which often contribute to initial acquisition of HIV, still require attention. These risk factors may also exacerbate neuropsychological dysfunction and compromise adherence to prevention recommendations and treatment. Specifically, a more complete understanding of the effects of substance abuse on the progression of HIV related cognitive decline can inform evaluation and management of HIV seropositives with concurrent substance use disorders. This review provides an overview of the neuropsychology of HIV and substance abuse and the extant research that has examined the effects of both HIV disease and substance use on neuropsychological functioning and implications for treatment and future research.

Baseline Clinical Characteristics, Antiretroviral Therapy Use, and Viral Load Suppression Among HIV-Positive Young Men of Color Who Have Sex with Men

“…20 A clear negative effect of alcohol use on adherence has been previously reported. [21][22][23][24] A recent meta-analysis found that those who used alcohol were 50-60% as likely to be adherent compared to those who abstained. 24 These results suggest that more interventions that target adolescents' alcohol use in the context of ART are warranted.…”

Neuropsychiatric and Socioeconomic Status Impact Antiretroviral Adherence and Mortality in Rural Zambia

“…13,14 In a 2006 meta-analysis, poor adherence was found to be related to the cost of accessing medication, a lack of disclosure to one's spouse, alcohol use/misuse, and the complexity of the treatment regimen. 15 The presence of HIV-associated cognitive impairment might impact a person's capacity for good ART adherence, 16,17 but this has not been studied prospectively. Co-morbid psychiatric disorders, particularly if untreated, might adversely impact a person's capacity for adherence.…”

“…Co-morbid psychiatric disorders, particularly if untreated, might adversely impact a person's capacity for adherence. 17 The United States studies of mood disorders and ARV adherence generally focus on HIV+ populations with co-morbid drug abuse problems and in Africa most studies of the impact of psychiatric symptoms on adherence have been qualitative in nature. A quantitative study in Kwa-Zulu Natal did find that depression is associated with poorer ART adherence.…”

An Exploratory Factor Analysis of a Brief Self-Report Scale to Detect Neurocognitive Impairment Among Participants Enrolled in Methadone Maintenance Therapy

“…For example, individuals with opioid use disorders (OUDs) have documented deficits in executive function, attention, working memory, and episodic memory (Anand, Springer, Copenhaver, & Altice, 2010; Baldacchino, Balfour, Passetti, Humphris, & Matthews, 2012; Rapeli et al, 2006; Schiltenwolf et al, 2014; Verdejo-García, López-Torrecillas, Giménez, & Pérez-García, 2004). Cocaine and methamphetamine use is also correlated with lasting changes in brain structure and neurological functions, resulting in impaired executive function, memory, attention, new learning, information-processing speed, and visual-spatial perception (Anand et al, 2010; Nordahl, Salo, & Leamon, 2003; Norman, Basso, Kumar, & Malow, 2009; Shrestha, Huedo-Medina, & Copenhaver, 2015; Spronk, van Wel, Ramaekers, & Verkes, 2013; Vonmoos et al, 2014). Likewise, lifetime alcohol dependence has been found to impair attention, memory, and learning (Anand et al, 2010; Sabine Loeber et al, 2009; Solfrizzi et al, 2007; Stampfer, Kang, Chen, Cherry, & Grodstein, 2005).…”