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Substance use is a risk factor for neurocognitive deficits and neuropsychiatric distress in acute and early HIV infection

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Abstract

The acute and early stages of HIV infection (AEH) are characterized by substantial viral replication, immune activation, and alterations in brain metabolism. However, little is known about the prevalence and predictors of neurocognitive deficits and neuropsychiatric disturbances during this period. The present study examined the impact of demographic, HIV disease, and substance use factors on HIV-associated neurocognitive impairment and self-reported neuropsychiatric distress among 46 antiretroviral-naive adults with median duration of infection of 75 days relative to a sample of 21 HIV seronegative (HIV−) adults with comparable demographics and risk factors. Participants were administered a brief neurocognitive battery that was adjusted for demographics and assessed executive functions, memory, psychomotor speed, and verbal fluency, as well as the Profile of Mood States, a self-report measure of neuropsychiatric distress. Odds ratios revealed that AEH participants were nearly four times more likely than their seronegative counterparts to experience neurocognitive impairment, particularly in the areas of learning and information processing speed. Similarly, AEH was associated with a nearly fivefold increase in the odds of neuropsychiatric distress, most notably in anxiety and depression. Within the AEH sample, HIV-associated neurocognitive impairment was associated with problematic methamphetamine use and higher plasma HIV RNA levels, whereas neuropsychiatric distress was solely associated with high-risk alcohol use. Extending prior neuroimaging findings, the results from this study indicate that HIV-associated neurocognitive impairment and neuropsychiatric distress are highly prevalent during AEH and are associated with high-risk substance use.

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Acknowledgments

The Translational Methamphetamine AIDS Research Center (TMARC) group is affiliated with the University of California, San Diego (UCSD), and the Sanford-Burnham Medical Research Institute. The TMARC comprised Director: Igor Grant, MD; Co-Directors: Ronald J. Ellis, MD, PhD, Cristian Achim, MD, PhD, and Scott Letendre, MD; Center Manager: Steven Paul Woods, PsyD; Aaron Carr (Assistant Center Manager); Clinical Assessment and Laboratory Core: Scott Letendre, MD (P.I.), Ronald J. Ellis, MD, PhD, Rachel Schrier, PhD; Neuropsychiatric Core: Robert K. Heaton, PhD (P.I.), J. Hampton Atkinson, MD, Mariana Cherner, PhD, Thomas Marcotte, PhD; Neuroimaging Core: Gregory Brown, PhD (P.I.), Terry Jernigan, PhD, Anders Dale, PhD, Thomas Liu, PhD, Miriam Scadeng, PhD, Christine Fennema-Notestine, PhD, Sarah L. Archibald, MA; Neurosciences and Animal Models Core: Cristian Achim, MD, PhD, Eliezer Masliah, MD, Stuart Lipton, MD, PhD; Participant Unit: J. Hampton Atkinson, MD, Rodney von Jaeger, MPH (Unit Manager); Data Management and Information Systems Unit: Anthony C. Gamst, PhD, Clint Cushman (Unit Manager); Statistics Unit: Ian Abramson, PhD (P.I.), Florin Vaida, PhD, Reena Deutsch, PhD, Anya Umlauf, MS; Project 1: Arpi Minassian, PhD (P.I.), William Perry, PhD, Mark Geyer, PhD, Brook Henry, PhD; Project 2: Amanda B. Grethe, PhD (P.I.), Martin Paulus, MD, Ronald J. Ellis, MD, PhD; Project 3: Sheldon Morris, MD, MPH (P.I.), David M. Smith, MD, MAS, Igor Grant, MD; Project 4: Svetlana Semenova, PhD (P.I.), Athina Markou, PhD; Project 5: Marcus Kaul, PhD (P.I.). This research was supported by National Institutes of Health grants P01-DA12065, P50-DA026306, P30-MH62512, T32-DA31098, DA-034510, DA-032120, DA-034362, AI-090970, AI-100665, AI-080353, MH-097520, DA-034978, MH-83552, MH-62512, AI-74621, AI-36214, TW-008908, AI-69432, AI-096113, and AI-47745. This work was additionally supported by the Department of Veterans Affairs and grants awarded from the International AIDS Vaccine Initiative (IAVI), the National Science Foundation DMS0714991, and the James B. Pendleton Charitable Trust. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government.

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Authors and Affiliations

  1. Joint Doctoral Program in Clinical Psychology, San Diego State University and University of California, San Diego, CA, USA

    Erica Weber & Kaitlin Blackstone

  2. Department of Psychiatry, University of California, 220 Dickinson St., Suite B, San Diego, CA, 92103, USA

    Erica Weber, Erin E. Morgan, Jennifer E. Iudicello, Kaitlin Blackstone, Igor Grant, David J. Moore & Steven Paul Woods

  3. Department of Neurosciences, University of California, San Diego, CA, USA

    Ronald J. Ellis

  4. Department of Medicine, University of California, San Diego, CA, USA

    Scott L. Letendre, Susan Little, Sheldon Morris & Davey M. Smith

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  1. Erica Weber
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  2. Erin E. Morgan
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Weber, E., Morgan, E.E., Iudicello, J.E. et al. Substance use is a risk factor for neurocognitive deficits and neuropsychiatric distress in acute and early HIV infection. J. Neurovirol. 19, 65–74 (2013). https://doi.org/10.1007/s13365-012-0141-y

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