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Publication Abstract Display
Type: Published Abstract
Title: The temporal association of methamphetamine use, HIV status, and affective distress.
Authors: Montoya JL, Moore DJ, Umlauf A, Abramson I, Duarte N, Badiee J, Woods SP, Atkinson JH, Grant I, and the HNRP Group
Year: 2012
Publication: 120th Annual Convention of the American Psychological Association (Division 1), Orlando, FL
Volume: Issue: Pages:
Abstract:Statement of Problem Abuse of methamphetamine (MA) is highly prevalent among HIV-infected individuals. Additionally, depressive symptoms are hypothesized to be elevated in both MA dependent and HIV-infected individuals as compared to the general population. The extent to which disruptions in mood persist following periods of MA abstinence is unknown as previous investigations have either only examined the short-term consequences of MA on mood disruption or have investigated mood-related variables in the context of substance abuse treatment. The aim of this current study is to employ a longitudinal design to examine occurrence and correlated predictors of mood disruption among HIV-infected and non-infected individuals with and without lifetime (LT) MA use. Method Participants Participants included 274 English-speaking individuals enrolled in a longitudinal NIDA-funded program project at the University of California, San Diego studying the individual and combined neurobehavioral effects of MA and HIV. Participants were recruited from the San Diego community and substance abuse treatment programs. After providing written, informed consent, each participant underwent an extensive substance use interview and a medical and psychiatric evaluation at both a baseline visit (visit 1) and subsequent annual re-assessments. Participants in this study returned for their first follow-up visit (visit 2) after an average of 406.9 days (SD = 158.0, range 150 to 1298). Exclusion criteria were diagnoses of alcohol use disorders within 1 year, other substance dependence within 5 years (except marijuana), and major neurological (e.g., seizure disorders, stroke) or psychiatric (e.g., schizophrenia, bipolar disorder) conditions. Participants with (HIV+) or without (HIV-) HIV infection who meet DSM-IV criteria for MA dependence (MA+) within the past 18 months based on the Structured Clinical Interview for DSM-IV (SCID) were included in the sample. MA+ individuals must have self-reported abstinence from MA for at least 10 days prior to baseline and be urine toxicology negative for MA on the day of assessment. Since past history of mood disorder may predict current mood status, lifetime occurrence of major depressive disorder (MDD) was ascertained with the SCID. HIV infection was determined by enzyme linked immunosorbent assays (ELISA) and a Western Blot confirmatory test. We identified 73 MA+/HIV+, 54 MA+/HIV-, 77 MA-/HIV+, and 70 MA-/HIV-. The MA+ sample (n =127) reported a median [IQR] of 91 [34, 183] for last MA use at visit 1 and 137 [14, 477] at visit 2. Of the HIV+ sample (n = 150), the median was 392 [231, 566] for CD4 count, 213 [73, 321] for CD4 nadir count, and 2.6 [2.6, 4.3] for log plasma HIV RNA/μl load. The proportion with AIDS was 47%, and 49% were on ARV treatment. Each participant was administered the Beck Depression Inventory (BDI) at both visits in order to assess the degree of recent mood symptoms. Higher scores on the BDI indicate greater affective distress. The mean (SD) BDI score was 10.4 (9.0) at visit 1 and 8.6 (8.2) at visit 2. Participants were, on average, middle aged (37.1 years, SD=9.3), predominantly male (80%), Caucasian (64%), and high school educated (12.7 years; SD=2.4). One hundred five (38%) had a LT diagnosis of MDD at visit 1, and 127 (47%) met criteria for MA dependence. The means (SD) for the MA substance use variables measured at visit 1 were 1540 (3104) grams for LT MA quantity, 1550 (2392) days for LT MA duration, 23.9 (7.7) years for age of first MA use. The mean days since last MA use was 831 (1902) at visit 1 and 1010 (1996) at visit 2. Data Analyses The repeated-measures data were analyzed as a mixed-effects linear model. Analyses evaluated the effect of MA use and HIV status on mood (i.e., BDI score) with two models. BDI score was treated as the primary outcome variable and was transformed by square root to achieve normality in residuals in the following analyses. The first model aimed to evaluate the effect of MA and HIV statuses on BDI scores through a simple longitudinal model with random (i.e., subject-specific) intercepts without other covariates. The second model evaluates association between MA use variables measured at visit 1 (i.e., LT MA quantity, LT MA duration, and age of first MA use) and change in BDI from visit 1 to visit 2, as measured by subject-specific random slopes from a mixed-effects model of BDI on demographic covariates and LT MDD diagnosis at visit 1. Results There were significant group differences in BDI scores at both visits; specifically, the scores of the MA-/HIV- individuals were significantly lower than the scores of the other groups (p<0.001) at both visits whereas the other groups did not significantly differ from each other at visit 1 (p>0.05), but at visit 2, the MA+/HIV+ had significantly higher BDI scores than the MA+/HIV- group. Model 1 indicated that MA status, HIV status, and the interaction of these statuses were significant predictors of BDI scores (p<0.05). MA and HIV statuses interact in predicting BDI scores such that MA+/HIV+ individuals had the highest BDI scores followed in descending order by MA-/HIV+, MA+/HIV-, and MA-/HIV- individuals. For model 2 several demographic variables and LT MDD diagnosis were significant predictors of mean BDI scores (p<0.05) such that those with LT MDD, older age, lower education, and Hispanic ethnicity had higher BDI scores. After controlling for demographics, quantitative substance-use variables measured at visit 1 did not significantly correlate with subject-dependent slope coefficients in model 2 (p>0.05). Conclusion Our findings show that MA dependence, HIV status, and their interaction are significant predictors of mood disruption as measured by the BDI scores. Specifically, BDI scores were elevated for HIV+ compared to HIV- individuals regardless of MA status, and MA+/HIV+ individuals had the highest BDI scores. The extent of change in BDI scores was found to be unrelated to specific quantitative MA use characteristics, possibly suggesting that MA use may have an indirect influence on mood that is not captured by the specific quantitative MA variables included in our analyses. Future analyses should address the relationship of relapse between visits and changes in BDI as well as the effects of other comorbidities (e.g., Attention Deficit Hyperactivity Disorder, Hepatitis C Virus). This evidence suggests that there may be disruption of mood among HIV+ MA users and that treatment of mood-related problems may be required during abstinence and recovery.

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