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Publication Abstract Display
Type: Poster
Title: Frontal systems behaviors in comorbid HIV infection and methamphetamine dependence.
Authors: Marquine M, Iudicello J, Morgan EE, Brown G, Letendre S, Ellis R, Deutsch R, Woods SP, Grant I, Heaton RK, the TMARC Group
Date: 07-31-2013
Abstract:Frontal Systems Behaviors in HIV Infection and Methamphetamine Dependence Background: Neurocognitive and neuroimaging studies show that HIV infection and methamphetamine (MA) dependency are associated with neural injury preferentially involving frontostriatal circuits. Less is known, however, about how these commonly comorbid conditions affect neurobehavioral symptoms in daily life that are typically associated with frontal systems dysfunction (e.g., impulsivity, apathy). Methods: One-hundred and thirty-six adults enrolled in the Translational Methamphetamine AIDS Research Center participated in the current study (age M=39.31 years, SD=11.53; education M=13.43, SD=2.21; 84.56% male; 58.82% non-Hispanic White). The sample was divided into four groups: HIV negative/MA nondependent (n= 47); HIV negative/MA dependent (n=25); HIV infected/MA nondependent (n=36); and HIV infected/MA dependent (n=28). Participants completed self-report composite, standardized questionnaires of frontal systems behaviors, including impulsivity/disinhibition, sensation-seeking, and apathy. They also underwent comprehensive neuropsychiatric assessments that allowed for detailed characterization of premorbid/comorbid conditions, including lifetime Mood and Substance Disorders, Attention-Deficit/Hyperactivity Disorder (ADHD), and Antisocial Personality Disorder (ASPD). A comprehensive neurocognitive battery covering seven domains (i.e., speed of information processing, verbal fluency, learning, delayed recall, executive functions, attention/working memory and motor skills) relevant to neuroAIDS and MA was also administered. Results: Kruskal-Wallis and Chi-Square tests showed all risk groups had significantly higher rates of lifetime Mood Disorders than controls, and both of the MA dependent groups had higher rates of lifetime use of other substances, ASPD, and ADHD (ps<.05). A series of multivariable regression models adjusting for potentially confounding factors (i.e. demographics, comorbid psychiatric and substance use disorders, and neurocognitive deficits) identified an independent and significant association between HIV infection, MA dependence, and their combination to frontal systems behaviors. Specifically, MA dependence was associated with increased impulsivity/disinhibition, sensation-seeking and apathy; while HIV infection was associated with increased apathy (ps<.01). There was also a significant HIV X MA interaction on impulsivity/disinhibition (p = .03) and apathy (p<.01). Characterization of these interactions using Tukey Honestly Significant Difference tests indicated higher impulsivity in both MA groups than controls and a (nonsignificant) tendency for the MA only group to show higher impulsivity than the dual risk group. For apathy, the two risk groups with one risk factor had higher apathy than controls, but the dually affected group did not differ significantly. Interestingly, frontal systems behaviors were not significantly associated with global neurocognitive function in our overall sample (ps>.11). Conclusions: Overall, our findings suggest that HIV infection and MA dependence are associated with behavioral presentations typically associated with frontal systems compromise, and that these relationships cannot be explained by the higher rates of comorbid conditions in the risk groups. Specifically, MA history is associated with greater impulsivity/disinhibition, sensation seeking, and apathy, and HIV with greater apathy, but the effect on apathy is reduced when both conditions co-occur. Further, the relative independence of frontal systems behaviors and neurocognitive deficits in our sample is consistent with the view that they may have separable biopsychosocial underpinnings. Future studies should determine the independent (or synergistic) contribution of frontal systems behaviors and neurocognitive deficits to everyday functioning outcomes relevant to HIV and MA, such as HIV transmission risk and medication adherence.

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