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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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