Publication Abstract Display
Type: Published Abstract
Title: Abuse of methamphetamine and cocaine may enhance HIV associated neurotoxicity.
Authors: Grant I, Heaton RK, Dawson LK, Marcotte TD
Year: 1999
Publication: The International Journal of Neuropsychopharmacology
Volume: 2 Issue: S1 Pages: S172
Abstract:Objectives: Neurocognitive complications occur commonly in HIV disease and range of asymptomatic neuropsychological impairment to frank dementia. Overall, in a series of 637 HIV seropositive individuals, we noted that 43% had some form of NP impairment compared to 17% of seronegative but sociode-morgraphically similar controls. Because risk of HIV infection increasingly is associated with drug abuse, and since previous research has indicated heightened rates of NP impairment in drug abusers, we questioned whether these two factors may combine to enhance HIV associated neurotoxicity. Methods: Thirty central stimulant dependent individuals (meeting dependence criteria for methamphetamine, cocaine, or both) were examined with comprehensive neuropsychological testing. Of these, 17 were seropositive stimulant-dependent (HIV+STIM+) and 13 were HIV-/STIM+. From previous work we had 254 HIV+/STIM- and 71 HIV-/STIM- comparison subjects. Results: The overall rate of neuropsychological impairment increased from 13% in HIV-/STIM- to 39% in HIV+/STIM- and compared with 62% in HIV-/STIM+ and 71% in HIV+/STIM+. The neurocognitive abilities most likely to be impaired in STIM+ individuals included learning of new information, motor speed and coordination, and sensory deficits of various sorts. Comparisons of those with AIDS and those with asymptomatic HIV infection suggested that most of the increase in NP impairment in STIM+ individuals occurred in later stages of disease (54% of STIM- AIDS were impaired compared to 90% of STIM+ AIDS). The presence of stimulants in urine was also associated with heightened rate of impairment. When those positive for drugs in the urine were excluded from analyses, the rates of impairment were: HIV-/STIM+ 38%, and HIV+/STIM+ 71%. Conclusions: Dependence on cocaine or methamphetamine may enhance HIV associated neurotoxicity. This may be evident particularly in later stages of HIV disease. This enhanced neurotoxicity may be mediated by vascular changes that enhance migration of HIV into the CNS and/or activation of excitotoxic pathways that may be one common mechanism underlying HIV and stimulant damage to the brain.

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