Neurocognitive impairment and medication adherence in HIV patients with and without cocaine dependence

Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Box 90519, Durham, NC 27708, USA.
Journal of Behavioral Medicine (Impact Factor: 3.1). 04/2011; 34(2):128-38. DOI: 10.1007/s10865-010-9293-5
Source: PubMed


Cocaine abuse among HIV patients is associated with faster disease progression and mortality. This study examined the relationship between neurocognitive functioning and medication adherence in HIV patients with (n = 25) and without (n = 39) current cocaine dependence. Active users had greater neurocognitive impairment (mean T-score = 35.16 vs. 40.97, p < .05) and worse medication adherence (mean z-score = -0.44 vs. 0.27, p < .001). In a multiple regression model, neurocognitive functioning (β = .33, p < .01) and cocaine dependence (β = -.36, p < .01) were predictive of poorer adherence. There was a significant indirect effect of cocaine dependence on medication adherence through neurocognitive impairment (estimate = -0.15, p < .05), suggesting that neurocognitive impairment partially mediated the relationship between cocaine dependence and poorer adherence. These results confirm that cocaine users are at high risk for poor HIV outcomes and underscore the importance of treating both neurocognitive impairment and cocaine dependence among HIV patients.

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Available from: Christina S Meade
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    • "Cocaine can also induce monocyte transendothelial migration, expression of endothelial adhesion molecules, and disruption of intercellular junctions in the blood brain barrier (BBB) in vitro (Fiala et al., 2005). HIV patients with cocaine dependence reported to have a greater neurocognitive impairment and poorer HAART adherence compared to nondrug users (Meade et al., 2011). Dendritic varicosity formation was enhanced in primary hippocampus neurons in the presence of HIV-1 envelope glycoprotein gp120 and cocaine (Yao et al., 2009). "

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    • "Cocaine use in HIV-infected individuals is associated with higher morbidity and mortality (Baum et al. 2009; Cook et al. 2008) and worse cognitive outcomes (Meade et al. 2011; Meyer et al. 2013) than in individuals infected with HIV who have never used cocaine. Although in vitro studies demonstrate interactive neurotoxic effects of HIV viral proteins and cocaine (Buch et al. 2011; Ferris et al. 2008), the combined effects of cocaine and HIV on cognition and brain function in humans has not been fully elucidated. "
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    ABSTRACT: Crack cocaine use is associated with impaired verbal memory in HIV-infected women more than uninfected women. To understand the neural basis for this impairment, this study examined the effects of crack cocaine use on activation of the prefrontal cortex (PFC) and strategic encoding during a verbal memory task in HIV-infected women. Three groups of HIV-infected women from the Chicago Consortium of the Women's Interagency HIV Study were compared: current users of crack cocaine (n = 10), former users of cocaine (n = 11), and women who had never used cocaine (n = 9). Participants underwent functional magnetic resonance imaging during a verbal memory task and completed a neuropsychological test of verbal memory. On the neuropsychological test, current crack users performed significantly worse than other groups on semantic clustering, a measure of strategic encoding, p < 0.05. During encoding, activation in left anterior cingulate cortex (ACC) was lower in current and former cocaine users compared to never users. During recognition, activation in bilateral PFC, specifically left dorsal medial PFC and bilateral dorsolateral PFC, was lower in current and former users compared to women who had never used cocaine. Lower activation in left dorsolateral PFC was correlated with worse performance on the recognition task, p < 0.05. The verbal learning and memory deficits associated with cocaine use in women with HIV may be partially accounted for by alterations in ACC and PFC function.
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    • "Studies examining the effects of drug abuse on HAND in the era of cART described contradictory findings, which were further complicated by the possibility that drug abusers may not have adhered rigorously to their cART regimens (Mellins et al. 2009; Binford et al. 2012; Nahvi et al. 2012; Wood et al. 2003). Some studies reported that drug abuse increased neurocognitive impairment with HIV infection (Meade et al. 2011a, b), while others indicated that it had no effect on HAND (Byrd et al. 2011; Basso and Bornstein 2003). All classes of illegal drugs increase extracellular dopamine in the CNS (Kimmel et al. 2005; Desai et al. 2010; Di Chiara and Imperato 1988; Koob 1992a; Pierce and Kumaresan 2006; Koob and Bloom 1988; Carboni et al. 1989). "
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    ABSTRACT: Central nervous system (CNS) complications resulting from HIV infection remain a major public health problem as individuals live longer due to the success of combined antiretroviral therapy (cART). As many as 70 % of HIV infected people have HIV associated neurocognitive disorders (HAND). Many HIV infected individuals abuse drugs, such as cocaine, heroin or methamphetamine, that may be important cofactors in the development of HIV CNS disease. Despite different mechanisms of action, all drugs of abuse increase extracellular dopamine in the CNS. The effects of dopamine on HIV neuropathogenesis are not well understood, and drug induced increases in CNS dopamine may be a common mechanism by which different types of drugs of abuse impact the development of HAND. Monocytes and macrophages are central to HIV infection of the CNS and to HAND. While T cells have not been shown to be a major factor in HIV-associated neuropathogenesis, studies indicate that T cells may play a larger role in the development of HAND in HIV infected drug abusers. Drug induced increases in CNS dopamine may dysregulate functions of, or increase HIV infection in, monocytes, macrophages and T cells in the brain. Thus, characterizing the effects of dopamine on these cells is important for understanding the mechanisms that mediate the development of HAND in drug abusers.
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