Everyday functional ability in HIV and methamphetamine dependence

Abstract

Background Methamphetamine (METH) use is a risk factor for the transmission of HIV. Each is associated with neurocognitive impairment and subsequent problems in everyday functioning, yet additive effects of HIV and METH are not consistently observed. This study used the UCSD Performance-Based Skills Assessment (UPSA-2) to assess whether METH use disorder and HIV together resulted in poorer functional outcome than either condition alone. Method Participants in the Translational Methamphetamine AIDS Research Center (TMARC) cohort were stratified based upon HIV infection and METH use disorder: HIV−/METH− (n=49), HIV−/METH+ (n=48), HIV+/METH− (n= 37), and HIV+/METH+ (n=38). They were administered the UPSA-2 which measures abilities in six domains of everyday functioning. Main effects and interactions of HIV and METH were examined, as were relationships between UPSA-2 scores and disease characteristics. Results Significant HIV-by-METH interactions were observed for the UPSA-2 total score and Comprehension/Planning and Financial subscales such that METH was associated with lower scores in HIV- participants but not HIV+ participants. METH was associated with lower scores on the Communications subscale. All three risk groups had lower scores than HIV−/METH−participants. Recency and frequency of METH use were associated with lower scores. Lower Medication Management scores were related to lower nadir CD4 counts. Conclusions METH use disorder and HIV each impair functional performance, but there is no additive effect when the two conditions occur together. The neurocognitive sequelae of combined HIV infection and METH use are complex and warrant further study, as do the potential effects of compensatory strategies and other factors.

Apathy is associated with poorer abstinence self-efficacy in individuals with methamphetamine dependence

“…This relationship may be further compounded by increased apathy, which is also independently associated with executive function deficits and learning difficulties ( Castellon et al, 2000 , Cole, 2007 ). Combined with evidence linking NCI with a variety of other adverse health and functional outcomes in METH users, which may further interfere with treatment outcomes ( Aharonovich et al, 2003 , Henry et al, 2010 , Minassian, 2017 , Sadek, 2007 , Weber, 2012 ), individuals should be screened for NCI prior to treatment to appropriately tailor intervention strategies to their cognitive strengths and/or weaknesses.…”

Both HIV and Tat expression decrease prepulse inhibition with further impairment by methamphetamine

“…For example, clinical studies found that HIV and a history of METH dependence additively impaired cognitive function (Kesby et al, 2015;Rippeth et al, 2004). However, other clinical studies found that HIV and METH dependence did not additively impair everyday functional skills (Minassian et al, 2017) or impulsivity, disinhibition, or sensation-seeking (Marquine et al, 2014). Therefore, combined HIV and METH dependence likely has varying effects on CNS processes depending on the function examined.…”

Synergistic Impairment of the Neurovascular Unit by HIV-1 Infection and Methamphetamine Use: Implications for HIV-1-Associated Neurocognitive Disorders

“…Neurocognitive deficits are thought to substantially impact the ability to engage in the vital tasks of daily living. Although comorbid HIV-1 infection and METH dependence have been associated with worsening cognitive performance, additive effects of HIV-1 and METH were not observed for everyday functioning [ 139 ]. Results from two recent human studies demonstrated that individuals with comorbid HIV-1 and METH use disorder exhibited the highest rates of frailty (state of increased vulnerability to multisystem damage) and significantly poorer sleep quality compared to singly affected (HIV-/METH+ and HIV+/METH-) groups [ 140 , 141 ].…”