HIV-Related Neurocognitive Disorders and Drugs of Abuse: Mired in Confound, Surrounded by Risk

Abstract

It has long been known that human immunodeficiency virus (HIV) uses the central nervous system (CNS) as a reservoir and nursery to replicate; therein, it does damage to cells and creates an inflammation that in turn allows for more virus to pass the blood-brain barrier. The inflammatory process itself can cause considerable damage. Neurocognitive disturbance from HIV infection is also known to occur at any stage of the infection. Likewise, common drugs of abuse also have adverse neurocognitive effects on their own. This review examines the literature available to try to elucidate the mechanisms of neurocognitive disorders in the HIV-infected individuals who have used drugs of abuse. Although the incidence of HIV-associated dementia (HAD) has decreased with the advent of highly active anti-retroviral therapy, less severe forms of neurocognitive impairment persist, even with supported immune systems and undetectable viral loads. Considerations for prevention are discussed.

Lifetime Marijuana and Alcohol use, and Cognitive Dysfunction in People with Human Immunodeficiency virus Infection

“…It is well documented that marijuana causes deficits in recall. 14,39,42,43 We hypothesized that current and lifetime marijuana use would be significantly associated with the MoCA memory score since this section of the measure directly tests recall by requiring participants to repeat a list of words directly after hearing them and again five minutes later. No significant association was found.…”

“…A strength of this study was that we thoroughly evaluated many variables known to influence cognition and added them into the analyses as covariates to adjust for potential confounders. 1,5,42,48,49 Also, the main independent and dependent variables were assessed using validated instruments, which is another strength of this study. Specifically, self-report cognitive dysfunction measured by the MOS-HIV CF4 has been validated against the Reitan Trail Making Test.…”

Circulatory Astrocyte and Neuronal EVs as Potential Biomarkers of Neurological Dysfunction in HIV-Infected Subjects and Alcohol/Tobacco Users

“…HIV-associated neurocognitive disorders (HAND) affect almost 30%-60% of infected individuals, and they comprise clinical symptomatology ranging from asymptomatic to minor cognitive motor disorders [10,11], which are mainly prevalent in subjects who are not virally suppressed with ART [10,12]. These complications are further exacerbated in the presence of substance abuse [13,14]. Substance abuse, particularly alcohol consumption and tobacco smoking, is known to exacerbate HIV replication and its associated complications [15][16][17][18][19][20].…”

Neurocognitive decline as a major predictor of nonadherence to antiretroviral therapy among adults living with HIV in Dodoma region, central Tanzania

“… 9 , 10 , 11 , 12 From the onset of HIV infection, central nervous system (CNS) acts as a reservoir where the HIV is accommodated and induces a cascade of inflammatory reactions leading to HIV encephalitis that could be responsible for cognitive impairment even among those with undetectable viral load and good immune markers. 9 , 10 , 11 , 12 , 13 , 14 Compared to cognitively intact adults, HIV patients with cognitive deficits have significantly higher risks for poor adherence to ARTs. 15 , 16 , 17 Psychiatric disorders, including depression and bipolar disorders, may also negatively impact adherence to ART and retention in HIV care.…”