The nature and consequences of cognitive deficits among tobacco smokers with HIV: a comparison to tobacco smokers without HIV

Abstract

HIV-infected smokers lose more years of life to tobacco-related disease than HIV. Since neurocognitive deficits are common among those with HIV and are associated with smoking persistence, these deficits may be a unique barrier to smoking cessation among HIV-infected smokers. Documenting unique differences in and correlates of cognition among HIV-infected smokers is a critical step towards developing a population-specific tobacco cessation treatment. We compared neurocognitive function between HIV-infected (n=103) and HIV-uninfected smokers (n=70), accounting for demographic and smoking-related variables. We also evaluated whether HIV-related health outcomes (e.g., CD4 count, viral load, depression ratings, quality of life [QoL]) and HAART adherence were associated with cognition. Participants completed neurocognitive tasks (N-back and Continuous Performance Task [CPT]) measuring working memory, attention, and processing speed, and intra-individual variability. Stepwise regression models were conducted and validated with resampling techniques. HIV-infected smokers performed worse than HIV-uninfected smokers on working memory, processing speed, and intra-individual variability (all p<0.01). ROC analysis for the model including cognitive measures demonstrated 85% area under the curve, which indicates “good prediction” for distinguishing between HIV-infected and HIV-uninfected smokers. This was a significant improvement over the model including demographic and smoking-related variables only (p=0.0003). Among HIV-infected smokers, neurocognitive performance was negatively associated with QoL and depression ratings. Smoking cessation interventions for HIV-infected smokers should consider cognitive neurorehabilitation as a potential strategy to decrease the likelihood of nicotine relapse and decrease tobacco-related morbidity in this population.

Cigarette smoke and nicotine effects on brain proinflammatory responses and behavioral and motor function in HIV-1 transgenic rats

“…These effects could potentially result in nicotine inducing an overall enhancement of inflammatory responses, which could exacerbate the nervous system damage that can occur in HIV-infected individuals. Such effects would be consistent with studies that show that smoking has deleterious effects on cognitive functioning among HIV-infected individuals (Chang et al 2017; Harrison et al 2017; Wojna et al 2007), although the specificity of such effects has been questioned (Bryant et al 2013). …”

“…Recent studies suggest that measures of attention, learning, and memory in HIV-infected individuals get even worse with cigarette smoking (Harrison et al 2017). Cigarette smoke exposure has been linked to an increased risk of other neurological disorders, such as stroke, Alzheimer’s disease, and multiple sclerosis (Ascherio and Munger 2007; Cataldo et al 2010; Shah and Cole 2010).…”

“…HIV-infected smokers also have a higher mortality than infected nonsmokers and HIV-negative individuals (Helleberg et al 2013), suggesting likely direct effects from smoking and interactions between smoking and HIV-1 infection on mortality. Also, although data may be conflicting as to whether cigarette smoking can increase progression to AIDS (Galai et al 1997; Nieman et al 1993), smoking has been associated with an increased HIV plasma viral load (Wojna et al 2007), and an increased risk of developing neurocognitive impairment (Harrison et al 2017; Wojna et al 2007). Approximately 40% of HIV-positive individuals are cigarette smokers (Lifson and Lando 2012), which is more than twice the prevalence of smoking among adults in the general population (Jamal et al 2016).…”

The association of memory disorders and chronic HIV disease in the antiretroviral therapy era: a systematic literature review

“…In the present review, it did emerge that low current CD4 count is a risk factor for the development of memory disorders , and this variable will play a relatively independent role from that played by other factors such as stage of HIV disease and viral load or dysplipidaemia . However, different results have been reported in other studies and, while the heterogeneity reported in the literature might be attributed to methodological and sample selection differences across studies, it seems important to underline that the effect of current CD4 count on memory function should be systematically analysed in connection with the role of chronic inflammation, as originally suggested by McArthur et al . .…”

“…Other authors have reported contrasting results, such as Harrison et al . , who found that higher current CD4 count was correlated with lower working memory performance and suggested that some ART drugs (e.g. efavirenz), while having a beneficial effect on immunological response, may lead to adverse effects on neurocognition .…”