title: Neuropsychological Dysfunction among HIV Infected Drug Abusers.
abstract: Human immunodeficiency virus (HIV) has been documented to cause direct and indirect central nervous system dysfunction that can be observed as a progressive decline in neuropsychological functioning in a large proportion of persons with HIV and AIDS. Neuropsychological decline in individuals with HIV is characterized by cognitive and motor slowing, attentional deficits, executive dysfunction and memory impairment (characterized by intact recognition and deficits in learning and delayed recall). Dementia occurs in a relatively small proportion of HIV infected individuals, though milder NP deficits are observed in 30-50% of persons with advanced disease. Recent evidence suggests that drug users, especially stimulant users, are at risk for accelerated progression of their HIV disease, including a greater risk of neuropsychological dysfunction. Methamphetamine may potentiate HIV Tat protein mediated neurotoxicity giving rise to striatal proinflammatory cytokine stimulation and activation of redox-regulated transcription factors. Oxidative stress due to mitochondrial dysfunction is another candidate process underlying the synergistic effects of stimulant use and HIV. Damage to neurotransmitter systems including the dopaminergic, serotonergic and glutamatergic systems which are affected by both stimulant use and HIV is an alternate explanation. Methamphetamine has also been shown to impede the effectiveness of HAART, which could then in turn allow for more rapid HIV disease progression. A greater prevalence of psychiatric disorders, particularly mood, anxiety and substance use disorders are also observed in HIV positive samples relative to the general population. The changing nature of the HIV pandemic is an ongoing challenge to investigators and clinicians working in this field. Emerging issues requiring additional attention are study of the interactive effects of normal aging and HIV on neurocognition as well as study of the effects of co-infection with Hepatitis C.
authors.affiliation: California State University, Los Angeles.
authors.forename: Ramani S
authors.initials: RS
authors.lastname: Durvasula
authors.forename: Charles H
authors.initials: CH
authors.lastname: Hinkin
references.citation: AIDS. 2000 Sep;14 Suppl 2:S8-17
references.pmid: 11061637
references.citation: Neurology. 1990 Feb;40(2):197-203
references.pmid: 2405289
references.citation: AIDS. 2004 Jan 1;18 Suppl 1:S19-25
references.pmid: 15075494
references.citation: J Neurovirol. 2003 Apr;9(2):205-21
references.pmid: 12707851
references.citation: Soc Psychiatry Psychiatr Epidemiol. 1989 Jan;24(1):12-6
references.pmid: 2496472
references.citation: J Infect Dis. 2003 Dec 15;188(12):1820-6
references.pmid: 14673760
references.citation: Neurology. 2002 Dec 24;59(12):1944-50
references.pmid: 12499488
references.citation: Am J Psychiatry. 1993 Feb;150(2):309-15
references.pmid: 8422083
references.citation: J Neuroimmunol. 2004 Feb;147(1-2):6-8
references.pmid: 14741417
references.citation: Neuropsychology. 1999 Apr;13(2):306-16
references.pmid: 10353380
references.citation: J Clin Exp Neuropsychol. 2003 Oct;25(7):893-903
references.pmid: 13680438
references.citation: Clin Infect Dis. 2005 Jul 1;41 Suppl 1:S38-44
references.pmid: 16265612
references.citation: Neurology. 2005 Apr 26;64(8):1343-7
references.pmid: 15851720
references.citation: Am J Epidemiol. 1992 Dec 1;136(11):1338-48
references.pmid: 1362630
references.citation: J Neurosci. 2001 Dec 1;21(23):9414-8
references.pmid: 11717374
references.citation: Neurology. 2001 Jan 23;56(2):257-60
references.pmid: 11160967
references.citation: J Int Neuropsychol Soc. 2000 Mar;6(3):336-47
references.pmid: 10824505
references.citation: J Subst Abuse Treat. 2003 Jun;24(4):323-30
references.pmid: 12867206
references.citation: J Neuropsychiatry Clin Neurosci. 1998 Summer;10(3):320-9
references.pmid: 9706540
references.citation: Neurology. 1993 Oct;43(10):2099-104
references.pmid: 8413973
references.citation: Am J Psychiatry. 1994 Jul;151(7):1055-62
references.pmid: 8010364
references.citation: Exp Neurol. 2003 Jan;179(1):60-70
references.pmid: 12504868
references.citation: J Clin Exp Neuropsychol. 1989 Oct;11(5):763-73
references.pmid: 2808663
references.citation: Am J Psychiatry. 1995 Apr;152(4):551-4
references.pmid: 7694903
references.citation: J Int Neuropsychol Soc. 1995 Nov;1(6):575-80
references.pmid: 9375245
references.citation: Am J Psychiatry. 2004 Feb;161(2):249-54
references.pmid: 14754773
references.citation: AIDS. 2005 Oct;19 Suppl 3:S72-8
references.pmid: 16251831
references.citation: J Consult Clin Psychol. 1990 Feb;58(1):22-30
references.pmid: 2181001
references.citation: Clin Infect Dis. 2006 May 15;42(10):1449-54
references.pmid: 16619159
references.citation: Mil Med. 1990 Feb;155(2):76-80
references.pmid: 2106656
references.citation: AIDS. 2004 Jan 1;18 Suppl 1:S75-8
references.pmid: 15075501
references.citation: J Nucl Med. 1996 Jul;37(7):1133-41
references.pmid: 8965184
references.citation: Neurology. 2004 Mar 23;62(6):957-62
references.pmid: 15037699
references.citation: Neurology. 2000 Mar 28;54(6):1344-9
references.pmid: 10746608
references.citation: J Acquir Immune Defic Syndr. 2002 Oct 1;31 Suppl 2:S62-9
references.pmid: 12394784
references.citation: Ann Intern Med. 1987 Dec;107(6):828-36
references.pmid: 3688675
references.citation: J Neuropsychiatry Clin Neurosci. 1995 Spring;7(2):180-7
references.pmid: 7626961
references.citation: J Clin Exp Neuropsychol. 2006 Apr;28(3):383-404
references.pmid: 16618627
references.citation: Proc Natl Acad Sci U S A. 2005 Oct 25;102(43):15647-52
references.pmid: 16227428
references.citation: AIDS. 2004 Jan 1;18 Suppl 1:S49-59
references.pmid: 15075498
references.citation: Neurology. 1992 Oct;42(10):1924-30
references.pmid: 1407574
references.citation: Psychoneuroendocrinology. 1999 Aug;24(6):657-77
references.pmid: 10399774
references.citation: Arch Gen Psychiatry. 1989 Aug;46(8):682-9
references.pmid: 2751402
references.citation: J Addict Dis. 2008;27(2):11-7
references.pmid: 18681187
references.citation: J Neuropsychiatry Clin Neurosci. 2003 Summer;15(3):317-25
references.pmid: 12928507
references.citation: J Int Neuropsychol Soc. 2004 Jan;10(1):1-14
references.pmid: 14751002
references.citation: AIDS Behav. 2006 Mar;10(2):185-90
references.pmid: 16477511
references.citation: Arch Neurol. 1992 Nov;49(11):1169-75
references.pmid: 1444884
references.citation: J Int Neuropsychol Soc. 1995 May;1(3):231-51
references.pmid: 9375218
references.citation: J Stud Alcohol. 1995 Nov;56(6):642-53
references.pmid: 8558896
references.citation: J Clin Exp Neuropsychol. 2000 Feb;22(1):16-24
references.pmid: 10649542
references.citation: J Natl Med Assoc. 1998 Nov;90(11):665-74
references.pmid: 9828581
references.citation: Arch Gen Psychiatry. 1990 Jun;47(6):527-31
references.pmid: 2350205
references.citation: N Engl J Med. 1985 Dec 12;313(24):1493-7
references.pmid: 2999591
references.citation: AIDS. 2001 Sep 28;15(14):1898-9
references.pmid: 11579260
references.citation: Arch Gen Psychiatry. 1991 Feb;48(2):124-30
references.pmid: 1671198
references.citation: J Int Neuropsychol Soc. 2001 Jan;7(1):20-6
references.pmid: 11253838
references.citation: Am J Psychiatry. 1995 Aug;152(8):1222-4
references.pmid: 7625478
references.citation: Brain. 2004 Nov;127(Pt 11):2452-8
references.pmid: 15319273
references.citation: J Neuropsychiatry Clin Neurosci. 1993 Summer;5(3):254-9
references.pmid: 8369633
references.citation: J Acquir Immune Defic Syndr (1988). 1993 May;6(5):503-11
references.pmid: 8483113
references.citation: J Clin Epidemiol. 2001 Dec;54 Suppl 1:S35-43
references.pmid: 11750208
references.citation: Prog Neuropsychopharmacol Biol Psychiatry. 2001 Nov;25(8):1523-36
references.pmid: 11642652
references.citation: J Clin Exp Neuropsychol. 2001 Apr;23(2):149-63
references.pmid: 11309669
references.citation: J Int Neuropsychol Soc. 2000 Mar;6(3):322-35
references.pmid: 10824504
references.citation: Neurology. 1991 Oct;41(10):1608-16
references.pmid: 1922803
references.citation: J Magn Reson Imaging. 1999 Oct;10(4):521-6
references.pmid: 10508318
references.citation: Neurology. 1997 Jan;48(1):223-30
references.pmid: 9008522
references.citation: Gen Hosp Psychiatry. 1991 Jan;13(1):4-8
references.pmid: 1993519
references.citation: Arch Gen Psychiatry. 2001 Aug;58(8):721-8
references.pmid: 11483137
references.citation: Compr Psychiatry. 1997 May-Jun;38(3):146-54
references.pmid: 9154370
references.citation: J Clin Exp Neuropsychol. 2006 Jan;28(1):29-42
references.pmid: 16448974
references.citation: J Clin Epidemiol. 2001 Dec;54 Suppl 1:S44-52
references.pmid: 11750209