title: Neurocognitive impact of substance use in HIV infection.
abstract: BACKGROUND
  : To determine how serious a confound substance use (SU) might be in studies on HIV-associated neurocognitive disorder (HAND), we examined the relationship of SU history to neurocognitive impairment (NCI) in participants enrolled in the Central Nervous System HIV Antiretroviral Therapy Effects Research study.
  
  
  METHODS
  : After excluding cases with behavioral evidence of acute intoxication and histories of factors that independently could account for NCI (eg, stroke), baseline demographic, medical, SU, and neurocognitive data were analyzed from 399 participants. Potential SU risk for NCI was determined by the following criteria: lifetime SU Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis, self-report of marked lifetime SU, or positive urine toxicology. Participants were divided into 3 groups as follows: no SU (n = 134), nonsyndromic SU (n = 131), syndromic SU (n = 134) and matched on literacy level, nadir CD4, and depressive symptoms.
  
  
  RESULTS
  : Although approximately 50% of the participants were diagnosed with HAND, a multivariate analysis of covariance of neurocogntive summary scores, covarying for urine toxicology, revealed no significant effect of SU status. Correlational analyses indicated weak associations between lifetime heroin dosage and poor recall and working memory and between cannabis and cocaine use and better verbal fluency.
  
  
  CONCLUSIONS
  : These data indicate that HIV neurocognitive effects are seen at about the same frequency in those with and without historic substance abuse in cases that are equated on other factors that might contribute to NCI. Therefore, studies on neuroAIDS and its treatment need not exclude such cases. However, the effects of acute SU and current SU disorders on HAND require further study.
authors: Department of Pathology, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029, USA. desiree.byrd@mssm.edu
authors: Desiree A
authors: DA
authors: Byrd
authors: Robert P
authors: RP
authors: Fellows
authors: Susan
authors: S
authors: Morgello
authors: Donald
authors: D
authors: Franklin
authors: Robert K
authors: RK
authors: Heaton
authors: Reena
authors: R
authors: Deutsch
authors: J Hampton
authors: JH
authors: Atkinson
authors: David B
authors: DB
authors: Clifford
authors: Ann C
authors: AC
authors: Collier
authors: Christina M
authors: CM
authors: Marra
authors: Benjamin
authors: B
authors: Gelman
authors: J Allen
authors: JA
authors: McCutchan
authors: Nichole A
authors: NA
authors: Duarte
authors: David M
authors: DM
authors: Simpson
authors: Justin
authors: J
authors: McArthur
authors: Igor
authors: I
authors: Grant
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology*; D013997:Time Factors