title: Independent effects of HIV infection and cocaine dependence on neurocognitive impairment in a community sample living in the southern United States.
abstract: BACKGROUND
  Prior studies have established that methamphetamine and HIV can have additive deleterious effects on neurocognitive functioning, but there has been relatively little research on other stimulants like cocaine. This study investigated the effects of cocaine and HIV on neurocognitive impairment in a large, well-characterized sample.
  
  
  METHODS
  The sample included 193 adults across four groups: HIV-positive cocaine users (n = 48), HIV-negative cocaine users (n = 53), HIV-positive non-drug users (n = 60), and HIV-negative non-drug users (n = 32). Cocaine users met criteria for lifetime dependence and had past-month cocaine use. A comprehensive battery assessed substance abuse and neurocognitive functioning.
  
  
  RESULTS
  Participants were mostly male (66%) and African-American (85%), with a mean age of 46.09 years. The rate of global impairment was 33%, with no significant main effects across groups on likelihood of impairment. There were main effects for cocaine on processing speed and executive functioning, with cocaine users having greater impairment (F = 9.33 and F = 4.22, respectively), and for HIV on attention, with HIV-infected persons having greater impairment (F = 5.55). There was an interaction effect for executive functioning, with the three patient groups having greater impairment than controls (F = 5.05). Nonparametric analyses revealed significant additive impairment in the presence of both HIV and cocaine for processing speed.
  
  
  CONCLUSIONS
  While cocaine does not appear to increase vulnerability to global HIV-associated neurocognitive impairment, it does have independent adverse effects on executive functioning and processing speed. Given prior evidence that domain-specific deficits predict real-world impairments, our results may help explain the poorer behavioral and functional outcomes observed in HIV-infected cocaine users.
authors.affiliation: Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences and Duke Global Health Institute, Box 90519, Durham, NC 27708, USA. Electronic address: christina.meade@duke.edu.
authors.forename: Christina S
authors.initials: CS
authors.lastname: Meade
authors.affiliation: Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences and Duke Global Health Institute, Box 90519, Durham, NC 27708, USA.
authors.forename: Sheri L
authors.initials: SL
authors.lastname: Towe
authors.affiliation: Duke University, Department of Psychology and Neuroscience, Box 90086, Durham, NC 27708, USA.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Skalski
authors.affiliation: University of North Carolina at Chapel Hill, Department of Neurology, Physicians Office Building, 170 Manning Drive, Chapel Hill, NC 27599, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Robertson
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001288:Attention; D019970:Cocaine-Related Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D003072:Cognition Disorders / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D056344:Executive Function; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009048:Motor Skills; D009483:Neuropsychological Tests; D012959:Socioeconomic Factors; D015144:Southeastern United States / Q000453:epidemiology; D014705:Verbal Behavior; D055815:Young Adult
keywords: Cocaine dependence; Drug abuse; HIV-associated neurocognitive disorders; HIV/AIDS; Neurocognitive impairment; Neuropsychology