title: Determinants of risk-taking in HIV-associated neurocognitive disorders.
abstract: OBJECTIVE
  Decision-making involves fronto-striatal brain areas that are particularly vulnerable to the effects of HIV infection. Some studies report impaired decision-making in people with HIV/AIDS with past or present addictions and/or accompanying HIV-associated neurocognitive disorders (HAND). The authors investigated risk-based decision-making in HIV/AIDS, separating individuals with or without accompanying HAND.
  
  
  METHODS
  A total of 288 HIV-infected persons underwent standardized neuropsychological testing. Participants were profiled based on neuropsychological and clinical assessments into 2 groups, neurocognitively normal (NN, n = 205) and HAND (n = 83). Risk-based decision-making was assessed via the Game of Dice Task (GDT). Sample characteristics were summarized by principal component analysis (PCA) prior to regression analyses predicting GDT performance.
  
  
  RESULTS
  The NN group performed within the normative range of the GDT, but the HAND group was impaired in all GDT measures. Across all participants, GDT performance was predicted by a combination of psychiatric comorbidities, alcohol abuse, education/premorbid IQ, and neuropsychological performance. Further analyses revealed marijuana use as an important additional predictor of impaired GDT performance. Within the GDT-impaired HAND group only, past or present immunosuppression emerged as the most robust predictor of GDT performance. Metabolic disorders and antiretroviral toxicity were also predictors of GDT performance in the HAND group.
  
  
  CONCLUSIONS
  The majority of HIV-infected individuals were unimpaired in the GDT. Some influence of psychiatric and substance use comorbidities on GDT performance emerged in the entire cohort. However, GDT deficits were restricted to individuals with HAND, related to immunosuppression, metabolic disorders and antiretroviral toxicity in this group only. (PsycINFO Database Record
authors.affiliation: Department of Psychiatry, University of Alberta.
authors.forename: Daniela
authors.initials: D
authors.lastname: Gomez
authors.affiliation: Department of Psychiatry, University of Alberta.
authors.forename: Christopher
authors.initials: C
authors.lastname: Power
authors.affiliation: Department of Medicine, University of Calgary.
authors.forename: M John
authors.initials: MJ
authors.lastname: Gill
authors.affiliation: Department of Psychiatry, University of Alberta.
authors.forename: Esther
authors.identifier: 0000-0003-4154-0145
authors.initials: E
authors.lastname: Fujiwara
mesh_terms: D015526:AIDS Dementia Complex / Q000150:complications / Q000523:psychology*; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D003657:Decision Making; D005260:Female; D005715:Gambling / Q000523:psychology; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000150:complications / Q000523:psychology; D008875:Middle Aged; D009483:Neuropsychological Tests; D012309:Risk-Taking