Cocaine Use May Moderate the Associations of HIV and Female Sex with Neurocognitive Impairment in a Predominantly African American Population Disproportionately Impacted by HIV and Substance Use

Hong Lai, Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
David D. Celentano, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Glenn Treisman, Department of Psychiatry and Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Jag Khalsa, Department of Microbiology, Immunology, & Tropical Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Gary Gerstenblith, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Bryan Page, Department of Anthropology, University of Miami, Miami, Florida, USA.
Raul N. Mandler, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA.
Yihong Yang, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland, USA.
Betty Salmeron, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland, USA.
Sandeepan Bhatia, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Shaoguang Chen, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Shenghan Lai, Department of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Karl Goodkin, Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Man Charurat, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.

Document Type

Journal Article

Publication Date

5-1-2023

Journal

AIDS patient care and STDs

Volume

37

Issue

5

DOI

10.1089/apc.2023.0006

Keywords

African Americans; HIV infection; NIH Toolbox cognition battery; cocaine use; female sex; neurocognitive impairment

Abstract

HIV-associated neurocognitive disorders (HAND) remain a major challenge for people with HIV in the antiretroviral therapy era. Cocaine use may trigger/exacerbate HAND among African American (AA) adults, especially women. Between 2018 and 2019, 922 adults, predominantly AAs, with/without HIV and with/without cocaine use in Baltimore, Maryland, were enrolled in a study investigating the association of HIV and cocaine use with neurocognitive impairment (NCI). Neurocognitive performance was assessed with the NIH Toolbox Cognition Battery (NIHTB-CB). NCI was considered to be present if the fully adjusted standard score for at least two cognitive domains was 1.0 standard deviation below the mean. Although the overall analysis showed HIV and female sex were associated with NCI, the associations were dependent on cocaine use. Neither HIV [adj prevalence ratio (PR): 1.12, confidence interval (95% CI): 0.77-1.64] nor female sex (adj PR: 1.07, 95% CI: 0.71-1.61) was associated with NCI among cocaine nonusers, while both HIV (adj PR: 1.39, 95% CI: 1.06-1.81) and female sex (adj PR: 1.53, 95% CI: 1.18-1.98) were associated with NCI in cocaine users. HIV was associated with two NIHTB-CB measures overall. In addition, HIV was associated with a lower dimensional change card sort score (an executive function measure) in cocaine users and not in nonusers. Cognitive performance was poorer in female than in male cocaine users. The adverse effect of HIV on cognitive performance predominantly affected cocaine users. However, cocaine use may moderate the impact of HIV and female sex on cognitive performance, highlighting the importance of reducing cocaine use in NCI prevention among the AA population.

Department

Microbiology, Immunology, and Tropical Medicine

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