Effects of HIV and Drug Abuse on Executive Brain Function: The Example of Decision-Making

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Effects of HIV and Drug Abuse on Executive Brain
Function The Example of Decision-Making

• Eileen Martin, PhDDepartment of
  PsychiatryUniversity of Illinois-Chicago
• Supported by HHS R01 DA12828
• and R01 DA13800

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NeuroAIDS General Points

• HIV has an Affinity for the Brain
• Spectrum of Cognitive Changes
• Continued Problem Despite Treatment
• Advances

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Neurocognitive FunctionsAffected by HIV

• Driving
• Employment
• Treatment adherence
• Risk behavior

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Employment Status and Neuropsychological
FunctionHIV and HIV- Women
H
HIV ABNL NP
HIV NL NP

HIV-
Martin et al, JINS 2000
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NP Performance and Antiretroviral Therapy
p lt .01
HIV ART
HIV NO ART
HIV-
Richardson et al., JINS 2002
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Similar Brain Regions are Affected by HIV and
Drug Abuse
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Basic Elements of Addiction Systems
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Prefrontal Cortex
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Executive Functions

• Braking, Control of Impulses
• Actions Based on Future Goals
• Examples
• Saving for Retirement
• Avoiding Road Rage
• Avoiding Risky Sex or Drug Use

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Rationale and Hypotheses for Current Studies

• Prefrontal cortical circuitry is a common pathway
  in drug abuse and neuroAIDS
• Are there additive effects of HIV and drug abuse
  ?

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PREACH ProjectUIC WSVA

• n 420 SDIs
• 90 African-American
• Age 40-45 years, 11-12 years education
• 44 HCV
• 20 female
• Supported by R01 DA12828

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Exclusion Criteria

• Neurologic AIDS-defining condition
• CVA or Seizure Disorder
• CHI with LOC gt 1 hour
• Schizophrenia
• Positive Tox Screen or Breathalyzer
• Current neuroleptics

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Substance Dependence CharacteristicsUIC/WSVA
Cohort
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Study Protocol - PREACH

• Medical and Psychiatric
• Substance Dependence
• Comorbid Conditions
• Neurocognitive Functions
• Risk Behavior

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Decision Making

• Actions influenced by future goal, less by
  current payoffs or rewards (Bechara et al., 1997)
• Less attractive option might be optimal
• Ventromedial/Orbitofrontal Cortex

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• Current Choices
• Partying
• Sleeping
• Sex
• Studying

• Future Goal
• GRADUATING

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High Risk Choices on Gambling TaskCrack/Heroin
Users
Martin et al., JINS, 2005




HIV- Drug Abuse
Normal Ss Iowa Cohort
HIV Drug Abuse
S
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DANCE ProjectDA R01 DA13800

• N 350 MSMs, 25-30, HS Education
• Mixed ethnicities
• HIV or HIV-
• Use or dont use Club Drugs
• Ecstasy
• Crystal Meth
• GHB, Ketamine

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Risky Choices on Gambling Task Ecstasy and Club
Drug Users Preliminary Findings


HIV OR Club Drugs
HIV AND Club Drugs
HIV- No Drugs
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Conclusions

• New Knowledge regarding Brain Systems affected in
  HIV and Drug Abuse
• Implications for Prevention, Adherence, Quality
  of Life
• Targets for Intervention

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Collaborators

• Infectious Disease
• David Pitrak, MD
• Richard Novak, MD
• Kenneth Pursell, MD
• Consultants
• Antoine Bechara, MD, PhD

• Psychiatry
• Rodney Eiger, MD
• Michael Fendrich, PhD
• Raul Gonzalez, PhD
• Jasmin Vassileva, PhD
• Silvana Grbesic, BS
• Joanna Jacobus, BS