Marijuana use, heavy drinking, and cognitive dysfunction in people with Human Immunodeficiency Virus-infection
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AIMS: Substance use and dependence is very common among people living with HIV-infection. Since substances like alcohol and marijuana as well as the HIV virus itself are believed to have negative effects on cognition and the brain, our aim was to test the hypothesis that current and lifetime marijuana and heavy alcohol use are associated with cognitive dysfunction in people with HIV-infection. METHODS: Boston ARCH cohort participants consisted of 215 HIV-infected adults with substance dependence or current or past injection drug use. In cross-sectional, regression analyses we tested the association between current marijuana use (number of days marijuana was used in the past 30 days), current heavy alcohol use (number of heavy drinking days in the past 30 days defined as ≥4 drinks for women and ≥ 5 for men in 24 hours), lifetime marijuana use (number of years marijuana was used ≥ 3 times per week), lifetime alcohol use (total Kg), duration of heavy alcohol use (# of years alcohol was use > 84 grams or > 6 drinks per day), and three measures of cognitive dysfunction: i) memory and ii) attention domains of the Montreal Cognitive Assessment (MoCA), and iii) 4-item cognitive function scale (CF4) from the Medical Outcomes Study HIV Health Survey (MOS-HIV, range 0-100). Eight multivariable models were fit comparing: 1. current marijuana use by each cognitive outcome, 2. current heavy alcohol use by each cognitive outcome, 3. lifetime marijuana use by each cognitive outcome, 4. lifetime alcohol use (Kg) by each cognitive outcome, 5. lifetime marijuana use, duration of heavy alcohol use, current heavy alcohol use, and current marijuana use by each cognitive outcome, 6. lifetime marijuana use, lifetime alcohol use (Kg), current heavy alcohol use, and current marijuana use by each cognitive outcome, 7. the interaction between current marijuana and heavy alcohol use by each cognitive outcome, and 8. the interaction between lifetime marijuana and lifetime alcohol use (Kg) by each cognitive outcome. Analyses were adjusted for demographics, primary language, comorbidities, depressive symptoms, anxiety, antiretroviral therapy, HIV-viral load, CD4 count, lifetime cocaine use, cocaine use in the past 30 days, illicit opioid use in the past 30 days, and any prescribed opioids. RESULTS: Participant characteristics were as follows: Mean age 49 yrs., 35% female, 20% white, 66% ≥ 12 years of education, 86% English as primary language, 82% unemployed, mean Charlson comorbidity score 2.9, 28% scored ≥ 3 on the PHQ-2 indicating depressive symptoms, 44% scored ≥ 8 on OASIS indicating symptoms of anxiety, 58% had Hepatitis C infection at some point in their life, 86% were on HAART, 72% had an HIV-viral load < 200 copies/mL, CD4 cell count/mm3 was 10% <200 and 33% 200 - <500, mean HIV duration was 16 years, lifetime cocaine use was 9 years, 30% used cocaine in the past 30 days, 25% used illicit opioids in the past 30 days, and 61% were prescribed opioids. Current marijuana use was significantly associated with a lower MOS-HIV CF4 score in three of the fully adjusted models (1,5, and 6) listed previously with a decrease in 0.30 points for every day of use, but neither MoCA score. Current heavy alcohol use was also associated with a higher MOS-HIV CF4 score in model 5, increasing 0.36 points for every day of use. This finding did not confirm our hypothesis and in fact was opposite our projections. Lifetime marijuana use and lifetime alcohol use were not associated with any measure of cognitive dysfunction, and there was no interaction between lifetime marijuana use and lifetime alcohol use with cognitive dysfunction, and no interaction between current marijuana use and current alcohol use with cognitive dysfunction. CONCLUSION: Current marijuana use may be associated with cognitive dysfunction. We also detected an unexpected association between current heavy alcohol use and better cognitive function, but it is not biologically plausible. However, we did not detect associations between lifetime alcohol or marijuana use and cognitive dysfunction among people with substance dependence and HIV-infection. Further research, particularly on long-term exposure to substances, should include subtler measures of cognitive dysfunction and consider whether or not cognitive dysfunction that may be the consequence of marijuana and alcohol use is detectable among those who have many other factors effecting cognition. These results suggest that marijuana use should not be considered benign for individuals with substance dependence and HIV-infection.
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