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

Effects of HIV and Drug Abuse on Executive Brain Function: The Example of Decision-Making. Eileen Martin, PhD Department of Psychiatry University of Illinois-Chicago Supported by HHS R01 DA12828 and R01 DA13800. NeuroAIDS: General Points. HIV has an Affinity for the Brain

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

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  1. 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

  2. NeuroAIDS: General Points • HIV has an Affinity for the Brain • Spectrum of Cognitive Changes • Continued Problem Despite Treatment Advances

  3. Neurocognitive FunctionsAffected by HIV • Driving • Employment • Treatment adherence • Risk behavior

  4. Employment Status and Neuropsychological FunctionHIV+ and HIV- Women H HIV+ ABNL NP HIV+ NL NP * HIV- Martin et al, JINS 2000

  5. NP Performance and Antiretroviral Therapy p < .01 HIV+ ART HIV+ NO ART HIV- Richardson et al., JINS 2002

  6. Similar Brain Regions are Affected by HIV and Drug Abuse

  7. Basic Elements of Addiction Systems

  8. Prefrontal Cortex

  9. Executive Functions • “Braking,” Control of Impulses • Actions Based on Future Goals • Examples • Saving for Retirement • Avoiding Road Rage • Avoiding Risky Sex or Drug Use

  10. 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 ?

  11. 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

  12. Exclusion Criteria • Neurologic AIDS-defining condition • CVA or Seizure Disorder • CHI with LOC > 1 hour • Schizophrenia • Positive Tox Screen or Breathalyzer • Current neuroleptics

  13. Substance Dependence CharacteristicsUIC/WSVA Cohort

  14. Study Protocol - PREACH • Medical and Psychiatric • Substance Dependence • Comorbid Conditions • Neurocognitive Functions • Risk Behavior

  15. 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

  16. Current Choices Partying Sleeping Sex Studying Future Goal GRADUATING

  17. High Risk Choices on Gambling TaskCrack/Heroin Users Martin et al., JINS, 2005 * * * * HIV- Drug Abuse Normal Ss Iowa Cohort HIV+ Drug Abuse S

  18. DANCE ProjectDA R01 DA13800 • N= 350 MSMs, 25-30, HS Education • Mixed ethnicities • HIV+ or HIV- • Use or don’t use Club Drugs • Ecstasy • Crystal Meth • GHB, Ketamine

  19. Risky Choices on Gambling Task Ecstasy and Club Drug Users Preliminary Findings * * HIV+ OR Club Drugs HIV+ AND Club Drugs HIV- No Drugs

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

  21. 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 Collaborators

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