Cocaine dependence does not contribute substantially to white matter abnormalities in HIV infection
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This study investigated the association of HIV infection and cocaine dependence with cerebral white matter integrity using diffusion tensor imaging (DTI). One hundred thirty-five participants stratified by HIV and cocaine status (26 HIV+/COC+, 37 HIV+/COC−, 37 HIV−/COC+, and 35 HIV−/COC−) completed a comprehensive substance abuse assessment, neuropsychological testing, and MRI with DTI. Among HIV+ participants, all were receiving HIV care and 46% had an AIDS diagnosis. All COC+ participants were current users and met criteria for cocaine use disorder. We used tract-based spatial statistics (TBSS) to assess the relation of HIV and cocaine to fractional anisotropy (FA) and mean diffusivity (MD). In whole-brain analyses, HIV+ participants had significantly reduced FA and increased MD compared to HIV− participants. The relation of HIV and FA was widespread throughout the brain, whereas the HIV-related MD effects were restricted to the corpus callosum and thalamus. There were no significant cocaine or HIV-by-cocaine effects. These DTI metrics correlated significantly with duration of HIV disease, nadir CD4+ cell count, and AIDS diagnosis, as well as some measures of neuropsychological functioning. These results suggest that HIV is related to white matter integrity throughout the brain, and that HIV-related effects are more pronounced with increasing duration of infection and greater immune compromise. We found no evidence for independent effects of cocaine dependence on white matter integrity, and cocaine dependence did not appear to exacerbate the effects of HIV.
KeywordsHIV infection White matter Diffusion tensor imaging (DTI) Magnetic resonance imaging (MRI) Cocaine Neurocognitive function
This study was funded by grants K23-DA028660, R21-DA036450, T32-AI007392, R01-AG039684, and R03-033828-02S1 from the U.S. National Institutes of Health. We are grateful to the UNC Center for AIDS Research (P30-AI50410) for its assistance with patient recruitment. The NIH had no further role in study design, data collection, analysis and interpretation of data, writing the report, or in the decision to submit the paper for publication. We thank all the individuals who participated in this study.
CSM designed the original project and secured grant funding; DMC, CSM, SLT, SAH, and NC conceptualized the current study; DMC, CSM, and SLT conducted the analyses, with guidance from DJM, NC, and SAH; DMC and CSM drafted the manuscript and SLT wrote additional sections; and all authors contributed to and have approved the final manuscript.
Compliance with ethical standards
Study procedures were approved by the institutional review boards at Duke University Health System and University of North Carolina at Chapel Hill.
Conflict of interest
The authors declare that they have no conflict of interest.
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