The nature and consequences of cognitive deficits among tobacco smokers with HIV: a comparison to tobacco smokers without HIV
- 221 Downloads
HIV-infected smokers lose more years of life to tobacco-related disease than HIV. Since neurocognitive deficits are common among those with HIV and are associated with smoking persistence, these deficits may be a unique barrier to smoking cessation among HIV-infected smokers. Documenting unique differences in and correlates of cognition among HIV-infected smokers is a critical step towards developing a population-specific tobacco cessation treatment. We compared neurocognitive function between HIV-infected (n = 103) and HIV-uninfected smokers (n = 70), accounting for demographic and smoking-related variables. We also evaluated whether HIV-related health outcomes (e.g., CD4 count, viral load, depression ratings, quality of life [QoL]) and HAART adherence were associated with cognition. Participants completed neurocognitive tasks (N-back and Continuous Performance Task [CPT]) measuring working memory, attention, and processing speed, and intra-individual variability. Stepwise regression models were conducted and validated with resampling techniques. HIV-infected smokers performed worse than HIV-uninfected smokers on working memory, processing speed, and intra-individual variability (all p < 0.01). ROC analysis for the model including cognitive measures demonstrated 85% area under the curve, which indicates “good prediction” for distinguishing between HIV-infected and HIV-uninfected smokers. This was a significant improvement over the model including demographic and smoking-related variables only (p = 0.0003). Among HIV-infected smokers, neurocognitive performance was negatively associated with QoL and depression ratings. Smoking cessation interventions for HIV-infected smokers should consider cognitive neurorehabilitation as a potential strategy to decrease the likelihood of nicotine relapse and decrease tobacco-related morbidity in this population.
KeywordsSmoking cessation HIV Cognition HIV-associated neurocognitive disorder Tobacco use
This research was supported by grants from the National Institute on Drug Abuse (R01 DA033681 and K23 DA035295) and through core services and support from the Penn Center for AIDS Research (P30 AI045008) and Penn Mental Health AIDS Research Center (P30 MH097488).
Compliance with ethical standards
Conflict of interest
Dr. Schnoll receives medication and placebo free from Pfizer and has provided consultation to Pfizer and GlaxoSmithKline. These companies had no involvement in this study.
Dr. Siegel has received grants and/or has acted as a consultant to Astellas, Merck, and Zynerba that is unrelated to the content of this manuscript.
Dr. Gross sits on a Data Safety and Management Board for a Pfizer drug treating inflammatory bowel disease that is unrelated to the contents of this manuscript.
- Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M, Clifford DB, Cinque P, Epstein LG, Goodkin K, Gisslen M, Grant I, Heaton RK, Joseph J, Marder K, Marra CM, McArthur JC, Nunn M, Price RW, Pulliam L, Robertson KR, Sacktor N, Valcour V, Wojna VE (2007) Updated research nosology for HIV-associated neurocognitive disorders. Neurology 69:1789–1799CrossRefPubMedPubMedCentralGoogle Scholar
- Doyle KL, Morgan EE, Morris S, Smith DM, Little S, Iudicello JE, Blackstone K, Moore DJ, Grant I, Letendre SL, Woods SP (2013) Real-world impact of neurocognitive deficits in acute and early HIV infection. J Neuro-Oncol 19:565–573Google Scholar
- Ellis RJ, Badiee J, Vaida F, Letendre S, Heaton RK, Clifford D, Collier AC, Gelman B, McArthur J, Morgello S, McCutchan JA, Grant I (2011). CD4 nadir is a predictor of HIV neurocognitive impairment in the era of combination antiretroviral therapy. AIDS (London, England) 25: 10.1097/QAD.0b013e32834a40cd.
- Grant I, Franklin DR Jr, Deutsch R, Woods SP, Vaida F, Ellis RJ, Letendre SL, Marcotte TD, Atkinson JH, Collier AC, Marra CM, Clifford DB, Gelman BB, McArthur JC, Morgello S, Simpson DM, McCutchan JA, Abramson I, Gamst A, Fennema-Notestine C, Smith DM, Heaton RK (2014) Asymptomatic HIV-associated neurocognitive impairment increases risk for symptomatic decline. Neurology 82:2055–2062CrossRefPubMedPubMedCentralGoogle Scholar
- Hakkers CS, Arends JE, Barth RE, Du Plessis S, Hoepelman AI, Vink M (2016). Review of functional MRI in HIV: effects of aging and medication. J Neurovirol.Google Scholar
- Health PDoP (2015). AIDS Activities Coordinating Office Surveillance Report, 2014. Philadelphia, PA: City of Philadelphia.Google Scholar
- Heaton RK, Franklin DR, Ellis RJ, McCutchan JA, Letendre SL, Leblanc S, Corkran SH, Duarte NA, Clifford DB, Woods SP, Collier AC, Marra CM, Morgello S, Mindt MR, Taylor MJ, Marcotte TD, Atkinson JH, Wolfson T, Gelman BB, McArthur JC, Simpson DM, Abramson I, Gamst A, Fennema-Notestine C, Jernigan TL, Wong J, Grant I (2011) HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors. J Neuro-Oncol 17:3–16Google Scholar
- Heaton RK, Franklin DR Jr, Deutsch R, Letendre S, Ellis RJ, Casaletto K, Marquine MJ, Woods SP, Vaida F, Atkinson JH, Marcotte TD, McCutchan JA, Collier AC, Marra CM, Clifford DB, Gelman BB, Sacktor N, Morgello S, Simpson DM, Abramson I, Gamst AC, Fennema-Notestine C, Smith DM, Grant I (2015) Neurocognitive change in the era of HIV combination antiretroviral therapy: the longitudinal CHARTER study. Clin Infect Dis 60:473–480CrossRefPubMedGoogle Scholar
- Ma Q, Vaida F, Wong J, Sanders CA, Kao YT, Croteau D, Clifford DB, Collier AC, Gelman BB, Marra CM, McArthur JC, Morgello S, Simpson DM, Heaton RK, Grant I, Letendre SL (2016) Long-term efavirenz use is associated with worse neurocognitive functioning in HIV-infected patients. J Neuro-Oncol 22:170–178Google Scholar
- Schouten J, Wit FW, Stolte IG, Kootstra NA, van der Valk M, Geerlings SE, Prins M, Reiss P (2014) Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV cohort study. Clin Infect Dis 59:1787–1797CrossRefPubMedGoogle Scholar
- Steyerberg E (2008). Clinical prediction models: a practical approach to development, validation, and updating. Springer Science & Business Media.Google Scholar
- Zachary RS (2000). Shipley Institute of Living Scale - Revised Manual. Western Psychological Services.Google Scholar