Marijuana use, heavy drinking, and cognitive dysfunction in people with HIV-infection and substance dependence

Abstract

s / Drug and Alcohol Dependence 156 (2015) e102–e182 e135 Marijuana use, heavy drinking, and cognitive dysfunction in people with HIV-infection and substance dependence Sara A. Lorkiewicz1, Alicia S. Ventura2, Timothy Heeren2, Michael R. Winter2, Alexander Walley1,3, Meg Sullivan1,3, Jeffrey Samet1,2,3, Richard Saitz1,2,3 1 School of Medicine, Boston University, Boston, MA, United States 2 School of Public Health, Boston University, Boston, MA, United States 3 Boston Medical Center, Boston, MA, United States Aims: To test the hypotheses that heavy drinking and marijuana use are associatedwith cognitive dysfunction inHIV-infected people. Methods: Boston ARCH cohort participants were HIV-infected adultswith substance dependence or current or past injection drug use (n=230). In cross-sectional regression analyses we tested the association between number of heavy drinking days (HDDs) in the past 30 (≥4 drinks for women, ≥ 5 for men in 24hours), days of marijuana use in the past 30, and 3 measures of cognitive dysfunction: i)memory and ii) attentiondomains of theMontreal Cognitive Assessment (MOCA), and iii) 4 item cognitive function scale from theMedicalOutcomes StudyHIVHealth Survey (MOS-HIV, range0100). Analyses were adjusted for demographics, primary language, comorbidities, depressive symptoms, anxiety, antiretroviral therapy (ART), HIV symptoms, opioid prescription, illicit sedative or opioid, or cocaine use, CD4 count, and hepatitis C. Results: Participant characteristics: Mean age 49 years; 36% female; 51% Black, 25% Hispanic; 85% English primary language; 66% ≥12 years education; 88% on ART; 39% with current opioid prescription; 26% illicit sedative or opioid use; 31% cocaine use; 60% hepatitis C; CD4 cell count/mm3 21) who used meth in the past three months, recruited through convenience and snowball sampling. Descriptive statistics of the first 88 participants (target N=150) and bivariate analysis by gender are provided. Results: Median age of participants is 28; 64.8% are men and 35.2% are women and transgender women; 87.5% were born in Mexico; 28.4% crossed the border to the U.S. in last 12 mo. In their lifetime, 67%hadbeen in jail and27.6%hadacquiredmethormoney in exchange for sex. Median age of first use was 18 and days since lastmethusewas5.Mosthadalsousedalcohol (97%), cocaine/crack (94%), marihuana (93%), or tobacco (93%). Most common use forms were tablet/pill (69%) and powder (60%); works were light bulb (58%) then pipe (49%); and meth was smoked (68%) and ingested (67%). Conclusions: Therewere significant gender differences for rock and power use, and snorting by nose (p<0.05), and high rates of poly-druguse. Thesefindingshave implications for future interventions and harm reduction efforts among meth users, which would need to be tailoredby gender, particularly the type of paraphernalia used. These findings may also be indicative of meth using behaviors among Hispanic populations living in cities on the U.S.-Mexico border region. Financial support: Supported by NIDA funded UTEP Vulnerability Issues in Drug Abuse (VIDA) Project (1R24DA029989-01). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.371