Abstract
HIV and major depressive disorder (MDD) commonly co-occur and are both linked to greater risk-taking behavior, possibly due to neurocognitive impairment (NCI). The present study examined the concordance of the Balloon Analog Risk Task (BART), a gold standard measure of risk-taking propensity, with NCI and real-world sexual risk behaviors in PWH with comorbid MDD. Participants included 259 adults, stratified by HIV serostatus (HIV + /HIV −) and lifetime MDD (MDD + /MDD −), who completed neuropsychological testing, the BART, and sexual risk behavior questionnaires. Logistic regression, stratified by HIV serostatus, examined joint effects of MDD and BART (linear and quadratic) on NCI. Follow-up linear regressions examined sexual risk behavior and neurocognitive domain T-scores as correlates of the BART. NCI prevalence was lowest in HIV − /MDD − , but BART scores did not differ by HIV/MDD status. In the HIV + group, BART performance predicted NCI such that high and low BART scores related to greater odds of NCI, but only in dual-risk HIV + /MDD + individuals. HIV + /MDD + individuals with both low and high BART scores exhibited poorer learning and recall, whereas processing speed and executive function were only poor in low BART risk-taking HIV + /MDD + . Higher BART scores linearly related to higher sexual risk behaviors only in MDD + individuals, independent of HIV serostatus. Low and high risk-taking on the BART may reflect discrete neurocognitive profiles in HIV + /MDD + individuals, with differential implications for real-world sexual risk behavior. HIV and comorbid MDD may disturb corticostriatal circuits responsible for integrating affective and neurocognitive components of decision-making, thereby contributing to risk-averse and risk-taking phenotypes.
Highlights
HIV disease is no longer considered a terminal illness due to effective antiretroviral therapy (ART)
The present study adds to the literature on risk-taking in HIV by characterizing the concordance of neurocognitive impairment (NCI) and risktaking propensity, as indexed by Balloon Analog Risk Task (BART) adjusted pumps, in a cohort of individuals stratified by HIV serostatus and major depressive disorder (MDD)
Neurocognition was strongest in the HIV − /MDD − group, compared to the HIV + groups, whereas BART adjusted pumps did not significantly differ across the four study groups
Summary
HIV disease is no longer considered a terminal illness due to effective antiretroviral therapy (ART). The average number of pumps on unexploded balloons is the primary score used to measure BART performance (i.e., risk-taking propensity), and this metric has been found to converge with real-world risk behaviors (e.g., substance use, unprotected sex; Hunt et al 2005; Lejuez et al 2002, 2004). Both low and high pumps may indicate suboptimal BART performance, but due to different mechanisms. We hypothesized that the relationships between risk-taking propensity, NCI, and HIV transmission risk behaviors would be strongest in PWH with MDD reflecting greater disturbance in the cognitive and affective components of risk taking and decision-making
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