The Influence of Neurocognitive Impairment on HIV Risk Behaviors and Intervention Outcomes among High-Risk Substance Users: A Systematic Review.

Roman Shrestha,Michael Copenhaver

doi:10.3389/fpubh.2016.00016

Abstract

Neurocognitive impairment (NCI) among high-risk substance users poses a substantial barrier to reducing risk behaviors in this population. Previous work suggests that NCI is intertwined in a close, reciprocal relationship with risk behaviors. Not only does substance use worsen cognitive impairment but cognitive impairment may also reduce the efficacy of interventions aimed at reducing risk and improving medication adherence. In this systematic review, we examine the potential impact of substance abuse and cognitive functioning in the context of HIV risk behaviors and risk-reduction intervention outcomes. The findings thus far suggest that, in order to be effective, risk-reduction interventions must take into account the impact of NCI on learning, memory, and behavior.

Highlights

Since the beginning of the HIV/AIDS epidemic, approximately 600,000 people have died of AIDSrelated illnesses in the United States alone
The findings of this study indicate that the majority of the available research has shown a close and reciprocal association between Neurocognitive impairment (NCI) and increased HIV risk behaviors among high-risk substance users
The literature suggested that NCI is associated with how well these same risk individuals respond to interventions aimed at reducing risk behaviors

Summary

Introduction

Since the beginning of the HIV/AIDS epidemic, approximately 600,000 people have died of AIDSrelated illnesses in the United States alone. Despite a wide array of preventive measures, the US is still facing a continuing epidemic, with approximately 50,000 new infections per year [1]. Substance use – including alcohol, injection drug use (IDU), and non-IDU – remains an important risk factors fueling the epidemic. The number of new HIV infections attributed to IDU has declined significantly over time, rates continue to be high among specific sub-populations, including racial/ ethnic minority groups [2]. Beyond risk from injection-related behaviors (e.g., sharing needles), use of illicit drugs is an important driver of sexual transmission of HIV. There is an urgent need for interventions targeting substance use-related behavioral changes in order to reduce rate of HIV incidence in this population

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Discussion

Conclusion