ABSTRACT
BACKGROUND: Prior research has demonstrated neuropsychological (NP) impairment in persons with histories of injection drug use (IDU), hepatitis C virus (HCV) infection, and methadone maintenance treatment (MMT), individually, but little is known about the NP effects of these three risk factors in combination. This issue is particularly important in China, which is addressing its highly HCV-comorbid IDU epidemic with widespread government sponsored MMT, especially in light of recent evidence suggesting that methadone may be neuroprotective in some circumstances. METHODS: We administered a comprehensive NP test battery to 195 Chinese heroin IDU individuals taking MMT (IDU+ group), the majority of whom were also HCV+ (87%; n=169), and compared their NP performance to that of 198 demographically comparable, non-IDU Chinese controls (IDU- group). All participants in both groups tested negative for HIV infection, which is also a common comorbidity in the Chinese IDU population. RESULTS: The IDU+ group did not have an increased rate of global NP impairment, or perform significantly worse on any individual NP test measure. Within the IDU+ group, liver disease characteristics and reported details of heroin use were not significantly associated with NP performance. CONCLUSION: Failure to detect NP impairment in IDU+ subjects with or without HCV infection was surprising, particularly considering the previously demonstrated sensitivity of our NP battery to neurocognitive disorders associated with HIV infection in China. One possible explanation, which should be explored in future research, is the potential neuroprotective effect of methadone in the context of HCV infection and/or heroin withdrawal.
Subject(s)
Asian People , Cognition Disorders/diagnosis , Methadone/therapeutic use , Neuropsychological Tests , Opiate Substitution Treatment , Substance Abuse, Intravenous/diagnosis , Adult , Asian People/ethnology , Asian People/psychology , Cognition Disorders/ethnology , Cognition Disorders/psychology , Female , Hepatitis C , Humans , Male , Opiate Substitution Treatment/psychology , Retrospective Studies , Risk Factors , Substance Abuse, Intravenous/ethnology , Substance Abuse, Intravenous/psychology , Treatment OutcomeABSTRACT
Three types of HIV-associated neurocognitive disorders (HAND) exist that are distinguished by presence and severity of impairment in cognitive and everyday functioning. Although well-validated neurocognitive measures exist, determining impairment in everyday functioning remains a challenge. We aim to determine whether Self-Report measures of everyday functioning are as effective in characterizing HAND as Performance-Based measures. We assessed 674 HIV-infected participants with a comprehensive neurocognitive battery; 233 met criteria for a HAND diagnosis by having at least mild neurocognitive impairment. Functional decline was measured via Self-Report and Performance-Based measures. HAND diagnoses were determined according to published criteria using three approaches to assess functional decline: (1) Self-Report measures only, (2) Performance-Based measures only, and (3) Dual-method combining Self-Report and Performance-Based measures. The Dual-method classified the most symptomatic HAND, compared to either singular method. Singular method classifications were 76% concordant with each other. Participants classified as Performance-Based functionally impaired were more likely to be unemployed and more immunosuppressed, whereas those classified as Self-Report functionally impaired had more depressive symptoms. Multimodal methods of assessing everyday functioning facilitate detection of symptomatic HAND. Singular Performance-Based classifications were associated with objective functional and disease-related factors; reliance on Self-Report classifications may be biased by depressive symptoms.
Subject(s)
Activities of Daily Living , Cognition Disorders/diagnosis , Cognition Disorders/etiology , HIV Infections/complications , Motor Activity/physiology , Self Report , Adult , Aged , Cognition Disorders/virology , Cohort Studies , Depression/etiology , Female , HIV Infections/diagnosis , HN Protein/metabolism , Humans , Immunoenzyme Techniques , Lipopolysaccharide Receptors/metabolism , Logistic Models , Male , Middle Aged , Neuropsychological Tests , Psychiatric Status Rating Scales , Sensitivity and Specificity , Statistics, Nonparametric , Young AdultABSTRACT
BACKGROUND: This pilot study examined rates of major depression and suicidality and their associations with daily functioning in HIV infected (HIV+) and uninfected (HIV-) persons in China. METHOD: HIV+ participants (N=28) and demographically matched HIV- controls (N=23) completed the Chinese Composite International Diagnostic Interview to determine lifetime rates of major depressive disorder (MDD) and suicidality. Current mood and suicidal ideation were assessed with the Beck Depression Inventory-I. The impact of depression and HIV infection on daily functioning was measured by an Activity of Daily Living questionnaire. RESULTS: Mean duration of known HIV+ status was 2 years. Almost 79% (n=22) of HIV+ but just 4% (n=1) of HIV- groups reported lifetime major depression. Of the 22 HIV+ individuals with lifetime MDD, only one had onset before learning of HIV status. The remainder developed MDD within 6 months after testing HIV positive. In those HIV+ subjects who met MDD criteria after HIV diagnosis, only two (9%) had received depression treatment, yet four (18%) had persisting active suicidal thoughts. Depression and HIV+ status independently predicted worse daily functioning. LIMITATIONS: Representativeness is limited in this small sample of convenience. CONCLUSION: This preliminary study presents evidence of high rates of major depression and suicidality in HIV-infected persons in China. Despite this, few had sought mental health assistance, suggesting a need to increase awareness of psychiatric comorbidity and access to mental health services.
