Impact of comorbidity of HIV infection and substance use disorder on brain aging and cognitive impairment

1. HIV感染与物质使用障碍共病对认知功能损害的影响 与马里兰州医学院的Shenghan Laigroup博士合作，我们开始调查HIV感染和物质使用障碍的共病对认知障碍的影响。一组922名成年人，主要是非洲裔美国人（AA），有/无艾滋病毒和可卡因使用障碍（CUD），参加了研究，调查艾滋病毒和可卡因使用与神经认知障碍（NCI）的关联。神经认知功能采用NIH认知成套测验（NIHTB-CB）进行评估。如果至少两个认知领域的完全校正标准评分低于平均值1.0标准差，则认为存在NCI。虽然总体分析显示艾滋病毒和女性参与者与NCI有关，但这种关联依赖于可卡因的使用。具体而言，艾滋病毒adj患病率（PR）：1.12，置信区间（95%CI）：0.77-1.64，女性也没有（adj PR：1.07，95% CI：0.71-1.61）与未使用可卡因的参与者中的NCI相关，而HIV和（adj PR：1.39，95%CI：1.06-1.81）和女性（adj PR：1.53，95%CI：1.18-1.98）与使用可卡因的参与者的NCI相关。总体而言，HIV与两项NIHTB-CB指标相关。此外，艾滋病毒与可卡因使用者而不是非使用者的较低维度变化卡分类评分（执行功能测量）相关。女性可卡因使用者的认知能力比男性可卡因使用者差。艾滋病毒对认知能力的不利影响主要影响可卡因使用者。然而，可卡因的使用可能会缓和艾滋病毒和女性对认知能力的影响，突出了减少可卡因使用在AA人群中预防NCI的重要性。(Lai例如，艾滋病患者护理（2023年） 2. HIV感染和物质使用障碍共病对脑老化和功能连接的影响 我们正在使用166名参与者（上述922名参与者中，包括有/无艾滋病毒和有/无可卡因使用）的大脑MRI数据来研究艾滋病毒感染和物质使用障碍的共病对大脑衰老和功能连接的影响。MRI数据包括结构图像（T1加权、T2加权、FLAIR和T1 Rho加权）、基于扩散的图像、脑血流图像（动脉自旋标记图像）和静息状态功能MRI。我们将使用脑年龄回归分析和计算实用软件（BARACUS）估计四组（HIV+&CUD+，HIV+&CUD-，HIV-&CUD+，HIV-&CUD-）的脑年龄。参与者的实际年龄和大脑预测年龄之间的差异（大脑年龄差距）将用于评估认知障碍。我们将分别使用基于扩散的MRI和脑血流MRI检查这些组中的白色物质完整性和脑血流。与认知功能相关的大规模网络内部和之间的功能连接（例如，执行控制网络、默认模式网络和显著性网络）将用于评估这些组中的认知障碍。

1. Impact of comorbidity of HIV infection and substance use disorder on cognitive impairment Collaborating with Dr. Shenghan Laigroup at the University of Maryland School of Medicine, we started investigating the impact of comorbidity of HIV infection and substance use disorder on cognitive impairment. A cohort of 922 adults, predominantly African Americans (AAs), with/without HIV and with/without cocaine use disorder (CUD) were enrolled in the study investigating the association of HIV and cocaine use with neurocognitive impairment (NCI). Neurocognitive performance was assessed with the NIH Toolbox Cognition Battery (NIHTB-CB). NCI was considered to be present if the fully adjusted standard score for at least two cognitive domains was 1.0 standard deviation below the mean. Although the overall analysis showed HIV and female participants were associated with NCI, the associations were dependent on cocaine use. Specifically, neither HIV adj prevalence ratio (PR): 1.12, confidence interval (95% CI): 0.77-1.64 nor female sex (adj PR: 1.07, 95% CI: 0.71-1.61) was associated with NCI among participants who did not use cocaine, while both HIV (adj PR: 1.39, 95% CI: 1.06-1.81) and female sex (adj PR: 1.53, 95% CI: 1.18-1.98) were associated with NCI in participants who used cocaine. HIV was associated with two NIHTB-CB measures overall. In addition, HIV was associated with a lower dimensional change card sort score (an executive function measure) in cocaine users and not in nonusers. Cognitive performance was poorer in female than in male cocaine users. The adverse effect of HIV on cognitive performance predominantly affected cocaine users. However, cocaine use may moderate the impact of HIV and female sex on cognitive performance, highlighting the importance of reducing cocaine use in NCI prevention among the AA population. (Lai et al., AIDS Patient Care STDS, 2023) 2. Impact of comorbidity of HIV infection and substance use disorder on brain aging and functional connectivity We are using brain MRI data collected on 166 participants (out of the 922 participants above, including with/without HIV and with/without cocaine use) to investigate the impact of comorbidity of HIV infection and substance use disorder on brain aging and functional connectivity. MRI data include structural images (T1-weighted, T2-weighted, FLAIR, and T1Rho-weighted), diffusion-based images, cerebral blood flow images (arterial-spin labeling images), and resting-state functional MRI. We will estimate brain age using Brain-Age Regression Analysis and Computation Utility Software (BARACUS) in the four groups (HIV+&CUD+, HIV+&CUD-, HIV-&CUD+, HIV-&CUD-). The difference between a participants chronological age and brain-predicted age (brain age gap) will be used to assess cognitive impairment. We will examine white matter integrity and cerebral blood flow in these groups using diffusion-based MRI and cerebral blood flow MRI, respectively. Functional connectivity within and between large-scale networks relevant to cognitive functions (e.g., executive control network, default-mode network, and salience network) will be used to assess cognitive impairments in these groups.