Cognitive Impairment among People Who Use Heroin and Fentanyl: Findings from the Miami Adult Studies on HIV (MASH) Cohort

ABSTRACT

Background: Cognitive impairment is common in people living with HIV (PLWH). Opioid drugs exert direct and indirect effects on cognitive processes, which may contribute to cognitive dysfunction among PLWH. This study was designed to determine if opioid use is associated with cognitive impairment and whether the effect differs between PLWH and HIV-uninfected adults. Other neuropsychiatric symptoms, such as depression and apathy, were also examined. We conducted a cross-sectional analysis of 265 PLWH and 284 HIV-uninfected participants from the Miami Adult Studies on HIV (MASH) cohort. The Mini-Mental State Examination (MMSE) was used to assess cognitive impairment. Substance use was self-reported. Overall, 26.8% of PLWH and 15.1% of HIV-uninfected used opioids. Cognitive impairment was more frequent among people who used heroin and/or fentanyl than those who misused prescription opioids (31.6% vs. 10.5%, p = .005). The use of heroin/fentanyl was associated with increased odds for cognitive impairment (adjusted OR: 2.21, 95% CI 1.05–4.64, p = .036). Among PLWH only, the misuse of opioids was associated with a higher frequency of neuropsychiatric symptoms such as depression and apathy. A higher risk for cognitive impairment was seen among people who used heroin and fentanyl. PLWH who misuse opioids may be at an increased risk for neuropathology, but elucidation of mechanisms for opioid-induced cognitive deficits is needed.

KEYWORDS:

• HIV
• heroin
• fentanyl
• opioid-related disorders
• cognitive impairment
• substance abuse

Acknowledgments

We thank all the MASH cohort study participants and the study research team for making this study possible.

Disclosure of interest

The authors report no conflict of interest.

Contributors

MK Baum is the Principal Investigator of “Cohort Studies on HIV/AIDS and Substance Abuse in Miami,” and designed the parent study along with A Campa and SS Martinez. JA Tamargo and MK Baum wrote the first draft of the manuscript. JA Tamargo and T Li conducted all statistical analyses. JA Tamargo and G Zarini conducted participant assessments and data collection. R Mandler, KE Sherman, and C Meade provided scientific advice and critical feedback of the manuscript. All authors contributed to and have approved the final manuscript.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by the National Institute on Drug Abuse at the National Institutes of Health under Grant [U01DA040381]. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.