Lifetime marijuana and alcohol use, and cognitive dysfunction in people with human immunodeficiency virus infection

ABSTRACT

Background: Substance use is common among people with human immunodeficiency virus (HIV) infection. Alcohol, marijuana, and HIV can have negative effects on cognition. Associations between current and lifetime marijuana and alcohol use and cognitive dysfunction in people with HIV infection were examined. Methods: Some 215 HIV-infected adults with Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) substance dependence or ever injection drug use were studied. In adjusted cross-sectional regression analyses associations were assessed between current marijuana use, current heavy alcohol use, lifetime marijuana use, lifetime alcohol use, duration of heavy alcohol use (the independent variables), and 3 measures of cognitive dysfunction (dependent variables): both the (i) memory and (ii) attention domains from the Montreal Cognitive Assessment (MoCA) and the (iii) 4-item cognitive function scale (CF4) from the Medical Outcomes Study HIV Health Survey (MOS-HIV). Analyses were adjusted for demographics, primary language, depressive symptoms, anxiety, comorbidities, antiretroviral therapy, hepatitis C virus (ever), duration of HIV infection (years), HIV-viral load (log copies/mL), CD4 cell count, lifetime and recent cocaine use, and recent illicit and prescribed opioid use. Results: Current marijuana use was significantly and negatively associated with the MOS-HIV CF4 score (adjusted mean difference = −0.40, P = .01). Current marijuana use was not significantly associated with either MoCA score. Lifetime marijuana use and current heavy and lifetime alcohol use and duration of heavy alcohol use were not associated with any measure of cognitive dysfunction. Conclusion: Current marijuana use was associated with one measure of cognitive dysfunction, but there was not a consistent pattern of association with lifetime marijuana use or alcohol use and measures of cognitive dysfunction. Understanding the mechanism by which marijuana, with and without alcohol, are associated with worse cognition warrants larger, longer studies with more precise and diverse measurements of cognitive function.

KEYWORDS:

• Alcohol
• cannabis
• cognitive function
• ethanol
• HIV infection
• lifetime
• marijuana

Acknowledgments

The authors would like to thank the Boston ARCH Cohort study participants for the time and effort they have dedicated to this research. We also wish to thank all staff at Boston University and Boston Medical Center who supported this project. Specifically, we want to acknowledge Margo Godersky, Kate Haworth, Keshia Toussaint, and Laura Vercammen for their work in recruitment, data collection, and participant retention; and Seville Meli for her leadership and assistance with study management.

The authors declare that they have no conflicts of interest.

Author contributions

S.A.L. and R.S. conceived the study question. A.S.V. was the project manager and led data collection. Both M.R.W. and T.C.H. conducted statistical analyses and supported interpretation of results. Both A.Y.W. and M.S. provided HIV clinical expertise and facilitated clinic access. R.S. was the Principal Investigator of the Boston ARCH Cohort study and J.H.S. was the Principal Investigator of the URBAN ARCH Consortium. S.A.L. wrote the first draft of the manuscript. All authors provided considerable editing, revisions, and content review of the initial manuscript draft. All authors read and approved the final draft of the manuscript.

Additional information

Funding

Funding for this study was provided through a collaborative agreement with the National Institute of Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health (grant numbers U01AA020784, U24AA020778, U24AA020779). NIAAA was not involved in the collection, analysis, or interpretation of data and was also not involved in writing the manuscript or the decision to submit it for publication. Funding was also provided from the National Center for Advancing Translational Science, National Institutes of Health, to the Boston University Clinical and Translation Science Institute (grant number UL1TR001430), which supplemented the cost of study visits conducted at the Boston University General Clinical Research Unit. The National Center for Advancing Translational Science was not involved in the collection, analysis, or interpretation of data and was also not involved in writing the manuscript or the decision to submit it for publication.