From the Joint Doctoral Program in Clinical Psychology (KB and EW), San Diego State University and University of California San Diego, San Diego, CA; and Department of Psychiatry (JEI, EEM, DJM, DRF, RJE, IG, and SPW), University of California San Diego, San Diego.
J Addict Med. 2013 Jul-Aug;7(4):255-63. doi: 10.1097/ADM.0b013e318293653d.
Disability among long-term methamphetamine (MA) users is multifactorial. This study examined the additive adverse impact of human immunodeficiency virus (HIV) infection, a common comorbidity in MA users, on functional dependence.
A large cohort of participants (N = 798) stratified by lifetime MA-dependence diagnoses (ie, MA+ or MA-) and HIV serostatus (ie, HIV+ or HIV-) underwent comprehensive baseline neuromedical, neuropsychiatric, and functional research evaluations, including assessment of neurocognitive symptoms in daily life, instrumental and basic activities of daily living, and employment status.
Independent, additive effects of MA and HIV were observed across all measures of functional dependence, independent of other demographic, psychiatric, and substance-use factors. The prevalence of global functional dependence increased in the expected stepwise fashion across the cohort, with the lowest rates in the MA-/HIV- group (29%) and the highest rates in the MA+/HIV+ sample (69%). The impact of HIV on MA-associated functional dependence was moderated by nadir CD4 count, such that polysubstance use was associated with greater disability among those HIV-infected persons with higher but not lower nadir CD4 count. Within the MA+/HIV+ cohort, functional dependence was reliably associated with neurocognitive impairment, lower cognitive reserve, polysubstance use, and major depressive disorder.
HIV infection confers an increased concurrent risk of MA-associated disability, particularly among HIV-infected persons without histories of immune compromise. Directed referrals, earlier HIV treatment, and compensatory strategies aimed at counteracting the effects of low cognitive reserve, neurocognitive impairment, and psychiatric comorbidities on functional dependence in MA+/HIV+ individuals may be warranted.
长期使用甲基苯丙胺（MA）的患者的残疾是多因素的。本研究调查了人类免疫缺陷病毒（HIV）感染的附加不利影响，这是 MA 使用者的常见合并症，对功能依赖的影响。
一项大型队列研究（N=798）根据终生 MA 依赖性诊断（即 MA+或 MA-）和 HIV 血清状态（即 HIV+或 HIV-）进行分层，接受了全面的基线神经医学、神经精神病和功能研究评估，包括日常生活中的神经认知症状评估、工具和基本日常生活活动以及就业状况。
在所有功能依赖测量中，MA 和 HIV 的独立、累加效应独立于其他人口统计学、精神病学和药物使用因素。在整个队列中，预计会以逐步的方式增加全球功能依赖的流行率，MA-/HIV-组的流行率最低（29%），MA+/HIV+组的流行率最高（69%）。HIV 对 MA 相关功能依赖的影响受 CD4 计数最低点的调节，即 CD4 计数较高而不是较低的 HIV 感染者中，多药物使用与更大的残疾有关。在 MA+/HIV+队列中，功能依赖与神经认知障碍、认知储备较低、多药物使用和重度抑郁症可靠相关。
HIV 感染会增加与 MA 相关的残疾的并发风险，尤其是在没有免疫受损史的 HIV 感染者中。可能需要针对 MA+/HIV+个体的认知储备、神经认知障碍和精神共病对功能依赖的影响进行有针对性的转介、早期 HIV 治疗和补偿策略。
