Gupta Saurabh, Iudicello Jennifer E, Shi Chuan, Letendre Scott, Knight Adam, Li Jianhua, Riggs Patricia K, Franklin Donald R, Duarte Nichole, Jin Hua, Hampton Atkinson J, Yu Xin, Wu Zunyou, Grant Igor, Heaton Robert K
HIV Neurobehavioral Research Program (HNRP), University of California San Diego, CA, USA; Gupta Psychology & Assessment Services, USA.
HIV Neurobehavioral Research Program (HNRP), University of California San Diego, CA, USA.
Drug Alcohol Depend. 2014 Apr 1;137:29-35. doi: 10.1016/j.drugalcdep.2013.12.021. Epub 2014 Jan 13.
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.
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.
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.
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.
先前的研究已分别证明,有注射吸毒史(IDU)、丙型肝炎病毒(HCV)感染史和美沙酮维持治疗(MMT)史的人群存在神经心理学(NP)损害,但对于这三种风险因素共同作用下的NP影响知之甚少。在中国,这个问题尤为重要,因为中国正在通过政府广泛资助的MMT来应对高度合并HCV的IDU流行,特别是鉴于最近有证据表明美沙酮在某些情况下可能具有神经保护作用。
我们对195名接受MMT的中国海洛因IDU个体(IDU+组)进行了全面的NP测试,其中大多数人也是HCV+(87%;n = 169),并将他们的NP表现与198名人口统计学特征相似的非IDU中国对照组(IDU-组)进行比较。两组的所有参与者HIV感染检测均为阴性,HIV感染在中国IDU人群中也是一种常见的合并症。
IDU+组的整体NP损害率没有增加,在任何单项NP测试指标上的表现也没有显著更差。在IDU+组中,肝脏疾病特征和报告的海洛因使用细节与NP表现没有显著关联。
在有或没有HCV感染的IDU+受试者中未检测到NP损害令人惊讶,特别是考虑到我们的NP测试先前已证明对中国与HIV感染相关的神经认知障碍具有敏感性。一个可能的解释,应在未来研究中进行探索,是美沙酮在HCV感染和/或海洛因戒断背景下的潜在神经保护作用。