Paolillo Emily W, Saloner Rowan, Montoya Jessica L, Campbell Laura M, Pasipanodya Elizabeth C, Iudicello Jennifer E, Moore Raeanne C, Letendre Scott L, Jeste Dilip V, Moore David J
Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California.
Department of Psychiatry, University of California San Diego, San Diego, California.
AIDS Res Hum Retroviruses. 2019 Nov/Dec;35(11-12):1044-1053. doi: 10.1089/AID.2019.0062. Epub 2019 Aug 12.
HIV and methamphetamine (MA) use disorder are commonly comorbid and individually associated with adverse health consequences, including frailty; however, less is known about the combined effects of both conditions. The current cross-sectional study examined how HIV and lifetime MA use disorder relate to frailty and explored associations between frailty and relevant clinical outcomes (i.e., neurocognitive and everyday functioning). Participants were categorized into three groups based on HIV status and lifetime MA diagnosis: HIV+/MA+ ( = 43), HIV+/MA- ( = 75), and HIV-/MA- ( = 92). A frailty index score (representing proportion of accumulated multisystem deficits) was calculated from 27 medical and psychiatric deficits. Multiple regression was used to examine frailty index score by HIV/MA group. Additional multiple regression models examined the interaction between frailty and HIV/MA group on cognitive and everyday functioning. Comorbid HIV+/MA+ participants had higher frailty index scores than both HIV-/MA- ( = -0.13, < .001) and HIV+/MA- participants ( = -0.06, = .007). Additional models linked higher frailty index score to worse global neurocognition ( = -17.6, = .018) and greater likelihood of everyday functioning dependence (odds ratio = 1.56, = .021). Although these relationships did not significantly differ by HIV/MA status, group-stratified analyses showed that associations of frailty with neurocognitive and everyday functioning were strongest among the HIV+/MA+ group. Multimodal public health interventions aimed at reducing frailty may help to decrease the likelihood of neurocognitive and everyday functioning problems. Current findings additionally lay groundwork for future longitudinal research examining whether frailty predicts onset of neurocognitive and functional decline in individuals with comorbid HIV and MA use disorder.
艾滋病毒与甲基苯丙胺（MA）使用障碍通常并存，且各自都与包括身体虚弱在内的不良健康后果相关；然而，对于这两种情况的综合影响了解较少。当前的横断面研究考察了艾滋病毒与终生MA使用障碍如何与身体虚弱相关，并探讨了身体虚弱与相关临床结局（即神经认知和日常功能）之间的关联。参与者根据艾滋病毒状态和终生MA诊断被分为三组：艾滋病毒阳性/MA阳性（n = 43）、艾滋病毒阳性/MA阴性（n = 75）和艾滋病毒阴性/MA阴性（n = 92）。从27项医学和精神方面的缺陷计算出一个身体虚弱指数评分（代表累积多系统缺陷的比例）。使用多元回归分析按艾滋病毒/MA组考察身体虚弱指数评分。额外的多元回归模型考察了身体虚弱与艾滋病毒/MA组在认知和日常功能方面的相互作用。艾滋病毒阳性/MA阳性的合并症参与者的身体虚弱指数评分高于艾滋病毒阴性/MA阴性参与者（β = -0.13，p <.001）和艾滋病毒阳性/MA阴性参与者（β = -0.06，p =.007）。额外的模型将较高的身体虚弱指数评分与较差的整体神经认知（β = -17.6，p =.018）以及日常功能依赖的更大可能性（比值比 = 1.56，p =.021）联系起来。尽管这些关系在艾滋病毒/MA状态方面没有显著差异，但分组分层分析表明，身体虚弱与神经认知和日常功能之间的关联在艾滋病毒阳性/MA阳性组中最强。旨在减轻身体虚弱的多模式公共卫生干预措施可能有助于降低神经认知和日常功能问题的可能性。当前的研究结果还为未来的纵向研究奠定了基础，该研究将考察身体虚弱是否能预测艾滋病毒和MA使用障碍合并症患者神经认知和功能衰退的发作。
