Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Campus Box 102848, Durham, NC, 27710, USA.
Brain Imaging and Analysis Center, Duke University Medical Center, Campus, Box 3918, Durham, NC, 27710, USA.
J Neurovirol. 2023 Feb;29(1):53-64. doi: 10.1007/s13365-023-01111-9. Epub 2023 Feb 14.
Cocaine use, which is disproportionately common in people living with HIV (PWH), is known to have neurotoxic effects that may exacerbate HIV neuropathogenesis. While both cocaine use and HIV disease are independently associated with deficits in gray matter (GM) volume, the additive effect of cocaine use to HIV disease on GM volume has not been explored. Here, we investigated subcortical and cortical brain volume differences between four groups of individuals with and without HIV disease and/or cocaine use. Participants also completed a comprehensive neuropsychological testing battery, and HIV disease characteristics were recorded. Within subcortical regions, cocaine use was independently associated with higher volume in the dorsal striatum and pallidum, while HIV disease was associated with lower volume in the nucleus accumbens and thalamus. For cortical regions, there was an additive effect of cocaine use on HIV disease in parietal and occipital lobe volume with PWH who used cocaine displaying the lowest GM volume. Within regions that differed between groups, higher neurocognitive function was positively associated with thalamic, nucleus accumbens, dorsal striatum, and occipital lobe volume. For regions that showed a significant main effect of HIV disease, lower nadir CD4 + T cell count was associated with lower nucleus accumbens and occipital lobe volume. Lower current CD4 + T cell count was associated with lower occipital lobe volume. These results suggest that PWH who use cocaine are at greater risk for cortical atrophy than cocaine use or HIV disease alone.
可卡因的使用在 HIV 感染者（PLWH）中尤为普遍，已知其具有神经毒性作用，可能会加剧 HIV 神经发病机制。虽然可卡因的使用和 HIV 疾病都与灰质（GM）体积减少独立相关，但可卡因的使用对 HIV 疾病对 GM 体积的附加影响尚未得到探索。在这里，我们研究了四组有或没有 HIV 疾病和/或可卡因使用的个体的皮质下和皮质脑体积差异。参与者还完成了全面的神经心理学测试组合，并记录了 HIV 疾病特征。在皮质下区域，可卡因的使用与背侧纹状体和苍白球的体积增加独立相关，而 HIV 疾病与伏隔核和丘脑的体积减少相关。对于皮质区域，可卡因的使用对 HIV 疾病在顶叶和枕叶体积上有叠加效应，使用可卡因的 PLWH 显示出最低的 GM 体积。在组间差异的区域内，较高的神经认知功能与丘脑、伏隔核、背侧纹状体和枕叶体积呈正相关。对于表现出 HIV 疾病显著主要影响的区域，最低 CD4+T 细胞计数与伏隔核和枕叶体积减少相关。当前 CD4+T 细胞计数较低与枕叶体积减少相关。这些结果表明，使用可卡因的 PLWH 比可卡因使用或 HIV 疾病单独存在时，皮质萎缩的风险更高。
