The nature and consequences of cognitive deficits among tobacco smokers with HIV: a comparison to tobacco smokers without HIV |
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Authors: | Joseph D Harrison Jessica A Dochney Sonja Blazekovic Frank Leone David Metzger Ian Frank Robert Gross Anita Hole Karam Mounzer Steven Siegel Robert A Schnoll Rebecca L Ashare |
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Institution: | 1.Department of Psychiatry,University of Pennsylvania Perelman School of Medicine,Philadelphia,USA;2.Pulmonary, Allergy, & Critical Care Division,University of Pennsylvania Presbyterian Medical Center,Philadelphia,USA;3.Division of Infectious Diseases,University of Pennsylvania Perelman School of Medicine,Philadelphia,USA;4.Center for Clinical Epidemiology and Biostatistics,University of Pennsylvania,Philadelphia,USA;5.Philadelphia Fight,Philadelphia,USA;6.Department of Psychiatry and Behavioral Sciences,Keck School of Medicine of the University of Southern California,Los Angeles,USA;7.Department of Psychiatry and Abramson Cancer Center,University of Pennsylvania,Pennsylvani,USA |
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Abstract: | HIV-infected smokers lose more years of life to tobacco-related disease than HIV. Since neurocognitive deficits are common among those with HIV and are associated with smoking persistence, these deficits may be a unique barrier to smoking cessation among HIV-infected smokers. Documenting unique differences in and correlates of cognition among HIV-infected smokers is a critical step towards developing a population-specific tobacco cessation treatment. We compared neurocognitive function between HIV-infected (n = 103) and HIV-uninfected smokers (n = 70), accounting for demographic and smoking-related variables. We also evaluated whether HIV-related health outcomes (e.g., CD4 count, viral load, depression ratings, quality of life QoL]) and HAART adherence were associated with cognition. Participants completed neurocognitive tasks (N-back and Continuous Performance Task CPT]) measuring working memory, attention, and processing speed, and intra-individual variability. Stepwise regression models were conducted and validated with resampling techniques. HIV-infected smokers performed worse than HIV-uninfected smokers on working memory, processing speed, and intra-individual variability (all p < 0.01). ROC analysis for the model including cognitive measures demonstrated 85% area under the curve, which indicates “good prediction” for distinguishing between HIV-infected and HIV-uninfected smokers. This was a significant improvement over the model including demographic and smoking-related variables only (p = 0.0003). Among HIV-infected smokers, neurocognitive performance was negatively associated with QoL and depression ratings. Smoking cessation interventions for HIV-infected smokers should consider cognitive neurorehabilitation as a potential strategy to decrease the likelihood of nicotine relapse and decrease tobacco-related morbidity in this population. |
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