Neurocognitive Decline Seen Among Binge Drinkers Living With HIV

Living with HIV while binge drinking correlated with the worsening of 4 facets of neurocognitive functioning—global neurocognition, processing speed, delayed recall, and working memory—in a recent study carried out among 4 groups of patients participating in National Institutes of Health–funded research studies at the University of California, San Diego (UCSD) HIV Neurobehavioral Research Program.

These findings of a secondary analysis of the patients’ baseline visits to the program appeared online recently in Journal of the International Neuropsychological Society.

“In addition to increased risk for physical illness (eg, liver disease and cardiovascular risk),” the authors wrote, “there is substantial evidence indicating that comorbid HIV and heavy alcohol use is more detrimental to brain structure and results in higher rates of neurocognitive impairment than either condition alone.”

Participants living with HIV (n = 86) and without HIV (n = 61) were stratified by their HIV and binge drinking status into 4 cohorts:

• HIV+/Binge+ (n = 30)
• HIV−/Binge+ (n = 23)
• HIV+/Binge− (n = 55)
• HIV−/Binge− (n = 38)

To be included, all participants had to report alcohol use of at least 1 drink in the previous 30 days. Binge drinking was defined as consuming 4 or more drinks in 2 hours for women and consuming 5 or more drinks in 2 hours for men. Analyses were carried out 3 ways:

• A comprehensive neuropsychological battery for neurocognitive T scores
• Analysis of covariance (ANCOVA) models for independent/interactive influences of HIV and binge drinking on neurocognitive outcomes
• Multiple linear regressions for whether HIV/binge group status influenced the relationship between age and neurocognition

Among the 4 groups evaluated, those with dual HIV-positive status and who were considered binge drinkers fared worst overall. Not only did they have worse outcomes regarding the 4 areas of neurocognitive ability previously stated compared with the other 3 groups (all P < .05), but the interaction between HIV status and binge drinking did not predict these outcomes (all P > .05), the authors wrote.

However, when they narrowed their analysis to a comparison between the HIV+/Binge+ and HIV−/Binge− groups, “Significant interactions between age and HIV/Binge group showed that HIV+/Binge+ participants demonstrated steeper negative relationships between age and neurocognitive outcomes of learning, delayed recall, and motor skills compared to HIV−/Binge− participants (all P < .05).”

A majority of the patients in the 4 groups were male and White. Those in the HIV+/Binge− group had the oldest mean (SD) age, at 46.42 (1.34), whereas those in the HIV−/Binge− group were the youngest, at 35.50 (11.95) years. The most common comorbidity was lifetime major depressive disorder, and all groups reported a history of lifetime alcohol use disorder (HIV−/Binge−, 13.2%; HIV−/Binge+, 82.6%; HIV+/Binge–, 27.3%; HIV+/Binge+, 83.3%; all P < .001).

Analyses also revealed a significant omnibus difference across the 4 patient groups in mean global neurocognitive function (F [3142] = 4.39; P = .006), as driven by differences in the following:

• Processing speed (F [3142] = 3.86; P = .011)
• Delayed recall (F [3142] = 3.27; P = .023)
• Working memory (F [3142] = 3.851; P = .011)

In addition, the cumulative negative effects of HIV and binge drinking could be seen in results from Jonckheere–Terpstra tests that indicated significantly lower global (JT = 2303.5; P < .001) and processing speed (JT = 2414.0; P = .001) performance per risk increase (0 risks = HIV−/Binge−; 1 risk = HIV−/Binge+ or HIV+/Binge−; 2 risks = HIV+/Binge+), and delayed recall and working memory deficits were more likely with binge drinking.

For the influence of age on these outcomes, through multiple linear regression, the investigators found significantly worse results in the HIV+/Binge+ group upon comparison with the HIV-/Binge- group for the following:

• Learning:
  • HIV+/Binge+: b = −0.43 (P = .001)
  • HIV-/Binge-: b = −0.06 (P = .647)
• Delayed recall:
  • HIV+/Binge+: b = −0.47 (P < .001)
  • HIV-/Binge-: b = −0.05 (P = .690)
• Motor skills:
  • HIV+/Binge+: b = −0.63 (P < .001)
  • HIV-/Binge-: b = 0.04 (P = .811)

“Given the rapidly growing population of older adults with and without HIV along with the increased rates of binge drinking among them, studying the combined effects of HIV and binge drinking across the lifespan is timely and important,” the authors wrote. “Our finding of HIV/Binge group differences in neurocognitive domains of processing speed, delayed recall, and working memory is also consistent with the frontostriatal and frontolimbic neural damage that has been observed in studies of adults with HIV and heavy alcohol use.”

They recommend instituting clinical screening for binge drinking behavior in patients living with HIV, notably because alcohol use disorder (AUD) is not a frequent diagnosis despite the binge drinking behavior. Psychoeducation and psychosocial interventions could also help to reduce binge drinking among older patients.

Future studies, too, should investigate outcomes following reducing or stoppage of binge drinking behavior in persons living with HIV “given evidence that improvements in neurocognitive functioning may be possible after sustained sobriety following AUD recovery among HIV− populations.”

Reference

Paolillo EW, Saloner R, Kohli M, et al. Binge drinking relates to worse neurocognitive functioning among adults aging with HIV. J Int Neuropsychol Soc. Published online July 26, 2021. doi:10.1017/S1355617721000783