Of the 1.2 million Americans living with HIV/AIDS, over half experience HIV-associated neurocognitive impairment. Marijuana is the most commonly abused drug among HIV+ persons;over a third have used marijuana in the past year, with >25% reporting no other drug use. Although chronic marijuana use also alters brain functioning and can produce neurocognitive impairment, few studies have investigated interactions between marijuana and HIV infection on brain functioning. It is hypothesized that marijuana's effect on brain functioning will be more pronounced among HIV+ individuals due to their already limited cognitive resources. The proposed project integrates training and research plans that are designed to develop the applicant's expertise in neurocognitive assessment, brain circuitry relevant to HIV infection and addiction, functional magnetic resonance imaging (fMRI) design and data analysis, and advanced statistical analysis. This research plan will allow her to implement and refine newly developed skills in these areas. Specifically, the applicant seeks to integrate cognitive and neuroscience techniques into her patient-oriented research. The proposed project will provide her with mentored training in (1) assessment of neurocognitive impairment associated with HIV infection and drug abuse, (2) the application of fMRI technology to clinical research, and (3) longitudinal analyses using repeated measures and multilevel designs. The training plan includes coursework and workshops, one-on-one mentorship, participation in seminars, directed readings, and attendance at national and international conferences. In Study 1 (Neurocognitive Assessment), 75 HIV+ persons stratified by marijuana use will complete a battery of neurocognitive and experimental decision-making tasks. The goal is to identify patterns of neurocognitive functioning associated with co-occurring HIV infection and marijuana use (Aim 1), and to test whether these relationships are moderated by HIV disease progression (Aim 2). Study 2 (fMRI Analysis) utilizes fMRI to examine brain activation patterns as a function of marijuana use during a decision-making task with the aim of elucidating neural mechanisms underlying cognitive processes altered by HIV and marijuana (Aim 3). This integration of research methodologies is expected to inform future research in this understudied field. Furthermore, at the culmination of this fellowship, the applicant will have a specialized skll set and be well prepared to begin the next phase of her training, in which she intends to gain further expertise in the application of fMRI technology to patient-oriented research in HIV+ persons.

Public Health Relevance

More than half of those living with HIV/AIDS experience HIV-associated neurocognitive decline. Marijuana is the mostly commonly abused drug among HIV+ individuals, and its impact on brain functioning may be pronounced among this population due to their already limited cognitive resources. The proposed research utilizes neurocognitive testing, experimental decision-making tasks, and fMRI technology to investigate the effects of marijuana use on brain functioning among patients with HIV/AIDS, with the expectation that findings will: (1) elucidate the neural mechanisms underlying cognitive processes altered by HIV and marijuana;and (2) inform future research endeavors in this understudied field.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZRG1)
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Lin, Yu
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Duke University
Schools of Medicine
United States
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Skalski, Linda M; Towe, Sheri L; Sikkema, Kathleen J et al. (2016) The impact of marijuana use on memory in HIV-infected patients: a comprehensive review of the HIV and marijuana literatures. Curr Drug Abuse Rev :
Meade, Christina S; Towe, Sheri L; Skalski, Linda M et al. (2015) Independent effects of HIV infection and cocaine dependence on neurocognitive impairment in a community sample living in the southern United States. Drug Alcohol Depend 149:128-35