The purpose of this study is to evaluate causal association between neuropsychological executive dysfunction and HIV infection among young injection drug users (IDUs) through two linked studies. First, a case- control study will be conducted to compare the baseline neuropsychological performance of 11 HIV-positive and 400 HIV-negative IDUs. The primary aim of the case-control study is to estimate the strength of association between executive dysfunction and being HIV infected using logistic regression modeling to adjust for suspected confounders, including CD4 counts. Second, a longitudinal study would be conducted in which the cohort of 400 seronegative IDUs completing the baseline neuropsychological battery will be re-assessed on three subsequent occasions, roughly six months apart, and the data analyzed primarily by GLM/GEE models. The primary aim of the longitudinal study is to estimate the magnitude of the suspected causal relationship between executive dysfunction and HIV-risk behaviors while adjusting for time-invariant (e.g. sex, ethnicity) and time-varying (e.g. degree of drug abuse) covariates. In the longitudinal study, we also seek to evaluate: (1) the degree to which specific executive dysfunctions predispose young IDUs to high-risk injection practices or sex behaviors, and (2) whether observed relationship between executive dysfunction and HIV-risk behaviors can be understood independent of levels of drug -taking frequency, or whether the observed data are more consistent with complex patterns of interdependency between executive dysfunction, drug-taking frequency, and HIV-risk-behaviors. The proposed study benefits substantially from linkages to NIDA- and CDC-funded studies of young IDUs. To date, our research team knows of no published report examining neuropsychological deficits that signal HIV-risk behaviors. If sucessful, this project will shed new light on significant and potentially malleable HIV-risk factors in young IDU initiates. This will be important evidence because injection drug abuse continues to account for a large proportion of HIV seroconversions particularly among young women and minorities. As such, this RO1 research project serves as an important initial step in a line of innovative investigations about suspected causal associations between neuropsychological deficits and HIV-risk behaviors in IDUs. Ultimately, this line of investigation should lead to changes in public and clinical practices designed to prevent HIV infection.
Showing the most recent 10 out of 31 publications