Cognitive Function: Alcohol Abuse History Could Pose Problems for HIV Patients

HIV patients with a history of alcohol abuse (HAA) may be at higher risk for cognitive problems than HIV patients without HAA, according to a recent study. HIV-negative people with HAA, but who currently abstain, showed no significant loss of cognitive function. That suggests HAA either adds to the problems HIV infection can cause or has an interactive association with HIV's neurological effects, said Dr. Robert Bornstein, a professor of psychiatry, psychology and neurology in Ohio State's College of Medicine and Public Health.

"This study suggests that previous alcohol abuse may create a point of vulnerability that is exacerbated by the effects of the virus on the brain," said Bornstein. "There appears to be just enough alteration to cognitive function to make the brain more susceptible to the damaging impact of a second, independent process," he said. "Further studies would be required to determine if this combined effect is specific to HIV."

Even in patients without reported HAA, deficits in memory and learning, slower reaction time and decision-making are commonly reported in HIV patient studies. The most severe cognitive changes, including dementia, are almost always reported in the latest stage of the infection, but research has shown that even asymptomatic HIV patients can experience subtle cognitive impairments that affect their daily activities. Given that risk and the new findings, Bornstein said health care providers should be aware that patients with HAA are likely at greater risk for cognitive impairment.

In the study, 33 participants (12 HIV-negative, 21 HIV-positive) with HAA were compared to 47 people (18 HIV-negative, 29 HIV-positive) reporting no HAA or dependence. HIV-positive participants with HAA showed significant impairments in verbal IQ (7.7 percent lower), verbal reasoning (5.2 percent lower) and reaction time (about 10 percent slower with each hand) compared to HIV patients without HAA.

All participants with HAA had reduced their current alcohol intake, regardless of HIV-status, and had significantly reduced consumption compared to patients without HAA, said Bornstein. "The findings related to abuse history cannot be attributed to current use of alcohol," he said. "But the findings also show that even if patients with HIV infection and a history of alcohol abuse make a significant lifestyle change by abstaining from alcohol, they are not protected from the apparent adverse effects of alcohol abuse when combined with HIV infection.

"Our data suggest that the time at which alcohol consumption is stopped in HIV-positive patients could serve as an important predictor of their brain function in later stages of the illness," said Bornstein.

The full study, "The Effect of Previous Alcohol Abuse on Cognitive Function in HIV Infection," appeared in American Journal of Psychiatry (2004;161(2):249-54).

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