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Age-Accelerated Increase of White Matter Hyperintensity Volumes Is Exacerbated by Heavy Alcohol Use in People Living With HIV.

Authors
  • Pfefferbaum, Adolf1
  • Zhao, Qingyu2
  • Pohl, Kilian M1
  • Sassoon, Stephanie A3
  • Zahr, Natalie M1
  • Sullivan, Edith V4
  • 1 Center for Health Sciences, SRI International, Menlo Park, California; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
  • 2 Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
  • 3 Center for Health Sciences, SRI International, Menlo Park, California.
  • 4 Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California. Electronic address: [email protected].
Type
Published Article
Publication Date
Feb 01, 2024
Volume
95
Issue
3
Pages
231–244
Identifiers
DOI: 10.1016/j.biopsych.2023.07.023
PMID: 37597798
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Antiretroviral treatment has enabled people living with HIV infection to have a near-normal life span. With longevity comes opportunities for engaging in risky behavior, including initiation of excessive drinking. Given that both HIV infection and alcohol use disorder (AUD) can disrupt brain white matter integrity, we questioned whether HIV infection, even if successfully treated, or AUD alone results in signs of accelerated white matter aging and whether HIV+AUD comorbidity further accelerates brain aging. Longitudinal magnetic resonance imaging-FLAIR data were acquired over a 15-year period from 179 control individuals, 204 participants with AUD, 70 participants with HIV, and 75 participants with comorbid HIV+AUD. White matter hyperintensity (WMH) volumes were quantified and localized, and their functional relevance was examined with cognitive and motor testing. The 3 diagnostic groups each had larger WMH volumes than the control group. Although all 4 groups exhibited accelerating volume increases with aging, only the HIV groups showed faster WMH enlargement than control individuals; the comorbid group showed faster acceleration than the HIV-only group. Sex and HIV infection length, but not viral suppression status, moderated acceleration. Correlations emerged between WMH volumes and attention/working memory and executive function scores of the AUD and HIV groups and between WMH volumes and motor skills in the 3 diagnostic groups. Even treated HIV can show accelerated aging, possibly from treatment sequelae or legacy effects, and notably from AUD comorbidity. WMH volumes may be especially relevant for tracking HIV and AUD brain health because each condition is associated with liability for hypertensive processes, for which WMHs are considered a marker. Copyright © 2023 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

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