By Jill Pease
With advancements in treatment, people with HIV are living longer. More than half of Americans with HIV are now over age 50.
Yet with longer lives comes an additional health concern. As people living with HIV age, about half will experience some sort of cognitive decline.
Now, with the support of a $6.6 million program project grant from the National Institute on Alcohol Abuse and Alcoholism, UF researchers, along with colleagues at the University of Miami, Florida State University and the University of Louisville, will evaluate three promising interventions that may improve cognitive function in those with HIV who consume alcohol.
Previous studies have shown elevated risk for adverse health effects in people with HIV who consume hazardous amounts of alcohol, including higher levels of HIV virus, lower medication adherence, more rapid disease progression and cognitive impacts.
Even with contemporary antiretroviral therapy, cognitive function declines can occur earlier in people living with HIV, and can have a detrimental effect on patients’ ability to manage their disease, said Robert Cook, M.D., M.P.H., one of the project’s principal investigators and director of the Southern HIV and Alcohol Research Consortium, or SHARC.
“Cognitive function is needed for day-to-day decision-making, such as medication adherence, and to be able to engage in behavior change, including alcohol-reduction interventions,” said Cook, a professor of epidemiology and medicine at PHHP and the UF College of Medicine.
Scientists believe that cognitive decline in people with HIV is associated with systemic inflammation, which may be caused by the disease itself. Alcohol consumption may also contribute through effects on the gut microbiome, although the mechanisms that influence gut inflammation and brain pathways are not well understood.
“Previous research by our team and others shows connections between current and lifetime alcohol use and adverse effects on cognitive function,” said Ronald Cohen, Ph.D., one of the study’s other principal investigators, director of the Center for Cognitive Aging and Memory Clinical Translational Research and a PHHP professor of clinical and health psychology. “Our neuroimaging findings show that heavy alcohol use is associated with structural and functional brain abnormalities in people living with HIV.”
The new project will include two clinical trials led by different teams of investigators. One trial will focus on an intervention to help motivate people to reduce their drinking. The other trial will evaluate both a transcutaneous vagus nerve stimulator device and a probiotic intended to improve the gut microbiome. The strategies used in the trials have been designed for application in real-world settings.