Ongoing Research Projects
Neurocognitive Effects of Opiate Agonist Treatment in HIV-infected Drug Users
Grant Information: National Institute of Drug Abuse - NIH R01DA032552
Study Period: 08/01/12-07/31/17
Total Award: $3,329,725
Overview: Rates of HIV-associated neurocognitive (NC) disorders remain high, despite the emergence of HAART. HIV-infected drug users exhibit accelerated and more severe NC dysfunction than either HIV-infected persons without drug use histories, or uninfected drug users. Because the risk of NC impairment is also elevated in opioid users regardless of HIV-status, there is additive risk of NC impairment for HIV-infected opioid users. How medications commonly used to treat opioid dependence affect the progression NC dysfunction is poorly understood. Methadone is the most commonly used medication for opioid addiction treatment, and some studies suggest that methadone, a full mu opioid receptor agonist, may be associated with NC deficits. However, these studies have largely lacked longitudinal follow-up to assess whether long-term methadone maintenance is associated with progression of NC dysfunction. Further, despite its therapeutic benefits, methadone is under- utilized, with only 12% of opioid-dependent Americans receiving methadone in 2005. To remedy this, buprenrophine was approved for opioid addiction treatment in 2002. Buprenorphine, a partial mu opioid receptor agonist and kappa opioid receptor antagonist, may have favorable NC effects compared to methadone. However, few studies have examined buprenorphine's NC effects, and none have included longitudinal follow-up or focused on HIV-infected persons. To ensure that treatment providers understand the full range of buprenorphine's effects, it is crucial to evaluate the relative NC effects of buprenorphine and methadone in opioid users with and without HIV infection. The aims of this large-scale randomized clinical trial are: (1) to determine whether buprenorphine is associated with significant improvement in NC function compared to methadone; (2) to assess the impact of buprenorphine treatment on change in NC function over time; and (3) to assess the impact of methadone treatment on changes in NC function over time. This is t he irst randomized longitudinal trial investigating the impact of methadone and buprenorphine on neurocognitive outcomes. Findings from this study have the potential to impact treatment recommendations for opioid dependence for drug users with or without HIV, to improve NC outcomes, and to deepen our understanding of brain-drug interactions.
Medication Adherence Among HIV+ Hispanics
Grant Information: NIH K23MH079718
Study Period: 09/01/07- 08/31/13
Total Award: $929,831
Overview: This study examines the neurocognitive and sociocultural aspects of antiretroviral adherence among HIV+ Latino/a adults. The primary aims of the study are to (1) characterize neurocognitive sequelae among HIV+ Latinos; (2) compare rates of antiretroviral adherence among HIV+ Latinos and non-Hispanic Whites; and (3) determine whether neurocognitive, sociocultural factors, and health beliefs and behaviors are related to antiretroviral adherence and biological outcomes among HIV+ Latinos. The majority of study participants come from the five boroughs of New York City, with the most from the East [Spanish] Harlem section of Manhattan, which is predominantly Latina/o. Data collection for the MÁS study is currently closed, and the lab is working on data analysis, presentation, and publication.
CNS HIV Antiretroviral Therapy Effects Research (CHARTER)
Grant Information: NIH N01MH22005
Study Period: 4/01/03 – Present
Overview: The CNS HIV Antiretroviral Therapy Effects Research (CHARTER) study aims to assess the long-term effects of potent anti-retroviral therapy on HIV-induced disease of the nervous system. The study was commissioned by the National Institute of Mental Health and the National Institute of Neurological Diseases and Stroke to examine a diverse group of HIV-infected persons broadly reflective of patients at university-affiliated HIV treatment centers in the United States. CHARTER was designed with broad inclusion criteria, and a large sample size so as to afford ascertainment of the frequency and severity of HAND, as well as the specific contributions of HIV vs other factors (comorbidities) to neurocognitive impairment.
Recent Student Presentations
Arce Rentería M., Byrd, D., Miranda, C., Fuentes, A., Rosario, A., Coulehan, K., Sheynin, J., Morgello, S., Rivera Mindt, M. (February, 2013)The Role of Neurocognitive Dispersion in HIV+ Adults with a History of Substance Use Disorders.Poster presented at the41st Annual Meeting of the International Neuropsychological Society, Waikoloa, HI.
Arias, F., Arnsten, J.H., Cunningham, C.O., Coulehan, K., Brisbane, M., Segal, K., Batchelder, A. & Rivera Mindt, M. Neurocognitive Characteristics of Opioid Dependent Adults Seeking Buprenorphine Treatment. Poster presented at the 41st Annual Meeting of the International Neuropsychological Society, Waikoloa, HI.
Coulehan, K., Arnsten, J., Cunningham, C., Arias, F., Brisbane, M., Segal, K., Batchelder, A. & Rivera Mindt, M. Neurocognitive Effects of Buprenorphine and Methadone: A Systematic Review. Poster presented at the 41stAnnual Meeting of the International Neuropsychological Society, Waikoloa, HI, February 2013.
Fuentes, A., Miranda, C., Coulehan, K., Arce Renteria, M., Rosario, A., Arentoft, A., Monzones, J., Sheynin, J., Byrd, D., Morgello, S., & Rivera Mindt, M. (February 2013). Neurocognition Influences Health Locus of Control in a Sample of HIV-Seropositive Adults. Poster presented at the 41st Annual Meeting of the International Neuropsychological Society, Waikoloa, HI.
Miranda, C., Arce Rentería, M., Rosario, A., Sheynin, J., Fuentes, A., Arentoft, A., Monzones, J., Byrd, D., Morgello, S., & Rivera Mindt, M. (2013, February). The Relative Utility of Three English Language Dominance Measures in Predicting the Neuropsychological Test Performance of HIV+ Bilingual Latino Adults. Poster presented at the 41st Annual Meeting of the International Neuropsychological Society, Waikoloa, HI.