Impact of HIV and recreational drugs on cognitive functions in young men having sex with men.

ObjectivesThis study characterizes the structural and metabolic cerebral correlates of human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) in a preclinical setting that considers the lifestyle of young European men exposed to HIV, including recreational drugs. DesignProspective inclusion of participants. MethodsSimultaneous structural brain magnetic resonance imaging (MRI) and positron emission tomography using [18F]-fluorodeoxyglucose (FDG-PET) were acquired on a hybrid PET-MRI system in 23 asymptomatic young men with HIV+ (mean age: 33.6 years, age range: 23-60 years; normal CD4+ cell count, undetectable viral load). Neuroimaging data were compared with that of a group of 26 young HIV-men, highly well matched for what concerns age, lifestyle, named pre-exposure prophylaxis users (HIV-PrEP), and to a group of 23 undifferentiated matched young men (i.e., healthy controls). A comprehensive neuropsychological assessment was also administered to the HIV+ and HIV-PrEP subjects. ResultsHIV+ subjects had lower performances in executive, attentional and working memory functions compared to HIV-PrEP subjects. No structural or metabolic differences were found between those two groups. Compared to healthy controls, HIV+ and HIV-PrEP exhibited a common frontal hypometabolism in the right prefrontal cortex that correlated with the level of recreational drug use. No structural brain abnormality was found. ConclusionA dynamic prevention of recreational drugs use in HIV+ and HIV-PrEP subjects is mandatory to cope with their negative impact on brain function and their neurocognitive consequences. A complex interplay between recreational drugs and HIV might be involved in the development of neurocognitive disorders in young men with HIV.