Objective

Brain activity linked with error processing has rarely been examined among persons living with HIV (PLWH) despite importance for monitoring and modifying behaviors that could lead to adverse health outcomes (e.g., medication non-adherence, drug use, risky sexual practices). Given that cannabis (CB) use is prevalent among PLWH and impacts error processing, we assessed the influence of HIV serostatus and chronic CB use on error-related brain activity while also considering associated implications for everyday functioning and clinically-relevant disease management behaviors.

Methods

A sample of 109 participants, stratified into four groups by HIV and CB (HIV+/CB+, n = 32; HIV+/CB−, n = 27; HIV−/CB+, n = 28; HIV−/CB−, n = 22), underwent fMRI scanning while completing a modified Go/NoGo paradigm called the Error Awareness Task (EAT). Participants also completed a battery of well-validated instruments including a subjective report of everyday cognitive failures and an objective measure of medication management abilities.

Results

Across all participants, we observed expected error-related anterior insula (aI) activation which correlated with better task performance (i.e., less errors) and, among HIV− participants, fewer self-reported cognitive failures. Regarding awareness, greater insula activation as well as greater posterior cingulate cortex (PCC) deactivation were notably linked with aware (vs. unaware) errors. Regarding group effects, unlike HIV− participants, PLWH displayed a lack of error-related deactivation in two default mode network (DMN) regions (i.e., PCC, medial prefrontal cortex [mPFC]). No CB main or interaction effects were detected. Across all participants, reduced error-related PCC deactivation correlated with reduced medication management abilities and PCC deactivation mediated the effect of HIV on such abilities. More lifetime CB use was linked with reduced error-related mPFC deactivation among HIV− participants and poorer medication management across CB users.

Conclusions

These results demonstrate that insufficient error-related DMN suppression linked with HIV infection, as well as chronic CB use among HIV− participants, has real-world consequences for medication management behaviors. We speculate that insufficient DMN suppression may reflect an inability to disengage task irrelevant mental operations, ultimately hindering error monitoring and behavior modification.

中文翻译：

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HIV 感染与错误相关的默认模式网络抑制减少和药物管理能力较差有关

客观的

与错误处理相关的大脑活动很少在 HIV 感染者 (PLWH) 中进行检查，尽管对于监测和改变可能导致不良健康结果（例如，药物治疗不依从性、吸毒、危险的性行为）的行为很重要。鉴于大麻​​ (CB) 使用在 PLWH 中很普遍并影响错误处理，我们评估了 HIV 血清状态和慢性 CB 使用对错误相关大脑活动的影响，同时还考虑了对日常功能和临床相关疾病管理行为的相关影响。

方法

109 名参与者的样本，按 HIV 和 CB 分为四组（HIV+/CB+，n  = 32；HIV+/CB-，n  = 27；HIV-/CB+，n  = 28；HIV-/CB-，n  = 22 ), 在完成称为错误意识任务 (EAT) 的修改后的 Go/NoGo 范例时进行了 fMRI 扫描。参与者还完成了一系列经过充分验证的工具，包括日常认知失败的主观报告和药物管理能力的客观测量。

结果

在所有参与者中，我们观察到预期的错误相关前脑岛 (aI) 激活与更好的任务表现（即更少的错误）相关，并且在 HIV 参与者中，自我报告的认知失败更少。关于意识，更大的脑岛激活以及更大的后扣带皮层（PCC）失活与有意识（相对于无意识）错误显着相关。关于群体效应，与 HIV 参与者不同，PLWH 在两个默认模式网络 (DMN) 区域（即 PCC、内侧前额叶皮层 [mPFC]）中显示缺乏与错误相关的失活。未检测到 CB 主要或交互作用。在所有参与者中，与错误相关的 PCC 失活减少与药物管理能力下降相关，而 PCC 失活介导了 HIV 对这些能力的影响。更多的终生 CB 使用与 HIV 参与者中错误相关的 mPFC 失活减少以及 CB 用户的药物管理较差有关。

结论

这些结果表明，与 HIV 感染相关的错误相关 DMN 抑制不足，以及 HIV 参与者长期使用 CB，对药物管理行为具有现实影响。我们推测 DMN 抑制不足可能反映出无法脱离与任务无关的心理操作，最终阻碍错误监控和行为修正。