Interdisciplinary clinical research on the combined effects of substance abuse and HIV infection on brain structure and function is of considerable public health importance. However, there are presently very few laboratories conducting such research and limited training programs dedicated to preparing the next generation of investigators in clinical research at the intersection of addictions and neuroAIDS. Accordingly, we established a Ruth L Kirschstein National Research Service Award Institutional Training Grant (NRSA T32) with funding from NIDA entitled, “Training in Research on Addictions in Interdisciplinary NeuroAIDS (TRAIN)” The aim of TRAIN is to prepare two pre-doctoral students in coordination with the SDSU/UCSD Joint Doctoral Program (JDP) and one postdoctoral fellow in clinical neuropsychology for multidisciplinary academic careers focused on the central nervous system (CNS) effects of substance abuse and HIV infection. Students and fellows are actively engaged in individualized, flexible career development plans that will include applied research training didactics (e.g. formal class work and structured seminars), and targeted clinical experiences.
Among HIV-infected persons, substance use is a risk factor for poorer systemic disease outcomes, hepatitis C co-infection, non-adherence to antiretroviral (ARV) therapies, and HIV transmission. HIV-infected substance users are also at high risk for structural and functional damage to the CNS. Although addiction and HIV are each independently associated with neural injury, cognitive impairment and poorer everyday functioning outcomes, more recent research reveals that their combined effects may have a synergistic impact on the CNS. Importantly, deficits in such areas are known to increase the risk of poor everyday functioning outcomes in HIV-infected substance users, such as medication non-adherence, unemployment, engagement in risky behaviors, and automobile driving accidents. While the importance of the compounding effects of HIV and addictions is coming into better focus, much still needs to be learned about the prevalence, profile, neural mechanisms and cognitive architecture of everyday functioning problems in these patients. The neurocognitive, neuroimaging and functional characteristics of this growing epidemic remain poorly understood which greatly hampers the development of effective cognitive, behavioral and pharmacological interventions to improve outcomes.