Effects of experimentally-induced reductions in alcohol consumption on brain cognitive, and clinical outcomes and motivation for changing drinking in older persons with HIV infection

Abstract: Persons living with HIV (PLWH) are an especially vulnerable population in the COVID-19 pandemic given theircompromised immune system and comorbidities (e.g., substance use, mental health issues). Currently, noresearch has examined how the broad impacts of COVID-19 (e.g., extended social isolation, anxiety, familyloss) are affecting alcohol use and care engagement in PLWH. Further, it is unclear whether these impactsaffect cognition or the brain. This urgent supplement will allow us to capture this window of opportunity andcollect timely data to address these gaps. Our ongoing U01 study of a cohort consisting of PLWH and personswithout HIV focusing on using a contingency management protocol to reduce alcohol consumption providesmany unique strengths to support this supplement. This supplement is within the scope of the parent grantbut extents the parent study by incorporating COVID-19-related questions/measures into the ongoing datacollection. We will collect additional data through questionnaires, electronic at-home cognitive testing viaCANTAB Connect, stress severity quantification via cortisol analysis of hair samples, and qualitativeinterviews. We will also conduct COVID-19 antibody tests (through blood samples) and MRIs that we conductas part of the parent grant procedure. The specific aims of this supplement include: 1) Determine theinfluence of specific psychosocial factors (e.g., social isolation, loneliness, anxiety, and food and housinginsecurity) on alcohol use trajectory and HIV-related health behavior and outcomes (ART adherence, andhealth care engagement) during the period of the pandemic and social distancing. We will also examine whichbaseline factors (e.g., clinical, demographic, neuroimaging, cognitive) best predict individual differences inoutcome; 2) Assess the feasibility and acceptability of (1) an at-home, electronically delivered neurocognitiveassessment on the CANTAB Connect system and (2) participant mail-in hair samples. For those willing andable to complete one or both of these measures, we will examine the relationships of the psychosocial factorsassessed in Aim 1 on cognitive performance and/or stress severity as measured by cortisol levels from hairsamples obtained from participants; 3) Obtain additional neuroimaging from participants to ensure we havedata from both before and after the coronavirus crisis, and (should there be sufficient prevalence), determinewhether participants found to have been infected with COVID-19 (with or without symptoms) have a greaterextent of white matter hypersensitivity (WMH) on FLAIR brain MRI, along with other associated structural,functional, and metabolic brain changes (fMRI, MRS); and an exploratory aim to will conduct a qualitativeinterview to explore factors that are subjectively judged to be interfering with drinking abstinence and HIVmedication adherence, and what might help in this regard. These results will provide valuable evidence on howthe COVID-19 pandemic affects alcohol use and HIV care, in addition to changes in cognition and the brain,which can potentially inform future prevention and treatment programs during future emergency situations.