Reduced Error-Related Default Mode Network Deactivations Linked with HIV Infection and Poor Medication Management

Description: Unthresholded maps from analyses reported in following publication: ABSTRACT Objective: Brain function supporting error-monitoring has rarely been examined among persons living with HIV (PLWH) despite its importance for recognizing and preventing maladaptive behavior (e.g. drug use, medication non-adherence, gambling, risky sexual behavior) that could lead to worsened health and economic outcomes among this vulnerable population. As medicinal and recreational cannabis use is prevalent among PLWH, we aimed to assess interactive impacts of HIV infection and chronic cannabis use (CB) on error-processing brain function and investigate the implications for everyday functioning and clinically relevant disease management behaviors. Methods: Our sample of 109 participants was stratified into four groups based on HIV serostatus and cannabis use history (HIV+/CB+, n=32; HIV+/CB-, n=27; HIV-/CB+, n=28; HIV-/CB-, n=22). Participants underwent fMRI scanning while completing a Go/NoGo, motor inhibition paradigm called the Error Awareness Task (EAT) that probes error-processing, and error-awareness mechanisms. Participants also completed a battery of well-validated instruments including an objective behavioral measure of medication management abilities and self-reports of everyday cognitive failures and cannabis use history. Results: We observed error-related brain activity in the anterior insula that was associated improved cognitive-control performance across the full sample, and less self-reported cognitive failures among HIV- controls. Regarding error awareness, we found significantly more insula responsivity and posterior cingulate cortex (PCC) deactivation to aware errors relative to unaware errors. Regarding group effects, PLWH displayed a lack of error-related deactivation in two default mode network (DMN) hub regions (the PCC and medial prefrontal cortex [mPFC]) that was contrarily observed among HIV- controls and associated with their improved cognitive control, task performance. CB main and interaction effects were not detected. Across all groups, less error-related PCC deactivation was associated with worsened medication management behavioral performance and mediated the effect of HIV-status on medication management abilities. However, DMN deactivation was not significantly related to self-reported cognitive failures. Amount of CB used over the lifetime was associated with reduced mPFC deactivation to errors among CB using HIV- controls, and worsened medication management abilities across all CB users. Conclusions: These results demonstrate insufficient error-related DMN deactivation among PLWH with critical consequences for medication management behaviors.

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