Effect of chronic alcohol abuse on the CNS morbidity of HIV disease.

NS DISEASE is a frequent cause of human immuno-C deficiency virus (HW) morbidity and mortality. The newest " su~cessful'~ treatments for HIV disease, the pro-tease inhibitors, have limited CNS penetration. Because of this, CNS morbidity may become even more important in the management of HIV disease. There is a high prevalence of heavy alcohol use in populations at high risk for HIV infection; however, there is littie research addressing the effect of heavy alcohol use on the severity and course of HIV disease. Moreover, the toxicity of heavy alcohol use alone can result in CNS morbidity in otherwise healthy individuals. Although in many cases the insults of chronic heavy alcohol use and HIV disease may independently not be sufficient to yield clinically significant findings, their cumulative effects may result in clinical signs of impaired CNS functioning. We used event-related brain electrical potentials (ERPs) as indices of information processing operations to study the brain effects of alcohol abuse alone, €IN disease alone, and the comorbidity of alcohol abuse and HIV disease. We focused on the latency of the P3A EFW component, which reflects a frontal cortex-mediated orienting response to rare and/or novel events. We sought to: (1) determine whether P3A latency is delayed as a result of the morbid effects of chronic alcohol abuse, (2) establish the sensitivity of P3A latency to HIV CNS morbidity, and (3) examine P3A latency in the face of both chronic alcohol abuse and HIV disease. We investigated the effects of alcohol abuse on P3A latency in older male chronic alcoholics w i t h long-term (9.0 +-6.6 months) abstinence.' We studied older male alcoholics because the CNS morbidity of chronic alcohol abuse is thought to be largest and most persistent in both older people and in males. Twelve older abstinent chronic alcohol abusers (age: 61.7 f 8.5 years) and 11 older controls (age: 62.5 ? 10.2 years) were studied in auditory and visual threeandition P3A paradigms with standards, targets , and novel rare nontargets. In this paradigm, the P3A component is reliably elicited in response to the novel rare nontarget stimuli. P3A latency was delayed in both modalities in the abtinent older chronic alcoholics, compared with the controls P3B in the target condition tended to also be delayed in the older chronic alcoholics in the auditory modality (398.3 vs. 377.8 msec, p = 0.065). and was delayed in the visual modality (474.3 vs. 412.0 msec, …