NOT-DA-21-018 Notice of Special Interest (NOSI): Long-Term Neurocognitive Consequences of COVID-19 in Individuals Living with HIV and Substance Use Disorders

Syndemic (synergistic epidemic) is the aggregation of two or more, concurrent or sequential epidemics or disease clusters, interacting synergistically in a population, contributing to excess burden of disease and prognosis. The Severe Acute Respiratory Syndrome (SARS)-coronavirus (CoV)-2 is responsible for a new coronavirus disease-19 (COVID-19). SARS-CoV-2 affects a wide variety of organs, among them the central nervous system (CNS). In parallel, HIV-1 is known to have significant neurotropic properties which can lead to HIV-associated neurocognitive disorders (HAND), classified according to its severity in asymptomatic, mild, or severe (HIV-dementia).

Individuals with Substance Use Disorders (SUDs), especially those who inject drugs (PWID), are at high risk of developing HIV, with notorious morbidity and mortality rates. HIV and SUDs are well-known factors for neurocognitive impairment. The first wave of the U.S. COVID-19 pandemic impacted urban areas where both the HIV and SUDs epidemics are prominent. In this vein, COVID-19 CNS alterations in survivors have been reported in about 30% of patients who required hospitalization. Symptoms include anosmia, loss of taste, loss of hearing, headaches, mental “fogginess”, confusion, fatigue, dizziness, and in severe cases encephalopathy. Long-term neurocognitive aspects of COVID-19 are likely but still not fully understood. Thus, it is of major public health relevance to study the long-term neurocognitive consequences of the COVID-19, HIV and SUD’s syndemic, given the combined viral neurotropism of SARS-CoV-2, HIV-1, and the deleterious effects of SUDs in the brain.

Research Objectives:

NIDA is interested in receiving research applications focusing on studying the long-term neurocognitive consequences of the COVID-19/HIV/SUDs syndemic.

This NOSI encourages, but is not limited to, research applications in the following areas:

  1. Long-term neurocognitive effects of HIV/COVID-19/SUDs. Basic science studies to explore changes in neuroanatomy, neurophysiology, biochemistry, learning and behavior.
  2. Clinical studies to evaluate cognitive, behavioral, neuropsychiatric, neuro-therapeutic outcomes, etc. Staging and categorizing of cognitive dysfunction. Differentiation between HAND and COVID-19 neurocognitive impairment in individuals with and without SUDs. Validation of neurocognitive scales for HAND and COVI-19 neurocognitive impairment.
  3. Neurocognitive studies in individuals with HIV/COVID-19/SUDs classified by age/gender/race/socioeconomic status/drug of choice use/ART regime/HCV status/other co-morbidities/criminal justice involvement, etc.

4. Therapeutic strategies for such neurocognitive dysfunction in the context of HIV. Effectiveness of NMDA receptor antagonists, Anticholinergics, B12 supplements, Thiamine, SSRI’s, Benzodiazepines, Antipsychotics, etc., and its interactions with ART and SUDs. Cognitive Behavioral Therapy; Mindfulness; Meditation; Transcranial Magnetic Stimulation and others.