Prefrontal Recruitment Mitigates Risk-Taking Behavior in Human Immunodeficiency Virus-Infected Young Adults

Background Human immunodeficiency virus (HIV)-infected (HIV +) young adults often engage in risk-taking behavior. However, the disruptive effects of HIV on the neurobiological underpinnings of risky decision making are not well understood. Methods Risky decision making, measured via the Iowa Gambling Task (IGT), was compared voxel-wise to resting cerebral blood flow (rCBF) acquired via arterial spin labeling. Separate topographical maps were obtained for HIV-uninfected (HIV -; n = 62) and HIV + (n = 41) young adults (18-24 years old) and were compared to the full cohort of participants. For the HIV + group, rCBF was compared to recent and nadir CD4. Results IGT performance was supported by rCBF in 3 distinct brain regions: regions I, II, and III. The relationship between IGT performance and rCBF in HIV + individuals was most robust in region I, the ventromedial prefrontal and insular cortices. Region II contained strong relationships for both HIV - and HIV +. Region III, dorsolateral prefrontal and posterior cingulate cortices, contained relationships that were strongest for HIV - controls. IGT performance was intact among HIV + participants with higher rCBF in either region I or region III. By contrast, performance was worse among HIV + individuals with lower rCBF in both regions I and III when compared to HIV - controls (P =.01). rCBF in region III was reduced in HIV + compared with HIV - individuals (P =.04), and positively associated with nadir CD4 cell count (P =.02). Conclusions Recruitment of executive systems (region III) mitigates risk-taking behavior in HIV + and HIV - individuals. Recruitment of reward systems (region I) mitigates risk-taking behavior when region III is disrupted due to immunological compromise. Identifying individual recruitment patterns may aid anatomically directed therapeutics or psychosocial interventions.