Document Type



Doctor of Philosophy (PhD)



First Advisor's Name

Dr. Matthew T. Sutherland

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Dr. Angela R. Laird

Second Advisor's Committee Title

committee member

Third Advisor's Name

Dr. Aaron Mattfeld

Third Advisor's Committee Title

committee member

Fourth Advisor's Name

Dr. Wasim Maziak

Fourth Advisor's Committee Title

committee member


HIV, cannabis, error awareness, medication management, default mode network, insula, resting-state functional connectivity, TNF- α, inflammation, resource allocation index

Date of Defense



Neuroimaging research has identified brain alterations linked with the human immunodeficiency virus (HIV) that contribute to cognitive declines characterizing the disease. Given cannabis’s (CB’s) anti-inflammatory properties, use prevalence among people living with HIV (PLWH), and impact on neurocognition, my dissertation utilizes a between-groups study design to interrogate separate and interactive effects of HIV and CB on fMRI measures of brain activity. We investigate (1) task-based brain activity at the regional-level, (2) insular resting-state functional connectivity (rsFC) at the circuit-level, and (3) large-scale brain network interactions at the systems-level. Participants (N=114) were stratified into four groups (HIV+/CB+; HIV+/CB-; HIV-/CB+; HIV-/CB-) and underwent fMRI scanning while completing an Error Awareness Task (EAT) and while at rest. Participants also completed a battery of instruments including subjective reports of cognitive failures, and objective measures of cognition and medication management abilities. Blood samples quantified disease severity (viral load) and inflammation (tumor necrosis factor alpha [TNF-α]). Regarding task-based brain activity, PLWH displayed a lack of error-related deactivation in two default mode network (DMN) regions (posterior cingulate cortex [PCC], medial prefrontal cortex [mPFC]). Across all participants, reduced error-related PCC deactivation correlated with reduced medication management abilities and mediated the effect of HIV on such abilities. Regarding insular circuitry, we observed interactive HIVxCB effects on rsFC between two anterior insula (aI) subregions and sensorimotor cortices such that, CB use normalized altered rsFC that was observed among non-using PLWH and correlated with decreased somatic complaints and increased inflammation. Finally, regarding large-scale network interactions, PLWH displayed increased salience network (SN)-DMN rsFC that was associated with diminished error-awareness. These results demonstrate that insufficient error-related DMN suppression and heightened SN-DMN rsFC are linked with HIV and have consequences for error-processing and medication management. Additionally, these outcomes suggest a potential normalizing effect of CB on altered insula-sensorimotor neurocircuitries among PLWH and begin to elucidate inflammatory mechanisms through which CB use may impact brain function in the context of HIV.





Previously Published In

Flannery, J.S., Riedel, M.C., Salo, T., Poudel, R., Laird, A.R., Gonzalez, R. and Sutherland, M.T., 2021. HIV infection is linked with reduced error-related default mode network suppression and poorer medication management abilities. medRxiv. doi:

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.



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