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Collins LM, Kugler KC, Gwadz MV. Optimization of Multicomponent Behavioral and Biobehavioral Interventions for the Prevention and Treatment of HIV/AIDS. AIDS Behav 2016; 20 Suppl 1:S197-214. [PMID: 26238037 DOI: 10.1007/s10461-015-1145-4] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To move society toward an AIDS-free generation, behavioral interventions for prevention and treatment of HIV/AIDS must be not only effective, but also cost-effective, efficient, and readily scalable. The purpose of this article is to introduce to the HIV/AIDS research community the multiphase optimization strategy (MOST), a new methodological framework inspired by engineering principles and designed to develop behavioral interventions that have these important characteristics. Many behavioral interventions comprise multiple components. In MOST, randomized experimentation is conducted to assess the individual performance of each intervention component, and whether its presence/absence/setting has an impact on the performance of other components. This information is used to engineer an intervention that meets a specific optimization criterion, defined a priori in terms of effectiveness, cost, cost-effectiveness, and/or scalability. MOST will enable intervention science to develop a coherent knowledge base about what works and does not work. Ultimately this will improve behavioral interventions systematically and incrementally.
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Brennan PL, SooHoo S, Lemke S, Schutte KK. Alcohol Use Predicts 10-Year Depressive Symptom Trajectories in the Health and Retirement Study. J Aging Health 2015; 28:911-32. [PMID: 26628481 DOI: 10.1177/0898264315615837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine effects of late-middle-aged adults' baseline drinking behavior on their subsequent 10-year depressive symptom trajectories. METHOD Health and Retirement Study participants (N = 7,939) were assessed on baseline demographic, health, and drinking characteristics, and biennially assessed for the next 10 years on their depressive symptoms. RESULTS Growth mixture modeling generated four classes of depressive symptom trajectories: Consistently low (72%), consistently elevated (6%), increasing (12%), and decreasing (10%). Baseline abstinence from alcohol, possibly enforced by poorer health and a history of drinking problems, and heavier drinking, "binge" drinking, and having a history of drinking problems, raised risk of membership in the "consistently elevated" class. Abstinence by participants without history of drinking problems-and light, moderate, and heavier drinking-protected against membership in the "increasing" class. Abstinence by participants without history of drinking problems elevated-and moderate drinking reduced-likelihood of membership in the "decreasing" class. DISCUSSION Late-middle-aged adults' alcohol use is associated with the subsequent long-term course of their depressive symptoms.
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Affiliation(s)
| | - Sonya SooHoo
- VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Sonne Lemke
- VA Palo Alto Health Care System, Menlo Park, CA, USA
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Kelso NE, Sheps DS, Cook RL. The association between alcohol use and cardiovascular disease among people living with HIV: a systematic review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2015; 41:479-88. [PMID: 26286352 DOI: 10.3109/00952990.2015.1058812] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND People living with HIV-infection (PLWH) have higher prevalence and earlier onset of cardiovascular disease (CVD), compared to uninfected populations. It is unclear how alcohol consumption is related to CVD among PLWH. OBJECTIVES To summarize the current literature and strength of evidence regarding alcohol consumption as a risk factor for CVD among PLWH, to generate summary estimates for the effect of alcohol consumption on CVD outcomes, and to make recommendations for clinical practice and future research based on the findings and limitations of existing studies. METHODS A systematic review was conducted using Pubmed/Medline to identify relevant peer-reviewed articles published between 1 January 1999 and 1 January 2014. After critical review of the literature, 13 studies were identified. Risk ratios were extracted or calculated and sample size weighted summary estimates were calculated. RESULTS The prevalence of a CVD diagnosis or event ranged from 5.7-24.0%. The weighted pooled crude effect sizes were 1.75 (95% CI 1.06, 3.17) for general and 1.78 (95% CI 1.09, 2.93) for heavy alcohol use on CVD. The pooled adjusted effect size was 1.37 (95% CI 1.02, 1.84) for heavy alcohol use on CVD. Pooled estimates differed by CVD outcome and alcohol measure; alcohol consumption was most significant for cerebral/ischemic events. CONCLUSION HIV clinicians should consider risk factors that are not included in the traditional risk factor framework, particularly heavy alcohol consumption. Neglect of this risk factor may lead to underestimation of risk, and thus under-treatment among PLWH.
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Affiliation(s)
- Natalie E Kelso
- a Department of Epidemiology , College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville , FL , USA
| | - David S Sheps
- a Department of Epidemiology , College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville , FL , USA
| | - Robert L Cook
- a Department of Epidemiology , College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville , FL , USA
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Walley AY, Palmisano J, Sorensen-Alawad A, Chaisson C, Raj A, Samet JH, Drainoni ML. Engagement and Substance Dependence in a Primary Care-Based Addiction Treatment Program for People Infected with HIV and People at High-Risk for HIV Infection. J Subst Abuse Treat 2015; 59:59-66. [PMID: 26298399 DOI: 10.1016/j.jsat.2015.07.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 07/07/2015] [Accepted: 07/15/2015] [Indexed: 12/31/2022]
Abstract
To improve outcomes for people with substance dependence and HIV infection or at risk for HIV infection, patients were enrolled in a primary care-based addiction treatment program from 2008-2012 that included a comprehensive substance use assessment, individual and group counseling, addiction pharmacotherapy and case management. We examined whether predisposing characteristics (depression, housing status, polysubstance use) and an enabling resource (buprenorphine treatment) were associated with engagement in the program and persistent substance dependence at 6 months. At program enrollment 61% were HIV-infected, 53% reported heroin use, 46% reported alcohol use, 37% reported cocaine use, and 28% reported marijuana use in the past 30 days, 72% reported depression, 19% were homeless, and 53% had polysubstance use. Within 6-months 60% had been treated with buprenorphine. Engagement (defined as 2 visits in first 14 days and 2 additional visits in next 30 days) occurred in 64%; 49% had substance dependence at 6-months. Receipt of buprenorphine treatment was associated with engagement (Adjusted Odds Ratio (AOR) 8.32 95% CI: 4.13-16.77). Self-reported depression at baseline was associated with substance dependence at 6-months (AOR 3.30 95% CI: 1.65-6.61). Neither housing status nor polysubstance use was associated with engagement or substance dependence. The FAST PATH program successfully engaged and treated patients in a primary care-based addiction treatment program. Buprenorphine, a partial opioid agonist, was a major driver of addiction treatment engagement. Given depression's association with adverse outcomes in this clinical population, including mental health treatment as part of integrated care holds potential to improve addiction treatment outcomes.
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Affiliation(s)
- Alexander Y Walley
- Boston Medical Center, General Internal Medicine; Boston University School of Medicine, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States.
| | - Joseph Palmisano
- Boston University School of Public Health, Data Coordinating Center, 801 Massachusetts Avenue, Third Floor, Boston, MA 02118 United States
| | - Amy Sorensen-Alawad
- Boston University School of Medicine, Geriatrics Section, Boston, MA 02118 United States
| | - Christine Chaisson
- Boston University School of Public Health, Data Coordinating Center, 801 Massachusetts Avenue, Third Floor, Boston, MA 02118 United States
| | - Anita Raj
- University of California, San Diego, La Jolla, CA United States
| | - Jeffrey H Samet
- Boston Medical Center, General Internal Medicine; Boston University School of Medicine, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States
| | - Mari-Lynn Drainoni
- Boston University School of Public Health, Department of Health Policy and Management, 715 Albany Street T3W, Boston, MA 02118 United States; Boston University School of Medicine, Infectious Diseases Section, Boston, MA 02118 United States; Center for Healthcare Organization and Implementation Research, ENRM VA Hospital, Bedford, MA 01730, United States
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Attitudes and Training Needs of New England HIV Care and Addiction Treatment Providers: Opportunities for Better Integration of HIV and Alcohol Treatment Services. ADDICTIVE DISORDERS & THEIR TREATMENT 2015; 14:16-28. [PMID: 25745365 DOI: 10.1097/adt.0000000000000040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Unhealthy alcohol use is common among HIV-infected patients and contributes to co-morbidities, cognitive decline, unprotected sex, and poor medication adherence. Studies consistently show missed opportunities to address unhealthy alcohol use as part of care. Although treatment of other drug use has been integrated into HIV care in some settings, more information is needed regarding provider attitudes regarding the need for integration of alcohol treatment and HIV care. METHODS We surveyed 119 HIV and 159 addiction providers regarding the following domains: existing knowledge, desire for new knowledge (with subdomains relative advantage, compatibility, and complexity of integrating knowledge), and individual and program development needs. Scale scores for each domain were correlated with demographics to identify factors associated with training need. RESULTS Both HIV and addiction providers reported agreement with statements of existing knowledge and the need for additional skills. The priority attributed to training, however, was low for both groups. Knowledge and perceived prevalence of HIV and unhealthy alcohol use increased with years of experience. Perceived prevalence correlated with compatibility but not the relative advantage of training. CONCLUSIONS Though addressing alcohol use and HIV was acknowledged to be important, the priority of this was low, particularly early career providers. These providers may be important targets for training focusing on motivating coordination of care and skills related to assessment and counseling.
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Marshall BD, Operario D, Bryant KJ, Cook RL, Edelman EJ, Gaither JR, Gordon AJ, Kahler CW, Maisto SA, McGinnis KA, van den Berg JJ, Zaller ND, Justice AC, Fiellin DA. Drinking trajectories among HIV-infected men who have sex with men: a cohort study of United States veterans. Drug Alcohol Depend 2015; 148:69-76. [PMID: 25596785 PMCID: PMC4330114 DOI: 10.1016/j.drugalcdep.2014.12.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although high rates of alcohol consumption and related problems have been observed among HIV-infected men who have sex with men (MSM), little is known about the long-term patterns of and factors associated with hazardous alcohol use in this population. We sought to identify alcohol use trajectories and correlates of hazardous alcohol use among HIV-infected MSM. METHODS Sexually active, HIV-infected MSM participating in the Veterans Aging Cohort Study were eligible for inclusion. Participants were recruited from VA infectious disease clinics in Atlanta, Baltimore, New York, Houston, Los Angeles, Pittsburgh, and Washington, DC. Data from annual self-reported assessments and group-based trajectory models were used to identify distinct alcohol use trajectories over an eight-year study period (2002-2010). We then used generalized estimate equations (GEE) to examine longitudinal correlates of hazardous alcohol use (defined as an AUDIT-C score ≥4). RESULTS Among 1065 participants, the mean age was 45.5 (SD=9.2) and 606 (58.2%) were African American. Baseline hazardous alcohol use was reported by 309 (29.3%). Group-based trajectory modeling revealed a distinct group (12.5% of the sample) with consistently hazardous alcohol use, characterized by a mean AUDIT-C score of >5 at every time point. In a GEE-based multivariable model, hazardous alcohol use was associated with earning <$6000 annually, having an alcohol-related diagnosis, using cannabis, and using cocaine. CONCLUSIONS More than 1 in 10 HIV-infected MSM US veterans reported consistent, long-term hazardous alcohol use. Financial insecurity and concurrent substance use were predictors of consistently hazardous alcohol use, and may be modifiable targets for intervention.
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Affiliation(s)
- Brandon D.L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA,Send correspondence to: Brandon D.L. Marshall, Assistant Professor, Department of Epidemiology Brown University School of Public Health, 121 South Main Street (Box G-S-121-2), Providence, RI, 02912, T: 401-863-6427, F: 401-863-3713
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA
| | - Kendall J. Bryant
- National Institute on Alcohol Abuse and Alcoholism, 6000 Executive Blvd, Rockville, MD, 20852, USA
| | - Robert L. Cook
- Department of Epidemiology, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610, USA
| | - E. Jennifer Edelman
- Department of Internal Medicine, Yale University School of Medicine, 367 Cedar Street, PO Box 20802, New Haven, CT, 06520-8025, USA,Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510-2483
| | - Julie R. Gaither
- Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510-2483,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, CT, 06520-8034
| | - Adam J. Gordon
- University of Pittsburgh School of Medicine (Mailcode 151-C-H), 7180 Highland Drive, Pittsburgh, PA, 15206,VA Pittsburgh Healthcare System, University Drive (151-C), Pittsburgh, PA, 15240
| | - Christopher W. Kahler
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA,Center for Alcohol and Addiction Studies and the Alcohol Research Center of HIV (ARCH), Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA
| | - Stephen A. Maisto
- Department of Psychology, Syracuse University, 430 University Avenue, Syracuse, NY, 13244,VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Avenue, Syracuse, NY, 13210
| | - Kathleen A. McGinnis
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Jacob J. van den Berg
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA,Division of Infectious Diseases, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Nickolas D. Zaller
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, 4301 West Markham #820, Little Rock, AR, 72205, USA
| | - Amy C. Justice
- Department of Internal Medicine, Yale University School of Medicine, 367 Cedar Street, PO Box 20802, New Haven, CT, 06520-8025, USA,Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510-2483,VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - David A. Fiellin
- Department of Internal Medicine, Yale University School of Medicine, 367 Cedar Street, PO Box 20802, New Haven, CT, 06520-8025, USA,Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510-2483
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Peltzer K, Szrek H, Ramlagan S, Leite R, Chao LW. Depression and social functioning among HIV-infected and uninfected persons in South Africa. AIDS Care 2014; 27:41-6. [PMID: 25105215 DOI: 10.1080/09540121.2014.946383] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Depression and other health problems are common co-morbidities among persons living with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS). The aim of this study was to investigate depression, health status, and substance use in relation to HIV-infected and uninfected individuals in South Africa. Using a cross-sectional case-control design, we compared depression, physical health, mental health, problem alcohol use, and tobacco use in a sample of HIV-infected (N = 143) and HIV-uninfected (N = 199) respondents who had known their HIV status for two months. We found that depression was higher, and physical health and mental health were lower in HIV-positive than HIV-negative individuals. Poor physical health also moderated the effect of HIV infection on depression; HIV-positive individuals were significantly more depressed than HIV-negative controls, but only when general physical health was also poor. We did not find an association between alcohol or tobacco use and HIV status. These results suggest the importance of incorporating the management of psychological health in the treatment of HIV.
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Affiliation(s)
- Karl Peltzer
- a HIV/STIs and TB Research Programme , Human Sciences Research Council , Pretoria , South Africa
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58
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Brown JL, DeMartini KS, Sales JM, Swartzendruber AL, DiClemente RJ. Interventions to reduce alcohol use among HIV-infected individuals: a review and critique of the literature. Curr HIV/AIDS Rep 2014; 10:356-70. [PMID: 23990322 DOI: 10.1007/s11904-013-0174-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Alcohol use disorders are common among HIV-infected individuals and are associated with adverse physiological complications and increased engagement in other health risk behaviors. This paper provides a review and critique of interventions to reduce alcohol use among HIV-infected individuals, including a: (a) synthesis of core intervention components and trial designs; (b) summary of intervention efficacy to reduce alcohol use outcomes; and (c) methodological critique and guidance for future research. We reviewed 14 behavioral interventions that reported on alcohol use outcomes among HIV-infected individuals. Findings were mixed for intervention efficacy to reduce alcohol frequency and quantity. There was limited evidence that interventions reduced binge drinking frequency or alcohol abuse or dependence symptoms. Despite the prevalence of disordered alcohol use among HIV-infected individuals, there is lack of efficacious intervention approaches. Efficacious intervention approaches to reduce alcohol use among HIV-infected individuals are urgently needed.
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Affiliation(s)
- Jennifer L Brown
- Department of Psychology, Texas Tech University, Box 42051, Lubbock, TX, 79409-205, USA,
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Muñoz-Laboy M, Severson N, Perry A, Guilamo-Ramos V. Differential impact of types of social support in the mental health of formerly incarcerated Latino men. Am J Mens Health 2014; 8:226-39. [PMID: 24323767 PMCID: PMC4565496 DOI: 10.1177/1557988313508303] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The role of social support in the mental health of formerly incarcerated Latino men (FILM) is an issue overlooked in public health prevention efforts. The objectives of this analysis were to (a) describe the levels of social support perceived and received by FILM; (b) identify the associations, if any, between levels of social support and mental health indicators such as depression and anxiety; and (c) explore the impact of familism and hypermasculinity on the receptivity of social support and the potential role of these factors in mediating associations between social support and mental health indicators. To accomplish the objectives, we conducted a cross-sectional survey with FILM (n = 259), ages 18 to 59, in New York City, and one nominated member of their social network (n = 130 dyads). In this analysis, we examined four dimensions of social support (instrumental, informational, appraisal, and emotional) from two perspectives: provided (as reported by members of the social networks) and perceived (as reported by FILM). The major outcome variables for this analysis were the presence/absence of major anxiety and depressive symptoms. Our logistic regression analyses suggest that perceived emotional support was inversely associated with both anxiety and depression. Our findings suggest that familism mediated the association between perceived emotional support and anxiety/depression. Therefore, we must consider designing network enhancement interventions that focus on both FILM and their social support systems.
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60
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Lim JK, Tate JP, Fultz SL, Goulet JL, Conigliaro J, Bryant KJ, Gordon AJ, Gibert C, Rimland D, Goetz MB, Klein MB, Fiellin DA, Justice AC, Lo Re V. Relationship between alcohol use categories and noninvasive markers of advanced hepatic fibrosis in HIV-infected, chronic hepatitis C virus-infected, and uninfected patients. Clin Infect Dis 2014; 58:1449-58. [PMID: 24569533 DOI: 10.1093/cid/ciu097] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND It is unclear if the risk of liver disease associated with different levels of alcohol consumption is higher for patients infected with human immunodeficiency virus (HIV) or chronic hepatitis C virus (HCV). We evaluated associations between alcohol use categories and advanced hepatic fibrosis, by HIV and chronic HCV status. METHODS We performed a cross-sectional study among participants in the Veterans Aging Cohort Study who reported alcohol consumption at enrollment (701 HIV/HCV-coinfected; 1410 HIV-monoinfected; 296 HCV-monoinfected; 1158 HIV/HCV-uninfected). Alcohol use category was determined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire and alcohol-related diagnoses and was classified as nonhazardous drinking, hazardous/binge drinking, or alcohol-related diagnosis. Advanced hepatic fibrosis was defined by FIB-4 index >3.25. RESULTS Within each HIV/HCV group, the prevalence of advanced hepatic fibrosis increased as alcohol use category increased. For each alcohol use category, advanced hepatic fibrosis was more common among HIV-infected than uninfected (nonhazardous: 6.7% vs 1.4%; hazardous/binge: 9.5% vs 3.0%; alcohol-related diagnosis: 19.0% vs 8.6%; P < .01) and chronic HCV-infected than uninfected (nonhazardous: 13.6% vs 2.5%; hazardous/binge: 18.2% vs 3.1%; alcohol-related diagnosis: 22.1% vs 6.5%; P < .01) participants. Strong associations with advanced hepatic fibrosis (adjusted odds ratio [95% confidence interval]) were observed among HIV/HCV-coinfected patients with nonhazardous drinking (14.2 [5.91-34.0]), hazardous/binge drinking (18.9 [7.98-44.8]), and alcohol-related diagnoses (25.2 [10.6-59.7]) compared with uninfected nonhazardous drinkers. CONCLUSIONS Advanced hepatic fibrosis was present at low levels of alcohol consumption, increased with higher alcohol use categories, and was more prevalent among HIV-infected and chronic HCV-infected patients than uninfected individuals. All alcohol use categories were strongly associated with advanced hepatic fibrosis in HIV/HCV-coinfected patients.
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Affiliation(s)
- Joseph K Lim
- Veterans Affairs (VA) Connecticut Healthcare System, West Haven
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61
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Taniguchi T, Shacham E, Onen NF, Grubb JR, Overton ET. Depression severity is associated with increased risk behaviors and decreased CD4 cell counts. AIDS Care 2014; 26:1004-12. [PMID: 24479743 DOI: 10.1080/09540121.2014.880399] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Depression is a common comorbidity among HIV-infected individuals. We studied the relationship between depressive symptoms, risk behaviors (risky-sexual behavior, tobacco, alcohol, and illicit drug use) and HIV outcomes. This cross-sectional study conducted in 2009 at the Washington University HIV Clinic included screening for depression with patient health questionnaire, survey of sexual behavior, illicit drug, alcohol, and tobacco use within 30 days. Sociodemographics, plasma HIV RNA levels, CD4 cell counts, and sexually transmitted disease test results were obtained from medical records. Multivariate logistic and linear regression models were used to assess the association between depressive symptoms severity and risk behaviors, HIV outcomes and combination antiretroviral therapy (cART) adherence. A total of 624 persons completed the assessment of whom 432 (69%) were male and 426 (68%) African-American. The median CD4 cell count was 410 cells/mm(3) and 479 persons (77%) were on cART of whom 112 (23%) had HIV RNA level > 400 copies/mL. Overall, 96 (15%) had symptoms of major depressive disorder. Depressive symptom severity was associated with increased likelihood of high-risk drinking (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.1-5.1), current tobacco use (OR, 1.8; 95% CI, 1.1-2.9), illicit drug use (OR, 1.7; 95% CI, 1.0-2.8), and risky-sexual behavior (OR, 1.5; 95% CI, 0.8-2.7). Suboptimal cART adherence (visual analog scale < 95%) was also associated with depressive symptoms severity (p < 0.05). After adjustment for age, sex, race, receipt of cART, and cART adherence, depressive symptoms severity was independently associated with lower CD4 cell count (p < 0.05) but not with higher HIV RNA level (p = 0.39). Depression adversely affects HIV-infected individuals, requiring greater effort at utilizing multidisciplinary interventions.
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Affiliation(s)
- Toshibumi Taniguchi
- a Department of Developmental Genetics , Chiba University Graduate School of Medicine , Chiba , Japan
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62
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Palfai T, Cheng D, Coleman S, Bridden C, Krupitsky E, Samet J. The influence of depressive symptoms on alcohol use among HIV-infected Russian drinkers. Drug Alcohol Depend 2014; 134:85-91. [PMID: 24120857 PMCID: PMC4524808 DOI: 10.1016/j.drugalcdep.2013.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 09/12/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Depressive symptoms have been linked to HIV progression through a number of biobehavioral mechanisms including increased alcohol use. Although research supports an association between alcohol use and depressive symptoms among HIV patients, there have been few studies that have examined whether depressive symptoms predict subsequent drinking, especially among heavy drinking HIV-infected patients. METHOD Heavy drinking Russian HIV-infected patients (n=700) were recruited from addiction and HIV care settings for a randomized controlled trial of a risk reduction intervention [HERMITAGE]. GEE overdispersed Poisson regression analyses were conducted to assess the association between depressive symptoms and alcohol consumption 6-months later. RESULTS In adjusted analyses, depressive symptom severity was significantly associated with drinks per day (global p=.02). Compared to the non-depressed category, mild depressive symptoms were significantly associated with more drinks per day [IRR=1.55, (95% CI: 1.14, 2.09)], while moderate [IRR=1.14, (95% CI: 0.83, 1.56)] and severe [IRR=1.48, (95% CI: 0.93, 2.34)] depressive symptoms were not. Associations between depressive symptom severity and heavy drinking days were not statistically significant (global p=.19). Secondary analyses using the BDI-II screening threshold (BDI-II>14) and the BDI-II cognitive subscale suggested an association between depressive symptoms and drinks per day over time but not heavy episodic drinking. CONCLUSIONS Among heavy drinking HIV-infected patients, elevated depressive symptoms were associated with greater subsequent alcohol use. These findings suggest that depressive symptoms may be important to address in efforts to reduce alcohol-related risks among HIV-infected populations.
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Affiliation(s)
- T.P. Palfai
- Department of Psychology, Boston University, 648 Beacon Street, Boston, MA 02021, USA,Corresponding author. Tel.: +1 617 353 9345; fax: +1 617 353 9609. (T.P. Palfai)
| | - D.M. Cheng
- Department of Biostatistics, School of Public Health, Boston University, Crosstown Center, 801 Massachusetts Avenue, Boston, MA 02218, USA
| | - S.M. Coleman
- Department of Biostatistics, School of Public Health, Boston University, Crosstown Center, 801 Massachusetts Avenue, Boston, MA 02218, USA
| | - C. Bridden
- Department of Medicine, Boston University School of Medicine, Crosstown Center, 801 Massachusetts Avenue, Boston, MA 02218, USA
| | - E. Krupitsky
- St. Petersburg Bekhterev Research Psychoneurological Institute, 3 Bekhterev Street, St. Petersburg 192019, Russia
| | - J.H. Samet
- Department of Medicine, Boston University School of Medicine, Crosstown Center, 801 Massachusetts Avenue, Boston, MA 02218, USA
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Lim WY, Subramaniam M, Abdin E, He VY, Vaingankar J, Chong SA. Lifetime and twelve-month prevalence of heavy-drinking in Singapore: results from a representative cross-sectional study. BMC Public Health 2013; 13:992. [PMID: 24499269 PMCID: PMC4028979 DOI: 10.1186/1471-2458-13-992] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/14/2013] [Indexed: 11/28/2022] Open
Abstract
Background The study aimed to establish the prevalence of heavy drinking, evaluate correlations between heavy drinking and socio-demographic factors, physical and psychiatric conditions, and assess the impact of heavy drinking on quality of life and days of work-loss. Methods Data from a nationally-representative cross-sectional sample were used. The sample comprised 6616 community-dwelling Singaporeans & Singapore Permanent Residents. The main instruments used were the World Mental Health Composite International Diagnostic Interview and EuroQol 5D. Heavy drinking was defined as consumption of 4 or more drinks, or 5 or more drinks in a day in women and men respectively. Results 12.6% of all adult Singapore residents reported heavy drinking in the last 12 months, and 15.9% reported lifetime heavy-drinking. Strong gender, ethnic, age and income differences were seen. Heavy drinking was positively associated with major depression, the presence of any mood disorder, and with chronic pain. It was also strongly associated with alcohol dependence, alcohol abuse, and nicotine dependence. Heavy-drinkers reported lower quality of life compared to non-heavy drinkers, measured using the EuroQol 5D Visual Analogue Scale. Conclusions Singapore has a relatively high prevalence of 12-month heavy drinking of 12.6%, and lifetime heavy drinking of 15.9%. Heavy drinking was positively associated with both physical and mental health conditions, and with declines in quality of life. Continued monitoring of heavy drinking behavior and sustained efforts to mitigate the risks associated with heavy drinking is needed.
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Affiliation(s)
- Wei-Yen Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, MD3, 16 Medical Drive, S(117597), Singapore, Singapore.
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Brandt CP, Gonzalez A, Grover KW, Zvolensky MJ. The Relation Between Emotional Dysregulation and Anxiety and Depressive Symptoms, Pain-Related Anxiety, and HIV-Symptom Distress Among Adults with HIV/AIDS. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2012. [DOI: 10.1007/s10862-012-9329-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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McGinnis KA, Justice AC, Kraemer KL, Saitz R, Bryant KJ, Fiellin DA. Comparing alcohol screening measures among HIV-infected and -uninfected men. Alcohol Clin Exp Res 2012; 37:435-42. [PMID: 23050632 DOI: 10.1111/j.1530-0277.2012.01937.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 07/11/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Brief measures of unhealthy alcohol use have not been well validated among people with HIV. We compared the Alcohol Use Disorders Identification Test (AUDIT) to reference standards for unhealthy alcohol use based on 30-day Timeline Follow Back (TLFB) and Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM), among 837 male HIV-infected and -uninfected patients in the Veterans Aging Cohort Study. METHODS Three reference standards were (i) Risky drinking-based on TLFB >14 drinks over 7 consecutive days or >4 drinks on 1 day; (ii) Alcohol dependence-based on a CIDI-SAM diagnosis; and (iii) Unhealthy alcohol use-risky drinking or a CIDI-SAM diagnosis of abuse or dependence. Various cutoffs for the AUDIT, AUDIT-C, and heavy episodic drinking were compared with the reference standards. RESULTS Mean age of patients was 52 years, 53% (444) were HIV-infected, and 53% (444) were African American. Among HIV-infected and -uninfected patients, the prevalence of risky drinking (14 vs. 12%, respectively), alcohol dependence (8 vs. 7%), and unhealthy alcohol use (22 vs. 20%) was similar. For risky drinking and alcohol dependence, multiple cutoffs of AUDIT, AUDIT-C, and heavy episodic drinking provided good sensitivity (≥80%) and specificity (≥90%). For unhealthy alcohol use, few cutoffs provided sensitivity ≥80%; however, many cutoffs provided good specificity. For all 3 alcohol screening measures, sensitivity improved when heavy episodic drinking was included with the cutoff. Sensitivity of measures for risky drinking and unhealthy alcohol use was lower in HIV-infected than in uninfected patients. CONCLUSIONS For identifying risky drinking, alcohol dependence, and unhealthy alcohol use, AUDIT-C performs as well as AUDIT and similarly in HIV-infected and -uninfected patients. Cutoffs should be based on the importance of specific operating characteristics for the intended research or clinical use. Incorporating heavy episodic drinking increased sensitivity for detecting alcohol dependence and unhealthy alcohol use.
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Affiliation(s)
- Kathleen A McGinnis
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15206-4900, USA
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Sassoon SA, Rosenbloom MJ, Fama R, Sullivan EV, Pfefferbaum A. Selective neurocognitive deficits and poor life functioning are associated with significant depressive symptoms in alcoholism-HIV infection comorbidity. Psychiatry Res 2012; 199:102-10. [PMID: 22648011 PMCID: PMC3433639 DOI: 10.1016/j.psychres.2012.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/10/2012] [Accepted: 05/11/2012] [Indexed: 11/25/2022]
Abstract
Alcoholism, HIV, and depressive symptoms frequently co-occur and are associated with impairment in cognition and life function. We administered the Beck Depression Inventory-II (BDI-II), measures of life function, and neurocognitive tests to 67 alcoholics, 56 HIV+ patients, 63 HIV+ alcoholics, and 64 controls to examine whether current depressive symptom level (significant, BDI-II>14 vs. minimal, BDI-II<14) was associated with poorer cognitive or psychosocial function in alcoholism-HIV comorbidity. Participants with significant depressive symptoms demonstrated slower manual motor speed and poorer visuospatial memory than those with minimal depressive symptoms. HIV patients with depressive symptoms showed impaired manual motor speed. Alcoholics with depressive symptoms showed impaired visuospatial memory. HIV+ alcoholics with depressive symptoms reported the poorest quality of life; alcoholics with depressive symptoms, irrespective of HIV status, had poorest life functioning. Thus, significant depressive symptoms were associated with poorer selective cognitive and life functioning in alcoholism and in HIV infection, even though depressive symptoms had neither synergistic nor additive effects on cognition in alcoholism-HIV comorbidity. The results suggest the relevance of assessing and treating current depressive symptoms to reduce cognitive compromise and functional disability in HIV infection, alcoholism, and their comorbidity.
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Affiliation(s)
| | - Margaret J. Rosenbloom
- Neuroscience Program, SRI International, Menlo Park, CA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Rosemary Fama
- Neuroscience Program, SRI International, Menlo Park, CA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Edith V. Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Adolf Pfefferbaum
- Neuroscience Program, SRI International, Menlo Park, CA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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Watkins CC, Treisman GJ. Neuropsychiatric complications of aging with HIV. J Neurovirol 2012; 18:277-90. [PMID: 22644745 DOI: 10.1007/s13365-012-0108-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/23/2012] [Accepted: 04/26/2012] [Indexed: 01/28/2023]
Abstract
Persons over age 50 are not only aging with human immunodeficiency virus (HIV) infection but also represent a high proportion of new HIV infections. Neuropsychiatric symptoms, including depression, cognitive impairment, and substance abuse, are very common in individuals infected with HIV. However, there is little understanding of the relationship between these HIV-related comorbid conditions in newly infected elderly patients compared to uninfected elderly and those who have survived after 20 years of HIV/AIDS. We summarize the current theories and research that link aging and HIV with psychiatric illnesses and identify emerging areas for improved research, treatment, and patient care.
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Affiliation(s)
- Crystal C Watkins
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Chander G. Addressing alcohol use in HIV-infected persons. TOPICS IN ANTIVIRAL MEDICINE 2011; 19:143-147. [PMID: 22156216 PMCID: PMC6148879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Alcohol use is common among persons with HIV infection and is associated with worse HIV treatment outcomes. Patients with hazardous levels of use are less likely to be receiving antiretroviral therapy, to be adherent to therapy, and to achieve virologic suppression. Screening, intervention, and referral to care for alcohol use disorder is an integral part of clinical care for individuals with HIV infection. Brief screening procedures can identify level of risk and determine whether patients require brief alcohol intervention or should be considered for behavioral therapy and pharmacologic treatment. Identification of concurrent mental health disorders is an important aspect of treating alcohol use disorders in HIV infection and other clinical settings. This article summarizes a presentation by Geetanjali Chander, MD, MPH, at the 14th Annual Clinical Conference for the Ryan White HIV/AIDS Program held in Tampa, Florida, in June 2011. The Clinical Conference is sponsored by the IAS-USA under the Health Resources and Services Administration (HRSA) contract number HHSH250200900010C.
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