151
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Women and vulnerability to HAART non-adherence: a literature review of treatment adherence by gender from 2000 to 2011. Curr HIV/AIDS Rep 2012; 8:277-87. [PMID: 21989672 DOI: 10.1007/s11904-011-0098-0] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A literature review of original research articles on adherence to antiretroviral therapy (ART) in developed countries, covering January 2000 to June 2011, was conducted to determine if gender differences exist in the prevalence of nonadherence to ART. Of the 1,255 articles reviewed, only 189 included data on the proportion of the study population that was adherent and only 57 (30.2%) of these reported proportional adherence values by gender. While comparing articles was challenging because of varied reporting strategies, women generally exhibit poorer adherence than men. Thirty of the 44 articles (68.2%) that reported comparative data on adherence by gender found women to be less adherent than men. Ten articles (17.5%) reported significant differences in proportional adherence by gender, nine of which showed women to be less adherent than men. These findings suggest that in multiple studies from developed countries, female gender often predicts lower adherence. The unique circumstances of HIV-positive women require specialized care to increase adherence to ART.
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152
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Gerbi GB, Habtemariam T, Robnett V, Nganwa D, Tameru B. Psychosocial factors as predictors of HIV/AIDS risky behaviors among people living with HIV/AIDS. ACTA ACUST UNITED AC 2012; 4:8-16. [PMID: 22374351 DOI: 10.5897/jahr11.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Infection with the human immunodeficiency virus (HIV) that causes acquired immunodeficiency syndrome (AIDS) is still rising globally. In order to develop effective HIV/AIDS risky behavior reduction intervention strategies and to further decrease the spread of HIV/AIDS, it is important to assess the prevalence of psychosocial problems and HIV/AIDS risky behaviors in people living with HIV/AIDS (PLWHA). The objective of this study is to assess the relationship between psychosocial variables and HIV/AIDS risky behaviors among PLWHA. A total of 341 questionnaires were distributed and 326 were fully completed and returned, 96% response rate. The relationships between the identified psychosocial and HIV/AIDS risky behaviors among PLWHA were analyzed using The Moment Structures software version 17.0 (SPSS Inc.) The results indicate that psychosocial health problems were significant predictors of HIV/AIDS risky behaviors in PLWA. Further cross-disciplinary research that addresses the manner in which psychosocial problems and HIV/AIDS risky behaviors interact with each other among PLWHA is needed.
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Affiliation(s)
- Gemechu B Gerbi
- Center for Computational Epidemiology, Bioinformatics and Risk Analysis (CCEBRA), College of Veterinary Medicine, Nursing and Allied Health (CVMNAH), Tuskegee University, Tuskegee, Alabama 36088, U.S.A
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153
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Weiser SD, Young SL, Cohen CR, Kushel MB, Tsai AC, Tien PC, Hatcher AM, Frongillo EA, Bangsberg DR. Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr 2011; 94:1729S-1739S. [PMID: 22089434 PMCID: PMC3226026 DOI: 10.3945/ajcn.111.012070] [Citation(s) in RCA: 306] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Food insecurity, which affects >1 billion people worldwide, is inextricably linked to the HIV epidemic. We present a conceptual framework of the multiple pathways through which food insecurity and HIV/AIDS may be linked at the community, household, and individual levels. Whereas the mechanisms through which HIV/AIDS can cause food insecurity have been fairly well elucidated, the ways in which food insecurity can lead to HIV are less well understood. We argue that there are nutritional, mental health, and behavioral pathways through which food insecurity leads to HIV acquisition and disease progression. Specifically, food insecurity can lead to macronutrient and micronutrient deficiencies, which can affect both vertical and horizontal transmission of HIV, and can also contribute to immunologic decline and increased morbidity and mortality among those already infected. Food insecurity can have mental health consequences, such as depression and increased drug abuse, which, in turn, contribute to HIV transmission risk and incomplete HIV viral load suppression, increased probability of AIDS-defining illness, and AIDS-related mortality among HIV-infected individuals. As a result of the inability to procure food in socially or personally acceptable ways, food insecurity also contributes to risky sexual practices and enhanced HIV transmission, as well as to antiretroviral therapy nonadherence, treatment interruptions, and missed clinic visits, which are strong determinants of worse HIV health outcomes. More research on the relative importance of each of these pathways is warranted because effective interventions to reduce food insecurity and HIV depend on a rigorous understanding of these multifaceted relationships.
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Affiliation(s)
- Sheri D Weiser
- Division of HIV/AIDS, San Francisco General Hospital, USA.
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154
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Su L. A marginalized conditional linear model for longitudinal binary data when informative dropout occurs in continuous time. Biostatistics 2011; 13:355-68. [PMID: 22133756 PMCID: PMC3297830 DOI: 10.1093/biostatistics/kxr041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Within the pattern-mixture modeling framework for informative dropout, conditional linear models (CLMs) are a useful approach to deal with dropout that can occur at any point in continuous time (not just at observation times). However, in contrast with selection models, inferences about marginal covariate effects in CLMs are not readily available if nonidentity links are used in the mean structures. In this article, we propose a CLM for long series of longitudinal binary data with marginal covariate effects directly specified. The association between the binary responses and the dropout time is taken into account by modeling the conditional mean of the binary response as well as the dependence between the binary responses given the dropout time. Specifically, parameters in both the conditional mean and dependence models are assumed to be linear or quadratic functions of the dropout time; and the continuous dropout time distribution is left completely unspecified. Inference is fully Bayesian. We illustrate the proposed model using data from a longitudinal study of depression in HIV-infected women, where the strategy of sensitivity analysis based on the extrapolation method is also demonstrated.
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Affiliation(s)
- Li Su
- MRC Biostatistics Unit, Robinson Way, Cambridge, UK.
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155
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Schuster R, Bornovalova M, Hunt E. The influence of depression on the progression of HIV: direct and indirect effects. Behav Modif 2011; 36:123-45. [PMID: 22089635 DOI: 10.1177/0145445511425231] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The authors suggest a theoretical model of pathways of HIV progression, with a focus on the contributions of depression-as well as secondary, behavioral and emotional variables. Literature was reviewed regarding (a) comorbid depression and the direct physiological effects on HIV progression and (b) intermediary factors between HIV and disease progression. Intermediary factors included (a) substance use, (b) social support, (c) hopelessness, (d) medication nonadherence, and (e) risky sexual behavior and the contraction of secondary infections. The authors suggest direct physiological pathways from depression to HIV progression and indirect pathways (e.g., behavioral, social, and psychological). In addition to depression, substance use, poor social support, hopelessness, medication nonadherence, and risky sexual behavior seem to be integral in HIV progression. Based on the individual relationships of these variables to depression and HIV progression, a comprehensive multipath model, incorporating all factors, serves to explain how severe emotional distress may lead to accelerated progression to AIDS.
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156
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Watkins CC, Pieper AA, Treisman GJ. Safety considerations in drug treatment of depression in HIV-positive patients: an updated review. Drug Saf 2011; 34:623-39. [PMID: 21751824 DOI: 10.2165/11592070-000000000-00000] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Major depressive disorder (MDD) is one of the most prevalent illnesses associated with HIV infection, and negatively affects medication adherence, disease progression and mortality in HIV disease. Co-morbid treatment of major depression in HIV disease is the optimal therapeutic approach, but discriminating MDD from normal fluctuations in mood state, personality or physiology is difficult. Definitive diagnosis of MDD is critical for drug safety and for avoiding unnecessary exposure to psychotropic medications. HIV patients respond to antidepressant treatment like the general population, and medication adverse effects and patient adherence are the best predictors of treatment outcome. This review attempts to assist the medical provider with the diagnosis and treatment of MDD in HIV patients. We outline the initial steps in screening and psychiatric referral, the antidepressants that are particularly useful in HIV-infected patients, and the adverse effects and pharmacological strategies for overcoming potential barriers to medication adherence. Potential interactions between the various classes of antidepressants and HIV/antiretroviral therapy, as well as management of HIV medication-related psychiatric adverse effects, are also discussed.
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Affiliation(s)
- Crystal C Watkins
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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157
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Vogenthaler NS, Hadley C, Rodriguez AE, Valverde EE, del Rio C, Metsch LR. Depressive symptoms and food insufficiency among HIV-infected crack users in Atlanta and Miami. AIDS Behav 2011; 15:1520-6. [PMID: 20099017 PMCID: PMC2934749 DOI: 10.1007/s10461-010-9668-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Depression contributes to worse general and HIV-related clinical outcomes. We examined the prevalence of and factors associated with depressive symptomatology among HIV-infected crack cocaine users recruited for Project HOPE (Hospital Visit is an Opportunity for Prevention and Engagement with HIV-positive Crack Users). We used multiple logistic regression to determine sociodemographic correlates associated with screening in for depression. Among 291 participants, three-quarters (73.5%) were identified as depressed. Higher odds of screening in for depression was associated with food insufficiency and monthly income below $600. Alcohol and crack use were not associated with screening in for depression. Depressive symptomatology is extremely prevalent among HIV-infected crack cocaine users and is associated with food insufficiency and lower income. Screening for depression and food insecurity should be included in HIV prevention and treatment programs. Improved recognition and mitigation of these conditions will help alleviate their contribution to HIV-related adverse health outcomes.
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Affiliation(s)
- Nicholas S Vogenthaler
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30303, USA.
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158
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Kyser M, Buchacz K, Bush TJ, Conley LJ, Hammer J, Henry K, Kojic EM, Milam J, Overton ET, Wood KC, Brooks JT. Factors associated with non-adherence to antiretroviral therapy in the SUN study. AIDS Care 2011; 23:601-11. [PMID: 21293992 DOI: 10.1080/09540121.2010.525603] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Adherence of 95% or greater to highly active combination antiretroviral therapy is generally considered necessary to achieve optimal virologic suppression in HIV-infected patients. Understanding factors associated with poor adherence is essential to improve patient compliance, maximize virologic suppression, and reduce morbidity and mortality. METHODS We evaluated baseline data from 528 patients taking antiretrovirals, enrolled from March 2004 to June 2006, in a multicenter, longitudinal, prospective cohort study (the SUN study). Using multiple logistic regression, we examined independent risk factors for non-adherence, defined as reporting having missed one or more antiretroviral doses in the past three days on the baseline questionnaire. RESULTS Of 528 participants (22% female, 28% black, median age 41 years, and median CD4 cell count 486 cells/mm(3)), 85 (16%) were non-adherent. In the final parsimonious multivariate model, factors independently associated with non-adherence included black race (adjusted odds ratio (aOR): 2.08, 95% confidence interval (CI): 1.20-3.60 vs. white race), being unemployed and looking for work (aOR: 2.03, 95% CI: 1.14-3.61 vs. all other employment categories), having been diagnosed with HIV ≥5 years ago (aOR: 1.95, 95% CI: 1.18-3.24 vs. being HIV-diagnosed <5 years ago), drinking three or more drinks per day (aOR: 1.73, 95% CI: 1.02-2.91 vs. drinking <3 drinks per day), and having not engaged in any aerobic exercise in the last 30 days (aOR: 2.13, 95% CI: 1.25-3.57). CONCLUSION Although the above factors may not be causally related to non-adherence, they might serve as proxies for identifying HIV-infected patients at greatest risk for non-adherence who may benefit from additional adherence support.
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Affiliation(s)
- Melanie Kyser
- National Center for HIV/AIDS, Viral Hepatitis, TB, and STD Prevention, Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
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159
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Rubin LH, Cook JA, Grey DD, Weber K, Wells C, Golub ET, Wright RL, Schwartz RM, Goparaju L, Cohan D, Wilson ML, Maki PM. Perinatal depressive symptoms in HIV-infected versus HIV-uninfected women: a prospective study from preconception to postpartum. J Womens Health (Larchmt) 2011; 20:1287-95. [PMID: 21732738 PMCID: PMC3168970 DOI: 10.1089/jwh.2010.2485] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Depression is common among HIV-infected women, predicts treatment nonadherence, and consequently may impact vertical transmission of HIV. We report findings from a study evaluating preconception, pregnancy, and postpartum depressive symptoms in HIV-infected vs. at-risk, HIV-uninfected women. METHODS We examined the prevalence and predictors of elevated perinatal (i.e., pregnancy and/or postpartum) depressive symptoms using a Center for Epidemiological Studies-Depression (CES-D) scale score of ≥16 in 139 HIV-infected and 105 HIV-uninfected women (62% African American) from the Women's Interagency HIV Study (WIHS). RESULTS The prevalence of elevated perinatal depressive symptoms did not differ by HIV serostatus (HIV-infected 44%, HIV-uninfected 50%, p=0.44). Among HIV-infected women, the strongest predictor of elevated symptoms was preconception depression (odds ratio [OR] 5.71, 95% confidence interval [CI] 2.67-12.19, p<0.001); crack, cocaine, and/or heroin use during preconception was marginally significant (OR 3.10, 95% CI 0.96-10.01, p=0.06). In the overall sample, additional significant predictors of perinatal depression included having multiple sex partners preconception (OR 2.20, 95% CI 1.12-4.32, p=0.02), use of preconception mental health services (OR 2.51, 95% CI 1.03-6.13, p=0.04), and not graduating from high school (OR 1.92, 95% CI 1.06-3.46, p=0.03). CONCLUSIONS Elevated perinatal depressive symptoms are common among HIV-infected and at-risk HIV-uninfected women. Depressive symptoms before pregnancy were the strongest predictor of perinatal symptoms. Findings underscore the importance of early and ongoing assessment and treatment to ensure low vertical transmission rates and improving postpregnancy outcomes for mothers and children.
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Affiliation(s)
- Leah H Rubin
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA.
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160
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Persons newly diagnosed with HIV infection are at high risk for depression and poor linkage to care: results from the Steps Study. AIDS Behav 2011; 15:1161-70. [PMID: 20711651 DOI: 10.1007/s10461-010-9778-9] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Little is known about the prevalence and impact of depression in persons newly diagnosed with HIV infection. The Steps Study is a prospective, observational cohort study of persons newly diagnosed with HIV infection. Participants were administered a battery of instruments, including the CES-D. Linkage to care was defined as attending at least one clinic appointment in each of the first two 90-day intervals following diagnosis. Of 180 participants, 67% screened positive for depression. In multivariate analysis, depression was associated with female sex, income <$25,000, recent substance abuse, baseline poor access to medical care, and low self-efficacy. Fifty-six and sixty-eight percent of depressed and not depressed participants linked to care, respectively. In multivariate analysis, depression was a borderline significant predictor of poor linkage. Depression is very prevalent in persons newly diagnosed with HIV infection. Interventions targeting linkage to care should address depression, substance abuse, and barriers to care.
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161
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Zhao L, Holzemer WL, Johnson M, Tulsky JP, Rose CD. HIV infection as a predictor of methadone maintenance outcomes in Chinese injection drug users. AIDS Care 2011; 24:195-203. [PMID: 21780984 DOI: 10.1080/09540121.2011.596520] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper's design is descriptive and correlational based on retrospective self-report survey data collected in Kunming city, China. The study investigated the difference between a group of Chinese HIV positive (N=36) and negative (N=131) opioid dependent adults maintained on methadone treatment. Comparisons were based on their quality of life (QOL), methadone treatment adherence, adverse symptom occurrence related to methadone treatment, and HIV-related behavior changes. No significant differences were found between the two groups in age, methadone maintenance dose, methadone adherence, sex desire, and drug craving level. Participants who were HIV positive reported significantly lower scores on physical health and total health-related qualify of life. They also reported greater engagement in injection related risk behavior before methadone treatment than those who tested HIV negative. For both groups, sexual and injection risk behavior significantly decreased following initiation of methadone treatment. A regression model revealed that those infected with HIV, associated significantly with higher likelihood of reporting constipation and lack of appetite, and higher frequency of reporting abdominal pain and nausea than HIV negative patients. The primary implication of these findings is that HIV positive persons in methadone treatment may require more focused services to meet their special HIV care and substance treatment needs.
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Affiliation(s)
- Lin Zhao
- Community Health Systems, University of California, San Francisco, CA, USA.
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162
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Soller M, Kharrazi N, Prentiss D, Cummings S, Balmas G, Koopman C, Israelski D. Utilization of psychiatric services among low-income HIV-infected patients with psychiatric comorbidity. AIDS Care 2011; 23:1351-9. [PMID: 21767117 DOI: 10.1080/09540121.2011.565024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION HIV-infected individuals face a tremendous burden of psychiatric comorbidity. This study evaluates a community health care system's effort to screen for psychiatric disorders among patients at an HIV clinic and evaluate adherence to psychiatric service utilization. METHODS Standardized screening measures were used to identify participants who met diagnostic symptom criteria for post-traumatic stress disorder (PTSD), acute stress disorder (ASD) and depression. All participants who screened positive were referred for psychiatric follow-up. Rates of utilization were measured and barriers to adherence were investigated. RESULTS Of the 210 participants, 118 patients met screening criteria for PTSD, ASD, and/or depression, and 116 of these had medical records available for review. Of the 116 patients with psychiatric comorbidity, 46.6% saw a psychiatrist and/or were prescribed a psychiatric medication. Thirty-two percent of Latinos, 40.5% of African Americans, and 38.5% of heterosexuals utilized referred psychiatric services, and these rates were significantly less than their counterparts. One hundred patients were seen by a social worker. DISCUSSION While a large burden of psychiatric comorbidity exists among this population of HIV-positive patients, only half adhered to recommended psychiatric services referrals. Further research is warranted to examine cost-effective interventions to maximize psychiatric screening, referral, and follow-up with mental health services in this vulnerable population.
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Affiliation(s)
- Marie Soller
- San Mateo County Behavioral Health and Recovery Services, Psychiatry Residency, San Mateo, CA, USA.
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163
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Martin EG, Barry CL. The adoption of mental health drugs on state AIDS drug assistance program formularies. Am J Public Health 2011; 101:1103-9. [PMID: 21493949 DOI: 10.2105/ajph.2010.300100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought state-level factors associated with the adoption of medications to treat mental health conditions on state formularies for the AIDS Drug Assistance Program. METHODS We interviewed 22 state and national program experts and identified 7 state-level factors: case burden, federal dollar-per-case Ryan White allocation size, political orientation, state wealth, passage of a mental health parity law, number of psychiatrists per population, and size of mental health budget. We then used survival analysis to test whether the factors were associated with faster adoption of psychotropic drugs from 1997 to 2008. RESULTS The relative size of a state's federal Ryan White HIV/AIDS Program allocation, the state's political orientation, and its concentration of psychiatrists were significantly associated with time-to-adoption of psychotropic drugs on state AIDS Drug Assistance Program formularies. CONCLUSIONS Substantial heterogeneity exists across states in formulary adoption of drugs to treat mental illness. Understanding what factors contribute to variation in adoption is vital given the importance of treating mental health conditions as a component of comprehensive HIV care.
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Affiliation(s)
- Erika G Martin
- Rockefeller College of Public Affairs & Policy, University at Albany, State University of New York, Albany, NY 12222, USA.
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164
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Miles MS, Isler MR, Banks BB, Sengupta S, Corbie-Smith G. Silent endurance and profound loneliness: socioemotional suffering in African Americans living with HIV in the rural south. QUALITATIVE HEALTH RESEARCH 2011; 21:489-501. [PMID: 21041516 PMCID: PMC3073239 DOI: 10.1177/1049732310387935] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We explored how community responses to HIV contribute to distress in African Americans living with HIV in the rural South of the United States. We listened to the voices of community members through focus groups and African Americans with HIV through interviews. Community avoidance of HIV, negative views of HIV, and discriminatory behavior powerfully affected the distress of people living with HIV (PLWH). Ongoing distress, coupled with limited support, led to a life in which many PLWH endured their pain in silence and experienced profound loneliness. We conceptualized their experiences as socioemotional suffering--the hidden emotional burden and inner distress of not only living with HIV, a complex serious illness, but also with the societal attitudes and behaviors that are imposed on the illness and on PLWH. To improve the quality of life and health of PLWH, we cannot focus solely on the individual, but must also focus on the local community and society as a whole.
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165
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Participant characteristics and HIV risk behaviors among individuals entering integrated buprenorphine/naloxone and HIV care. J Acquir Immune Defic Syndr 2011; 56 Suppl 1:S14-21. [PMID: 21317589 DOI: 10.1097/qai.0b013e318209d3b9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study was part of a national, multisite demonstration project evaluating the impact of integrated buprenorphine/naloxone treatment and HIV care. The goals of this study were to describe the baseline demographic, clinical, and substance use characteristics of the participants and to explore HIV transmission risk behaviors in this group. METHODS Nine sites across the United States participated. Data obtained by interview and chart review included demographic information, medical history, substance use, and risk behaviors.We performed a descriptive analysis of patient characteristics at entry and used logistic regression to evaluate factors associated with 1) unprotected anal or vaginal sex; and 2) needle-sharing within the previous 90 days. RESULTS Three hundred eighty-six individuals were included in the study: 303 (78.5%) received buprenorphine/naloxone; 41 (10.6%) received methadone; and 42 (10.9%) received another form of treatment. The analysis of risk behaviors was limited to those in the buprenorphine group (n = 303). Among those reporting vaginal or anal sex in the previous 90 days, 24% had sex without a condom. Factors significantly associated with unprotected sex were: having a partner; female gender; and alcohol use in previous 30 days. A total of 8.9% of participants shared needles in the previous 90 days. Factors significantly associated with needle-sharing were: amphetamine use; marijuana use; homelessness; and anxiety. CONCLUSIONS Addressing transmission risk behaviors is an important secondary HIV prevention strategy. In addition to treatment for opioid dependence, addressing other substance use, social issues, particularly housing, and mental health may have important implications for reducing HIV transmission in HIV-infected opioid-dependent patients.
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166
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Eller LS, Bunch EH, Wantland DJ, Portillo CJ, Reynolds NR, Nokes KM, Coleman CL, Kemppainen JK, Kirksey KM, Corless IB, Hamilton MJ, Dole PJ, Nicholas PK, Holzemer WL, Tsai YF. Prevalence, correlates, and self-management of HIV-related depressive symptoms. AIDS Care 2011; 22:1159-70. [PMID: 20824569 DOI: 10.1080/09540121.2010.498860] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Depressive symptoms are highly prevalent yet undertreated in people living with HIV/AIDS (PLHAs). As part of a larger study of symptom self-management (N=1217), this study examined the prevalence, correlates, and characteristics (intensity, distress, and impact) of depressive symptoms, and the self-care strategies used to manage those symptoms in PLHAs in five countries. The proportion of respondents from each country in the total sample reporting depressive symptoms in the past week varied and included Colombia (44%), Norway (66%), Puerto Rico (57%), Taiwan (35%), and the USA (56%). Fifty-four percent (n=655) of the total sample reported experiencing depressive symptoms in the past week, with a mean of 4.1 (SD 2.1) days of depression. Mean depression intensity 5.4 (SD 2.7), distressfulness 5.5 (SD 2.86), and impact 5.5 (SD 3.0) were rated on a 1-10 scale. The mean Center for Epidemiologic Studies Depression Scale score for those reporting depressive symptoms was 27 (SD 11; range 3-58), and varied significantly by country. Respondents identified 19 self-care behaviors for depressive symptoms, which fell into six categories: complementary therapies, talking to others, distraction techniques, physical activity, medications, and denial/avoidant coping. The most frequently used strategies varied by country. In the US sample, 33% of the variance in depressive symptoms was predicted by the combination of education, HIV symptoms, psychological and social support, and perceived consequences of HIV disease.
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Affiliation(s)
- L S Eller
- Rutgers The State University of New Jersey, Newark, USA.
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167
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Kipp AM, Desruisseau AJ, Qian HZ. Non-injection drug use and HIV disease progression in the era of combination antiretroviral therapy. J Subst Abuse Treat 2011; 40:386-96. [PMID: 21353444 DOI: 10.1016/j.jsat.2011.01.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 10/11/2010] [Accepted: 01/06/2011] [Indexed: 11/18/2022]
Abstract
Little is known about the effects of non-injection drug use (NIDU) on HIV antiretroviral treatment outcomes. We conducted a systematic literature search and identified nine publications from prospective cohort studies investigating the relationship between NIDU and clinical HIV disease progression. Hazard ratios from studies estimating the effect of drug use on time to AIDS-related mortality ranged from 0.89 to 3.61, and only two of these were statistically significant. Hazard ratios from studies assessing time to an AIDS-defining event ranged from 1.19 to 2.51, with 8 of the 14 estimates falling between 1.55 and 1.65 regardless of drug use definition and measurement of use or frequency. It is suggested that NIDU may have a moderate effect of increasing the risk of progression to AIDS, but its impact on AIDS-related mortality is uncertain. NIDU may affect HIV antiretroviral treatment outcomes primarily through interaction with antiretroviral therapy and, to a lesser extent, through immune modulation and deterioration of general health. The limitations about published studies are discussed, and future perspectives on research on this topic are provided.
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Affiliation(s)
- Aaron M Kipp
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
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168
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Tsai AC, Weiser SD, Petersen ML, Ragland K, Kushel MB, Bangsberg DR. A marginal structural model to estimate the causal effect of antidepressant medication treatment on viral suppression among homeless and marginally housed persons with HIV. ACTA ACUST UNITED AC 2011; 67:1282-90. [PMID: 21135328 DOI: 10.1001/archgenpsychiatry.2010.160] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Depression strongly predicts nonadherence to human immunodeficiency virus (HIV) antiretroviral therapy, and adherence is essential to maintaining viral suppression. This suggests that pharmacologic treatment of depression may improve virologic outcomes. However, previous longitudinal observational analyses have inadequately adjusted for time-varying confounding by depression severity, which could yield biased estimates of treatment effect. Application of marginal structural modeling to longitudinal observation data can, under certain assumptions, approximate the findings of a randomized controlled trial. OBJECTIVE To determine whether antidepressant medication treatment increases the probability of HIV viral suppression. DESIGN Community-based prospective cohort study with assessments conducted every 3 months. SETTING Community-based research field site in San Francisco, California. PARTICIPANTS One hundred fifty-eight homeless and marginally housed persons with HIV who met baseline immunologic (CD4+ T-lymphocyte count, <350/μL) and psychiatric (Beck Depression Inventory II score, >13) inclusion criteria, observed from April 2002 through August 2007. MAIN OUTCOME MEASURES Probability of achieving viral suppression to less than 50 copies/mL. Secondary outcomes of interest were probability of being on an antiretroviral therapy regimen, 7-day self-reported percentage adherence to antiretroviral therapy, and probability of reporting complete (100%) adherence. RESULTS Marginal structural models estimated a 2.03 greater odds of achieving viral suppression (95% confidence interval [CI], 1.15-3.58; P = .02) resulting from antidepressant medication treatment. In addition, antidepressant medication use increased the probability of antiretroviral uptake (weighted odds ratio, 3.87; 95% CI, 1.98-7.58; P < .001). Self-reported adherence to antiretroviral therapy increased by 25 percentage points (95% CI, 14-36; P < .001), and the odds of reporting complete adherence nearly doubled (weighted odds ratio, 1.94; 95% CI, 1.20-3.13; P = .006). CONCLUSIONS Antidepressant medication treatment increases viral suppression among persons with HIV. This effect is likely attributable to improved adherence to a continuum of HIV care, including increased uptake and adherence to antiretroviral therapy.
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Affiliation(s)
- Alexander C Tsai
- Langley Porter Psychiatric Institute, University of California at San Francisco, USA
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169
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Lawrence D, Kisely S, Pais J. The epidemiology of excess mortality in people with mental illness. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:752-60. [PMID: 21172095 DOI: 10.1177/070674371005501202] [Citation(s) in RCA: 175] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE to investigate the burden of excess mortality among people with mental illness in developed countries, how it is distributed, and whether it has changed over time. METHOD we conducted a systematic search of MEDLINE, restricting our attention to peer-reviewed studies and reviews published in English relating to mortality and mental illness. Because of the large number of studies that have been undertaken during the last 30 years, we have selected a representative cross-section of studies for inclusion in our review. RESULTS there is substantial excess mortality in people with mental illness for almost all psychiatric disorders and all main causes of death. Consistently elevated rates have been observed across settings and over time. The highest numbers of excess deaths are due to cardiovascular and respiratory diseases. With life expectancy increasing in the general population, the disparity in mortality outcomes for people with mental illness is increasing. CONCLUSIONS without the development of alternative approaches to promoting and treating the physical health of people with mental illness, it is possible that the disparity in mortality outcomes will persist.
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Affiliation(s)
- David Lawrence
- Centre for Developmental Health, Curtin University of Technology and Telethon Institute for Child Health Research, Perth, Australia.
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170
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Boryc K, Anastario MP, Dann G, Chi B, Cicatelli B, Steilen M, Gordon-Boyle K, Singh S, Morris M. A needs assessment of clients with HIV in a home-based care program in Guyana. Public Health Nurs 2010; 27:482-91. [PMID: 21087301 DOI: 10.1111/j.1525-1446.2010.00888.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To assess the needs of clients in a home-based care (HBC) program aimed at improving the quality of lives of people living with HIV in Region 4 of Guyana (Demerara-Mahaica region) following their involvement with the HBC program, volunteers, and nurse providers. DESIGN AND SAMPLE A cross-sectional analysis of a needs assessment conducted through a verbally administered questionnaire. We collected a cross-sectional sample of 84 HBC clients living with HIV from Region 4 in Guyana. MEASURES Respondents were administered a questionnaire that asked questions regarding the demographics; services received; quality of service delivery; and mental health and substance abuse. RESULTS The services most commonly received by respondents included nutritional assessment and counseling, HIV prevention education, emotional support, hygiene education, support for antiretroviral adherence, and support for HIV disclosure. Respondents reported further need of referrals to income-generation opportunities, food and nutritional supplement support, and support for children. Forty-two percent of the respondents screened positive for probable depression, and 37% of respondents screened positive for being at risk for a drinking problem. CONCLUSIONS While a substantial portion of needs were addressed by the HBC program, outstanding needs included linking people living with HIV to income-generation opportunities, food support, mental health, and services for children. We suggest that mental health and substance use services be factored into HIV programming and that referral systems be strengthened to ensure access to support services for people living with HIV.
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Affiliation(s)
- Kathryn Boryc
- Cicatelli Associates Inc., New York, New York 10003, USA
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171
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Physical and Psychological Symptoms and Risk of Virologic Rebound Among Patients With Virologic Suppression on Antiretroviral Therapy. J Acquir Immune Defic Syndr 2010; 54:500-5. [DOI: 10.1097/qai.0b013e3181ce6afe] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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172
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Reich WA, Lounsbury DW, Zaid-Muhammad S, Rapkin BD. Forms of social support and their relationships to mental health in HIV-positive persons. PSYCHOL HEALTH MED 2010; 15:135-45. [PMID: 20391231 DOI: 10.1080/13548501003623930] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A baseline assessment for an HIV health services study recruited 626 people living with HIV/AIDS (PLWHA) in New York city who participated in an interview querying social support, health status, substance use, and mental health. Data were modeled using hierarchical classes (HICLAS) analysis. HICLAS discriminated items reflecting general support and assistance vs. support from an important person in one's life who was named in addition to other family members and friends. HICLAS then identified respondents who reported that they had general support and assistance, support from an important person, both types, or neither type of support. Having one or more important persons as part of the respondent's social network was associated with more positive mental (but not physical) health than having only general support and assistance, or no support at all. Results argue for differentiating support obtained through one's relationship with an important person.
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173
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Sorsdahl KR, Mall S, Stein DJ, Joska JA. Perspectives towards mental illness in people living with HIV/AIDS in South Africa. AIDS Care 2010; 22:1418-27. [DOI: 10.1080/09540121003758655] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Katherine R. Sorsdahl
- a Department of Psychiatry & Mental Health , University of Cape Town, J-block, Groote Schuur Hospital , Observatory, Cape Town , 7925 , South Africa
| | - Sumaya Mall
- a Department of Psychiatry & Mental Health , University of Cape Town, J-block, Groote Schuur Hospital , Observatory, Cape Town , 7925 , South Africa
| | - Dan J. Stein
- a Department of Psychiatry & Mental Health , University of Cape Town, J-block, Groote Schuur Hospital , Observatory, Cape Town , 7925 , South Africa
| | - John A. Joska
- a Department of Psychiatry & Mental Health , University of Cape Town, J-block, Groote Schuur Hospital , Observatory, Cape Town , 7925 , South Africa
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174
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Hartley C, Pretorius K, Mohamed A, Laughton B, Madhi S, Cotton MF, Steyn B, Seedat S. Maternal postpartum depression and infant social withdrawal among human immunodeficiency virus (HIV) positive mother–infant dyads. PSYCHOL HEALTH MED 2010; 15:278-87. [DOI: 10.1080/13548501003615258] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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175
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Bansil P, Jamieson DJ, Posner SF, Kourtis AP. Trends in hospitalizations with psychiatric diagnoses among HIV-infected women in the USA, 1994-2004. AIDS Care 2010; 21:1432-8. [PMID: 20024721 DOI: 10.1080/09540120902814387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Psychiatric illnesses commonly co-occur with HIV infection and such illnesses have been linked to women's poorer medication adherence and suicide. Using hospital discharge data from the 1994-2004 Nationwide Inpatient Sample, we conducted this study to describe hospitalizations with psychiatric diagnoses from 1994 through 2004 and evaluate the association of specific psychiatric disorders among hospitalized HIV-infected women in the USA with their lack of adherence to medical treatment and suicide attempt. Multivariable logistic regression analyses were used to examine trends in hospitalizations with psychiatric diagnoses among nonpregnant HIV-infected women and the association between specific disorders and women's lack of adherence to medical treatment and suicide attempt. Between 1994 and 2004, the estimated number of all hospitalizations among nonpregnant HIV-infected women increased by 8%, while the number of hospitalizations with a psychiatric diagnosis in this population increased by 73%. After adjusting for demographic factors and alcohol/substance abuse, we found that HIV-infected women were more likely to be hospitalized for mood (odds ratio (OR): 2.35; 95% confidence interval (CI): 1.93-2.88), anxiety (OR: 2.24, 95%CI: 1.74-2.88), and psychotic (OR: 1.45, 95%CI: 1.10-1.90) disorders in 2004 than in 1994. There was a significant association of alcohol/substance abuse with mood, adjustment, anxiety, personality, and psychotic disorders. Noncompliance with medical treatment was significantly associated with psychotic disorders, whereas suicide attempt/self-inflicted injury was significantly associated with mood, adjustment, anxiety, personality, and psychotic disorders. The number of hospitalizations with a psychiatric diagnosis among HIV-infected women in the USA has increased substantially. As HIV-infected women live longer, these results highlight the need for targeted public health interventions to address mental health issues in this population.
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176
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Smith Fawzi MC, Eustache E, Oswald C, Surkan P, Louis E, Scanlan F, Wong R, Li M, Mukherjee J. Psychosocial functioning among HIV-affected youth and their caregivers in Haiti: implications for family-focused service provision in high HIV burden settings. AIDS Patient Care STDS 2010; 24:147-58. [PMID: 20214482 DOI: 10.1089/apc.2009.0201] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The study is an analysis of baseline data from a pilot psychosocial support intervention for HIV-affected youth and their caregivers in Haiti. Six sites in Haiti's Central Department affiliated with Partners In Health/Zanmi Lasante (PIH/ZL) and the Haitian Ministry of Health were included. Participants were recruited from a list of HIV-positive patients receiving care at PIH/ZL. The baseline questionnaire was administered from February 2006 to January 2007 with HIV-affected youth (n = 492), ages 10-17, and their caregivers (n = 330). According to findings at baseline, the youth reported high levels of anxiety, including constant fidgeting (86%), restlessness (83%), and worrying a lot (56%). Their parents/caregivers also reported a high level of depressive symptoms, such as low energy (73%), feeling everything is an effort (71%), and sadness (69%). Parents' depressive symptoms were positively associated with their children's psychological symptoms (odds ratio [OR] =1.6-2.4) and psychosocial functioning (OR =1.6 according to parental report). The significant levels of anxiety and depression observed among HIV-affected youth and their caregivers suggest that psychosocial interventions are needed among HIV-affected families in central Haiti and other high HIV burden areas. The results suggest that a family-focused approach to service provision may be beneficial, possibly improving quality of life, as well as psychosocial and physical health-related outcomes among HIV-affected youth and their caregivers, particularly HIV-positive parents.
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Affiliation(s)
- Mary C. Smith Fawzi
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts
| | | | | | - Pamela Surkan
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland
| | - Ermaze Louis
- Zanmi Lasante Sociomedical Complex, Cange, Haiti
| | | | - Richard Wong
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts
| | - Michelle Li
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts
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177
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Springer SA, Chen S, Altice F. Depression and symptomatic response among HIV-infected drug users enrolled in a randomized controlled trial of directly administered antiretroviral therapy. AIDS Care 2010; 21:976-83. [PMID: 20024753 DOI: 10.1080/09540120802657555] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Depression is highly prevalent among HIV-infected injection drug users (IDUs) and has been associated with poor adherence to antiretroviral therapy and increased morbidity and mortality. Factors associated with changes in depressive symptoms among this group receiving antiretroviral treatment that have not been extensively evaluated. METHODS This post-hoc analysis of prospective clinical trial analyzes the factors associated with changes in depressive symptomatology using the Center for Epidemiologic Studies of Depression Scale (CES-D) among HIV-infected IDUs enrolled in a prospective, six months randomized controlled trial of directly administered antiretroviral therapy (DAART) versus self-administered therapy. RESULTS Of the 127 evaluable IDUs enrolled in the study, 89 subjects (70%) had complete six-month follow-up data. Of these, 58 (63%) met baseline criteria for severe or major depressive disorder (MDD) using the CES-D. CES-D scores improved significantly from baseline to six months overall for the 89 subjects (p=0.01) and for the 58 who had MDD with six-month data (p=0.001). Using multiple regression, an improvement in CES-D score was independently associated with: (1) increase in CD4 count; (2) increase in adherence; (3) non-Caucasian race; and (4) older age. Worsening in CES-D score was associated with: (1) increase in HIV-1 RNA levels; (2) homelessness; (3) poor self-efficacy; (4) active drug use; and (5) male gender. Factors not correlated with changes in CES-D were receipt of DAART, engagement in drug treatment, use of antidepressant medication, and employment. Using generalized estimating equation modeling, factors that remained positively associated with improvements in CES-D score were absence of drug use at six months, having housing, higher self-efficacy, increase in CD4 count and increases in adherence. CONCLUSION Improvements in depressive symptoms could occur with improvement of alterable factors that are associated with strengthening adherence such as linkages to case management, mental health and substance abuse treatment services as well as through enhancement of social stabilization factors through social support and supportive housing.
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Affiliation(s)
- Sandra A Springer
- Yale School of Medicine, Yale University AIDS Program, New Haven, CT, USA.
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178
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Mkanta WN, Mejia MC, Duncan RP. Race, outpatient mental health service use, and survival after an AIDS diagnosis in the highly active antiretroviral therapy era. AIDS Patient Care STDS 2010; 24:31-7. [PMID: 20095900 DOI: 10.1089/apc.2009.0177] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We examined the relationships between survival after AIDS diagnosis and outpatient mental health service use among men with history of highly active antiretroviral therapy (HAART). Analysis involved 1913 black and 1684 white men with AIDS who received HIV care in 2003 in the Veterans Affairs health care system. Negative binomial regression was used to assess the association between service use and length of AIDS diagnosis. Patients with longer survival after AIDS had higher rates of outpatient visits for stress and adjustment disorders as well as for mood, anxiety, and sexual disorders. Blacks had more visits for stress and adjustment disorders (7.4 versus 5.1; p < 0.05). Multiple regression analysis showed that prolonged survival after AIDS (incident rate ratios [IRR] = 1.87; 95% confidence interval [CI] = 1.25-2.77), having CD4 cell count less than 200 cells/mm(3) (IRR = 1.91; 95% CI = 1.19-3.04), and mortality (IRR = 3.84; 95% CI = 1.29-11.43) were associated with greater number of visits for mood, anxiety, and sexual disorders. Injection drug users (IRR = 3.52; 95% CI = 1.94-6.38), men who have sex with men (IRR = 2.87; 95% CI = 1.62-5.06), and patients with AIDS-defining illness (IRR = 2.48; 95% CI = 1.47-4.17) had greater rates of visits for stress and adjustment disorders. Survival after AIDS is associated with mental health service use. As more HIV-infected persons survive longer, adequate risk assessment of mental health concerns that considers race and HIV risk factors should be undertaken to effectively address the impact of mental health on treatment outcomes and mortality.
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Affiliation(s)
- William N. Mkanta
- Department of Public Health, Western Kentucky University, Bowling Green, Kentucky
| | - Maria C. Mejia
- Research Service, Malcom Randall VAMC NF/SG Veterans Health System, Gainesville, Florida
| | - R. Paul Duncan
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida
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179
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Abstract
Although India is in the grip of HIV/AIDS epidemic, not much information is available on clinico-epidemiological and socio-behavioral aspects of people living with HIV/AIDS (PLWHA). This study analyzed these features using standard methodologies in 82 HIV sero-positives, AIDS patients attending ART clinic of three major government hospitals of Delhi. Majority of the patients (73%) were found to be young (<40 years) and married (79%). As high as 91.5% came from low socio-economic class and more than 95% acquired HIV transmission through heterosexual routes. A large proportion (63%) of these patients reported an extremely high level of anxiety, moderate level of stress and a borderline level of clinical depression. While most of the patients (72%) were well-adjusted with the ART, the rest of the patients reported difference in making adjustment with the treatment schedules. The study suggests that counseling and supportive therapy could play a pivotal role in controlling anxiety, stress, depression and rehabilitating people with HIV/AIDS.
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Affiliation(s)
- M A Khan
- Institute of Cytology and Preventive Oncology (ICPO), Noida, New Delhi, India
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180
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Reilly T, Smith L, Woodruff SI, Clapp JD, Cade J. Predictors of death and survival duration among a sample of persons living With HIV/AIDS. SOCIAL WORK IN HEALTH CARE 2010; 49:783-798. [PMID: 20938875 DOI: 10.1080/00981381003745020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A follow-up study was conducted on a sample of 120 ethnically diverse HIV-positive men and women first interviewed in 2000. Participant survival and death rates were ascertained from death records and analyses were performed to identify demographic and psychosocial predictors of survival from the original data. Consistent with past studies, factors associated with survival were age, CD4 count, years HIV positive, and lower alcohol use. Two analyses identified use of professional counseling as a unique factor associated with reduced risk of death. Contrary to our hypotheses, the results from these analyses did not suggest that social groups with fewer economic and institutional resources or those with limited access to highly active retroviral therapy (HAART) therapies were at reduced risk of survival.
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Affiliation(s)
- Thom Reilly
- School of Social Work, San Diego State University, San Diego, California 92182-4119, USA.
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181
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Cohen MH, Fabri M, Cai X, Shi Q, Hoover DR, Binagwaho A, Culhane MA, Mukanyonga H, Karegeya DK, Anastos K. Prevalence and predictors of posttraumatic stress disorder and depression in HIV-infected and at-risk Rwandan women. J Womens Health (Larchmt) 2009; 18:1783-91. [PMID: 19951212 PMCID: PMC2828188 DOI: 10.1089/jwh.2009.1367] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE During the 1994 Rwandan genocide, rape was used as a weapon of war to transmit HIV. This study measures trauma experiences of Rwandan women and identifies predictors associated with posttraumatic stress disorder (PTSD) and depressive symptoms. METHODS The Rwandan Women's Interassociation Study and Assessment (RWISA) is a prospective observational cohort study designed to assess effectiveness and toxicity of antiretroviral therapy in HIV-infected Rwandan women. In 2005, a Rwandan-adapted Harvard Trauma Questionnaire (HTQ) and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess genocide trauma events and prevalence of PTSD (HTQ mean > 2) and depressive symptoms (CES-D > or = 16) for 850 women (658 HIV-positive and 192 HIV-negative). RESULTS PTSD was common in HIV-positive (58%) and HIV-negative women (66%) (p = 0.05). Women with HIV had a higher prevalence of depressive symptoms than HIV-negative women (81% vs. 65%, p < 0.0001). Independent predictors for increased PTSD were experiencing more genocide-related trauma events and having more depressive symptoms. Independent predictors for increased depressive symptoms were making < $18 a month, HIV infection (and, among HIV-positive women, having lower CD4 cell counts), a history of genocidal rape, and having more PTSD symptoms. CONCLUSIONS The prevalence of PTSD and depressive symptoms is high in women in the RWISA cohort. Four of five HIV-infected women had depressive symptoms, with highest rates among women with CD4 cell counts < 200. In addition to treatment with antiretroviral therapy, economic empowerment and identification and treatment of depression and PTSD may reduce morbidity and mortality among women in postconflict countries.
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Affiliation(s)
- Mardge H Cohen
- Departments of Medicine, John Stroger (formerly Cook County) Hospital and Rush University, Chicago, Illinois, USA.
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182
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Su L, Hogan JW. Varying-coefficient models for longitudinal processes with continuous-time informative dropout. Biostatistics 2009; 11:93-110. [PMID: 19837655 PMCID: PMC2800163 DOI: 10.1093/biostatistics/kxp040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Dropout is a common occurrence in longitudinal studies. Building upon the pattern-mixture modeling approach within the Bayesian paradigm, we propose a general framework of varying-coefficient models for longitudinal data with informative dropout, where measurement times can be irregular and dropout can occur at any point in continuous time (not just at observation times) together with administrative censoring. Specifically, we assume that the longitudinal outcome process depends on the dropout process through its model parameters. The unconditional distribution of the repeated measures is a mixture over the dropout (administrative censoring) time distribution, and the continuous dropout time distribution with administrative censoring is left completely unspecified. We use Markov chain Monte Carlo to sample from the posterior distribution of the repeated measures given the dropout (administrative censoring) times; Bayesian bootstrapping on the observed dropout (administrative censoring) times is carried out to obtain marginal covariate effects. We illustrate the proposed framework using data from a longitudinal study of depression in HIV-infected women; the strategy for sensitivity analysis on unverifiable assumption is also demonstrated.
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Affiliation(s)
- Li Su
- MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 0SR, UK.
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183
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Davies SL, Horton TV, Williams AG, Martin MY, Stewart KE. MOMS: formative evaluation and subsequent intervention for mothers living with HIV. AIDS Care 2009; 21:552-60. [PMID: 19444662 DOI: 10.1080/09540120802301832] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Making Our Mothers Stronger (MOMS) Project is a randomized controlled behavioral trial, comparing a stress-reduction and social support intervention (Healthy MOMS) to a parenting skills intervention (Parenting Skills for MOMS) for mothers living with HIV. Outcomes include maternal mental and physical health, parenting behaviors, and children's behavior. To ensure that these interventions were tailored to the needs of HIV+ mothers, extensive formative work was conducted with members of the intended audience and relevant service providers. Findings from focus groups and semi-structured interviews highlighted the need for Healthy MOMS to: (1) include appropriate approaches to group discussion and problem solving; (2) address the stressors of being both a parent and a woman living with HIV; and (3) enhance social support. Six weekly group sessions focused on topics including coping with stress and anxiety; enhancing nutrition, exercise, and sexual health; improving medical adherence; improving communication with health care providers; and communicating health needs to family, friends, and co-workers. Initial anecdotal responses from participants suggest that the Healthy MOMS intervention addresses several salient issues for the growing population of HIV+ mothers who can benefit from long-term support in adapting to this chronic disease.
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Affiliation(s)
- Susan L Davies
- Department of Health Behavior, School of Public Health, University of Alabama, Birmingham, AL, USA.
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184
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Paddison J, Fricchione G, Gandhi RT, Freudenreich O. Fatigue in Psychiatric HIV Patients: A Pilot Study of Psychological Correlates. PSYCHOSOMATICS 2009. [DOI: 10.1016/s0033-3182(09)70837-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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185
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Trends in mortality and causes of death among women with HIV in the United States: a 10-year study. J Acquir Immune Defic Syndr 2009; 51:399-406. [PMID: 19487953 DOI: 10.1097/qai.0b013e3181acb4e5] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To assess trends in mortality and cause of death for women with HIV, we studied deaths over a 10-year period among participants in the Women's Interagency HIV Study, a representative US cohort. METHODS Deaths were ascertained by National Death Index Plus match, and causes of death determined by death certificate. RESULTS From 1995 through 2004, 710 of 2792 HIV-infected participants died. During this interval, the standardized mortality ratio fell from a high of 24.7 in 1996 to a plateau with a mean of 10.3 from 2001 to 2004. Over the decade, deaths from non-AIDS causes increased and accounted for the majority of deaths by 2001-2004. The most common non-AIDS causes of death were trauma or overdose, liver disease, cardiovascular disease, and malignancy. Independent predictors of mortality besides HIV-associated variables were depressive symptoms and active hepatitis B or C. Women who were overweight or obese were significantly less likely to die of AIDS than women of normal weight. CONCLUSIONS In the Women's Interagency HIV Study, the death rate has plateaued in recent years. Although HIV-associated factors predicted AIDS and non-AIDS deaths, other treatable conditions predicted mortality. Further gains in reducing mortality among HIV-infected women may require broader access to therapies for depression, viral hepatitis, and HIV itself.
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186
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Valverde EE, Cassetti I, Metsch LR, Bugarin G, Bofill L, Laurido M, McCoy C. Sex risk practices among HIV-positive individuals in Buenos Aires, Argentina. AIDS Patient Care STDS 2009; 23:551-6. [PMID: 19530955 DOI: 10.1089/apc.2008.0094] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We have limited information regarding the sexual risk behaviors of HIV-positive individuals in Argentina. It is important to understand these behaviors in order to develop strategies oriented at decreasing unsafe sex practices. A random sample of 140 HIV-positive individuals was recruited from an HIV primary care clinic in Buenos Aires, Argentina, between August and September 2005. Participants responded survey questions regarding their sexual behaviors in the previous three months. Logistic regression analysis was used to determine factors associated with inconsistent condom use during vaginal, anal, and oral sex. Of the 140 participants surveyed, 69% were male, the mean age was 38 years old, 29% reported having less than a high school education, and 84% reported having engaged in vaginal, anal, and/or oral sex in the past 3 months. Of 53 participants who reported engaging in anal sex, 60% were men who have sex with men, and 40% were heterosexuals. Inconsistent condom use was reported by 31% of participants engaging in anal sex, 39% of participants engaging in vaginal sex, and 71% of participants engaging in oral sex. When adjusting for other factors, participants reporting symptoms of depression were 5.2 times more likely to use condoms inconsistently during vaginal sex, and 4.3 times more likely to use condoms inconsistently during anal sex compared to participants reporting no depression symptoms. Providers should assess sexual risk practices of HIV-positive individuals reporting symptoms of depression, and provide counseling regarding the importance of consistent condom use to those patients who are engaging in unsafe sex practices.
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Affiliation(s)
- Eduardo E. Valverde
- University of Miami, Miller School of Medicine, Department of Epidemiology and Public Health, Miami, Florida
- Current affiliation: Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | | | - Lisa R. Metsch
- University of Miami, Miller School of Medicine, Department of Epidemiology and Public Health, Miami, Florida
| | | | - Lina Bofill
- University of Miami, Miller School of Medicine, Department of Epidemiology and Public Health, Miami, Florida
| | | | - Clyde McCoy
- University of Miami, Miller School of Medicine, Department of Epidemiology and Public Health, Miami, Florida
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187
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Kupprat SA, Dayton A, Guschlbauer A, Halkitis PN. Case manager-reported utilization of support group, substance use and mental health services among HIV-positive women in New York City. AIDS Care 2009; 21:874-80. [DOI: 10.1080/09540120802537849] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sandra A. Kupprat
- a Center for Health, Identity, Behavior & Prevention Studies , New York University , New York , USA
| | - Alex Dayton
- a Center for Health, Identity, Behavior & Prevention Studies , New York University , New York , USA
| | - Andrea Guschlbauer
- a Center for Health, Identity, Behavior & Prevention Studies , New York University , New York , USA
| | - Perry N. Halkitis
- b Department of Applied Psychology , New York University , New York , USA
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188
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Brandt R. Putting Mental Health on the Agenda for HIV+ Women: A Review of Evidence from Sub-Saharan Africa. Women Health 2009; 49:215-28. [DOI: 10.1080/03630240902915044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- René Brandt
- a AIDS and Society Research Unit, Centre for Social Science Research, University of Cape Town , Rondebosch, South Africa
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189
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Gonzalez JS, Hendriksen ES, Collins EM, Durán RE, Safren SA. Latinos and HIV/AIDS: examining factors related to disparity and identifying opportunities for psychosocial intervention research. AIDS Behav 2009; 13:582-602. [PMID: 18498050 PMCID: PMC3752383 DOI: 10.1007/s10461-008-9402-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Accepted: 04/28/2008] [Indexed: 10/22/2022]
Abstract
Latinos maintain an AIDS case rate more than 3 times higher than whites, a greater rate of progression to AIDS, and a higher rate of HIV/AIDS-related deaths. Three broad areas are reviewed related to these disparities: (1) relevant demographic, socioeconomic, and socio-cultural factors among Latinos; (2) drug abuse and mental health problems in Latinos relevant to HIV/AIDS outcomes; and (3) opportunities for psychosocial intervention. Latinos living with HIV are a rapidly growing group, are more severely impacted by HIV than whites, and confront unique challenges in coping with HIV/AIDS. A body of research suggests that depression, substance abuse, treatment adherence, health literacy, and access to healthcare may be fruitful targets for intervention research in this population. Though limited, the current literature suggests that psychosocial interventions that target these factors could help reduce HIV/AIDS disparities between Latinos and whites and could have important public health value.
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Affiliation(s)
- Jeffrey S Gonzalez
- Department of Psychiatry, Massachusetts General Hospital, 15 Parkman Street, ACC 812, Boston, MA 02114, USA.
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190
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Chida Y, Vedhara K. Adverse psychosocial factors predict poorer prognosis in HIV disease: a meta-analytic review of prospective investigations. Brain Behav Immun 2009; 23:434-45. [PMID: 19486650 DOI: 10.1016/j.bbi.2009.01.013] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 01/19/2009] [Accepted: 01/20/2009] [Indexed: 11/28/2022] Open
Abstract
There is a growing epidemiological literature focusing on the association between psychosocial stress and human immunodeficiency virus (HIV) disease progression or acquired immunodeficiency syndrome (AIDS), but inconsistent findings have been published. We aimed to quantify the association between adverse psychosocial factors and HIV disease progression. We searched Medline; PsycINFO; Web of Science; PubMed up to 19 January 2009, and included population studies with a prospective design that investigated associations between adverse psychosocial factors and HIV disease progression or AIDS. Two reviewers independently extracted data on study characteristics, quality, and estimates of associations. The overall meta-analysis examined 36 articles including 100 psychosocial and disease related relationships. It exhibited a small, but robust positive association between adverse psychosocial factors and HIV progression (correlation coefficient as combined size effect 0.059, 95% confidence interval 0.043-0.074, p<0.001). Notably, sensitivity analyses showed that personality types or coping styles and psychological distress were more strongly associated with greater HIV disease progression than stress stimuli per se, and that all of the immunological and clinical outcome indicators (acquired immunodeficiency syndrome stage, CD4+ T-cell decline, acquired immunodeficiency syndrome diagnosis, acquired immunodeficiency syndrome mortality, and human immunodeficiency virus disease or acquired immunodeficiency syndrome symptoms) except for viral load exhibited detrimental effects by adverse psychosocial factors. In conclusion, the current review reveals a robust relationship between adverse psychosocial factors and HIV disease progression. Furthermore, there would appear to be some evidence for particular psychosocial factors to be most strongly associated with HIV disease progression.
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Affiliation(s)
- Yoichi Chida
- Psychobiology Group, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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191
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Kapetanovic S, Christensen S, Karim R, Lin F, Mack WJ, Operskalski E, Frederick T, Spencer L, Stek A, Kramer F, Kovacs A. Correlates of perinatal depression in HIV-infected women. AIDS Patient Care STDS 2009; 23:101-8. [PMID: 19196032 PMCID: PMC2856494 DOI: 10.1089/apc.2008.0125] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Maternal perinatal depression (PND) may interfere with effective perinatal HIV care. In order to begin examining the prevalence and characteristics of PND in HIV-infected women, we analyzed data from the medical records of all HIV-infected women who had received perinatal care in the Maternal-Child and Adolescent Center for Infectious Diseases and Virology at LAC/USC Medical Center from 1997 through 2006. Data from 273 individual women (328 live births) were analyzed. Demographic, medical history, psychosocial, pregnancy related, and HIV-related factors measured during the perinatal period were examined for an association with PND using multivariate logistic regression with generalized estimating equations to account for the within subject correlation due to multiple births per mother. The overall prevalence of PND was 30.8%. Multivariate analysis showed that PND was significantly associated with substance abuse during pregnancy (odds ratio [OR] = 2.81, 95% confidence interval [CI]: 1.35-5.82) and past history of psychiatric illness (OR = 3.72, 95% CI: 2.06-6.71). Compared to mothers with CD4 nadir greater than 500 cells/mm3, mothers with a CD4 nadir during pregnancy #200 cells=mm3 were 3.1 times more likely to experience PND (OR = 3.01, 95% CI: 1.32-6.88). Women who had antiretroviral (ARV) medications adherence problems during pregnancy were more likely to experience PND than women who were adherent (OR = 2.14, 95% CI: 1.08-4.23). These preliminary results suggest that rates of PND among HIV-infected women are substantial. We conclude that pregnant HIV-infected women should be routinely screened for PND. Prospective studies examining the bio-psycho-social markers of PND in HIV-infected women are indicated.
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Affiliation(s)
- Suad Kapetanovic
- USC/Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, HRA Building, Suite 300, Los Angeles, CA 90033, USA.
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Mosack KE, Weinhardt LS, Kelly JA, Gore-Felton C, McAuliffe TL, Johnson MO, Remien RH, Rotheram-Borus MJ, Ehrhardt AA, Chesney MA, Morin SF. Influence of coping, social support, and depression on subjective health status among HIV-positive adults with different sexual identities. Behav Med 2009; 34:133-44. [PMID: 19064372 PMCID: PMC2653049 DOI: 10.3200/bmed.34.4.133-144] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The authors examined associations between psychosocial variables (coping self-efficacy, social support, and cognitive depression) and subjective health status among a large national sample (N = 3,670) of human immunodeficiency virus (HIV)-positive persons with different sexual identities. After controlling for ethnicity, heterosexual men reported fewer symptoms than did either bisexual or gay men and heterosexual women reported fewer symptoms than did bisexual women. Heterosexual and bisexual women reported greater symptom intrusiveness than did heterosexual or gay men. Coping self-efficacy and cognitive depression independently explained symptom reports and symptom intrusiveness for heterosexual, gay, and bisexual men. Coping self-efficacy and cognitive depression explained symptom intrusiveness among heterosexual women. Cognitive depression significantly contributed to the number of symptom reports for heterosexual and bisexual women and to symptom intrusiveness for lesbian and bisexual women. Individuals likely experience HIV differently on the basis of sociocultural realities associated with sexual identity. Further, symptom intrusiveness may be a more sensitive measure of subjective health status for these groups.
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Affiliation(s)
- Katie E. Mosack
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Lance S. Weinhardt
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Jeffrey A. Kelly
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Cheryl Gore-Felton
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Timothy L. McAuliffe
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Mallory O. Johnson
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Robert H. Remien
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Mary Jane Rotheram-Borus
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Anke A. Ehrhardt
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Margaret A. Chesney
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
| | - Stephen F. Morin
- Dr Mosack is with the Department of Psychology at the University of Wisconsin in Milwaukee. Drs Weinhardt, Kelly, and McAuliffe are with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Dr Gore-Felton is with the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Drs Johnson and Morin are with the Center for AIDS Prevention Studies at the University of California in San Francisco. Dr Remien is with the HIV Center for Clinical and Behavioral Studies in New York, NY. Dr Rotheram-Borus is with the Center for HIV Identification, Prevention, and Treatment Services at the University of California in Los Angeles. Dr Ehrhardt is with the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University in New York, NY. Dr Chesney is with the National Center for Complementary and Alternative Medicine in Bethesda, MD
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193
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Sanders-Phillips K, Pretorius L, Reddy P. Building international research partnerships to develop HIV programs for women of color in the context of social inequalities and human rights. SOCIAL WORK IN PUBLIC HEALTH 2009; 24:60-75. [PMID: 19229773 DOI: 10.1080/19371910802569534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This article examines relationships among social inequality, drug use, and HIV risk for women of color in the United States and South Africa. In the first section, social and cultural factors that may place women of color at risk for drug use and exposure to HIV are identified. In the second section, lessons learned while developing HIV prevention research protocols for women of color in South Africa are presented and discussed. Experience suggests that to effectively address women's risks of drug use and AIDS requires specific theoretical models and methodological approaches that acknowledge the critical interface that may exist among social inequality, drug use, and AIDS risk for women worldwide. Successful HIV prevention and intervention programs for women of color worldwide also require international research partnerships that are based on mutual respect between partners and attention to the needs and priorities of the target populations.
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194
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Abstract
Since the earliest days of the AIDS epidemic, clinicians have been concerned about the prevalence of depression among their patients. Epidemiologists, psychiatrists, psychologists, sociologists, and a broad array of other specialists have studied this topic, trying to determine the prevalence of depressive disorders and depressive symptoms as well as antecedents, correlates, and consequences. This review addresses the methodologic difficulties in determining depression prevalence, major findings regarding rates of disorder and correlates among different segments of the HIV community, effects of depression on HIV illness progression, psychopharmacologic and psychotherapeutic treatment findings, and behavioral effects of depression, such as its impact on medication adherence, employment, and risk behavior. Finally, the article summarizes international studies of depression prevalence in developing countries and the challenges regarding cross-national diagnostic definitions and measures.
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Affiliation(s)
- Judith G Rabkin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit 51, New York, NY 10032, USA.
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195
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Detweiler-Bedell JB, Friedman MA, Leventhal H, Miller IW, Leventhal EA. Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation. Clin Psychol Rev 2008; 28:1426-46. [PMID: 18848740 PMCID: PMC2669084 DOI: 10.1016/j.cpr.2008.09.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 08/15/2008] [Accepted: 09/02/2008] [Indexed: 11/22/2022]
Abstract
Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes.
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196
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YY1 and FoxD3 regulate antiretroviral zinc finger protein OTK18 promoter activation induced by HIV-1 infection. J Neuroimmune Pharmacol 2008; 4:103-15. [PMID: 19034670 DOI: 10.1007/s11481-008-9139-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 11/07/2008] [Indexed: 10/21/2022]
Abstract
OTK18 is a C2H2 type zinc finger protein involved in the regulation of HIV-1 replication in human mononuclear phagocytes. Previously, we reported OTK18 expression in brain perivascular macrophages but not in microglia in HIV encephalitis brain. We have cloned the OTK18 promoter region proximal to the transcriptional start site and determined the region responsible (-884/+1) for the basal transcriptional activity in a microglia cell line. Sequential deletion mutation analyses reveal three important response elements: Yingyang-1 (YY1; -805/-777), an HIV-1 response element for promoter activation; FoxD3 (-743/-725), a negative regulatory element; and Ets response element (-725/-707), a basal transcriptional activity response element. HIV-1 infection-induced upregulation of YY1 and c-Ets-1 protein, binding to the promoter region as determined by immunoblotting and chromatin immunoprecipitation and polymerase chain reaction (PCR) assays, and induction of YY1 was also observed in virus-infected monocyte-derived macrophages. Silencing of FoxD3 and YY1 in the cell line by small interfering RNA duplexes specific to these molecules significantly up- and downregulated basal OTK18 promoter activity in FoxD3 and YY1 response element-dependent manners, respectively. On the other hand, infection of primary cultured human microglia significantly reduced YY1 expression and induced FoxD3 as determined by immunoblotting and reverse transcription real-time PCR. These data suggest that HIV-1 induces OTK18 expression through a YY1-mediated manner in human macrophages, although its gene expression is suppressed by FoxD3 upregulation and YY1 downregulation in human microglia. This mechanism may explain the perivascular macrophage-specific expression of OTK18 in HIV encephalitis brains.
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197
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Schwartz RM, Hogben M, Liddon N, Augenbraun M, McCormack WM, Rubin S, Wilson TE. Coping with a diagnosis of C trachomatis or N gonorrhoeae: psychosocial and behavioral correlates. J Health Psychol 2008; 13:921-9. [PMID: 18809643 DOI: 10.1177/1359105308095066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The current study sought to add to the stress and coping literature by examining whether coping responses are elicited from a diagnosis of chlamydia or gonorrhea and, if so, whether active or passive coping responses are associated with particular psychological factors and prevention behaviors. Data from 259 urban, minority participants recently diagnosed with chlamydia or gonorrhea were analyzed. Results indicated that denial was associated with having more baseline depressive symptoms and with having more one-time partners at follow-up. Problem-focused coping was associated with more consistent condom use at follow-up. Important sex and ethnicity differences were found. Intervention implications are discussed.
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198
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Crane HM, Grunfeld C, Harrington RD, Uldall KK, Ciechanowski PS, Kitahata MM. Lipoatrophy among HIV-infected patients is associated with higher levels of depression than lipohypertrophy. HIV Med 2008; 9:780-6. [PMID: 18754804 DOI: 10.1111/j.1468-1293.2008.00631.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We sought to determine the association between body morphology abnormalities and depression, examining lipoatrophy and lipohypertrophy separately. METHODS An observational cross-sectional study of 250 patients from the University of Washington HIV Cohort was carried out. Patients completed an assessment including measures of depression and body morphology. We used linear regression analysis to examine the association between lipoatrophy or lipohypertrophy and depression. Analysis of variance was used to examine the relationship between mean depression scores and lipoatrophy and lipohypertrophy in 10 body regions. RESULTS Of 250 patients, 76 had lipoatrophy and 128 had lipohypertrophy. Mean depression scores were highest among patients with moderate-to-severe lipoatrophy (16.4), intermediate among those with moderate-to-severe lipohypertrophy (11.7), mild lipohypertrophy (9.9) and mild lipoatrophy (8.5), and lowest among those without body morphology abnormalities (7.7) (P=0.002). After adjustment, mean depression scores for subjects reporting moderate-to-severe lipoatrophy were 9.2 points higher (P<0.001), scores for subjects with moderate-to-severe lipohypertrophy were 4.8 points higher (P=0.02), and scores for subjects with mild lipohypertrophy were 2.8 points higher (P=0.03) than those for patients without body morphology abnormalities. Facial lipoatrophy was the body region associated with the most severe depression scores (15.5 vs. 8.9 for controls; P=0.03). CONCLUSIONS In addition to long-term cardiovascular implications, body morphology has a more immediate effect on depression severity.
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Affiliation(s)
- H M Crane
- Center for AIDS and STD Research, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA.
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199
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Metsch LR, Pereyra M, Messinger S, Del Rio C, Strathdee SA, Anderson-Mahoney P, Rudy E, Marks G, Gardner L. HIV transmission risk behaviors among HIV-infected persons who are successfully linked to care. Clin Infect Dis 2008; 47:577-84. [PMID: 18624629 DOI: 10.1086/590153] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We examined the relationship between receipt of medical care for human immunodeficiency virus (HIV) infection and HIV transmission risk behavior among persons who had received a recent diagnosis of HIV infection. METHODS We enrolled 316 participants from 4 US cities and prospectively followed up participants for 1 year. Generalized estimating equations were used to examine whether having at least 3 medical care visits in a 6-month period was associated with unprotected vaginal or anal intercourse with an HIV-negative partner or partner with unknown HIV status. RESULTS A total of 27.5% of the participants (84 of 305) self-reported having unprotected sex with an HIV-negative or unknown status partner at enrollment, decreasing to 12% (31 of 258) and 14.2% (36 of 254) at 6-month and 12-month follow-ups, respectively. At follow-up, people who had received medical care for HIV infection at least 3 times had reduced odds of engaging in risk behavior, compared with those with fewer visits. Other factors associated with reduced risk behavior were being >30 years of age, male sex, not having depressive symptoms, and not using crack cocaine. CONCLUSIONS Being in HIV care is associated with a reduced prevalence of sexual risk behavior among persons living with HIV infection. Persons linked to care can benefit from prevention services available in primary care settings.
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Affiliation(s)
- Lisa R Metsch
- Miller School of Medicine, University of Miami, Miami, Florida, USA
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Greeson JM, Hurwitz BE, Llabre MM, Schneiderman N, Penedo FJ, Klimas NG. Psychological distress, killer lymphocytes and disease severity in HIV/AIDS. Brain Behav Immun 2008; 22:901-11. [PMID: 18321678 DOI: 10.1016/j.bbi.2008.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 01/02/2008] [Accepted: 01/05/2008] [Indexed: 11/17/2022] Open
Abstract
Immunocellular mechanisms that account for the association between psychosocial risk factors and increased susceptibility to faster progression of HIV/AIDS are largely unknown. This study used structural equation modeling to test the hypothesis that enumerative and functional alterations in killer lymphocytes mediate the relationship between higher levels of psychological distress (defined by perceived stress, anxiety and depressive symptoms) and greater HIV disease severity (defined by HIV-1 viral load and T-helper (CD4(+)) cell count), independent of standard demographic and various HIV-related covariates. Participants were 200 HIV-1 seropositive adults on combination antiretroviral therapy (ages 20-55 years; 67% men; 62% black; 84% AIDS). The data fit a psychoimmune model in which the significant relationship between higher distress levels and greater disease severity was mediated by diminished natural killer (NK) cell count and cytotoxic function, as well as increased cytotoxic (CD8(+)) T-cell activation. Overall the findings indicated that the psychoimmune model accounted for 67% of the variation in HIV disease severity. In contrast, the data did not support a reverse directionality mediation model, where greater HIV disease severity predicted greater distress as a function of killer lymphocyte status. In sum, the psychoimmune associations of the final model are physiologically consistent and suggest that distress-related alterations in killer lymphocyte immunity may play a role in the biobehavioral mechanisms linked with HIV-1 pathogenesis.
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