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Kamkwalala AR, Garg A, Roy U, Matthews A, Castillo-Mancilla J, Lake JE, Sebastiani G, Yin M, Brown TT, Kamer AR, Jabs DA, Ellis RJ, Boffito M, Greene M, Schmalzle S, Siegler E, Erlandson KM, Moore DJ. Current Considerations for Clinical Management and Care of People with HIV: Findings from the 11th Annual International HIV and Aging Workshop. AIDS Res Hum Retroviruses 2021; 37:807-820. [PMID: 34405689 DOI: 10.1089/aid.2021.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The number of people with HIV (PWH) aged 50 years or older continues to steadily increase. The convergence of age- and HIV-related complications in these individuals presents a challenge for both patients and clinicians alike. New findings continue to emerge, as numerous researchers evaluate the combined impact of these two factors on quality of life, physiological systems, and mental health in PWH. Since its first occurrence in 2009, the International Workshop on HIV and Aging has served as a multidisciplinary meeting to share basic biomedical data, clinical trial results, treatment strategies, and epidemiological recommendations, toward better understanding and outcomes among like-minded scientific professionals. In this article, we share a selection of key findings presented in plenary talks at the 11th Annual International Workshop on HIV and Aging, held virtually from September 30, 2020 to October 2, 2020. We will also address the future directions of HIV and aging research, to further assess how the aging process intersects with chronic HIV.
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Affiliation(s)
| | - Ankita Garg
- Department of Infectious Diseases, University of Georgia, Athens, Georgia, USA
| | - Upal Roy
- Department of Health and Biomedical Sciences, The University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Avery Matthews
- Department of Psychiatry, South Texas Veteran Health Care System, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jose Castillo-Mancilla
- Department of Medicine, Division of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jordan E. Lake
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Giada Sebastiani
- Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Michael Yin
- Department of Infectious Disease, Columbia University, New York, New York, USA
| | - Todd T. Brown
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Angela R. Kamer
- Department of Periodontology and Implant Dentistry, New York University College of Dentistry, New York, New York, USA
| | - Douglas A. Jabs
- Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ronald J. Ellis
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Marta Boffito
- Department of HIV Services, Chelsea and Westminster Hospital, London, United Kingdom
| | - Meredith Greene
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sarah Schmalzle
- Department of Infectious Disease, University of Maryland, Baltimore, Maryland, USA
| | - Eugenia Siegler
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Kristine M. Erlandson
- Department of Medicine, Division of Infectious Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
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Primeaux SD, Simon L, Ferguson TF, Levitt DE, Brashear MM, Yeh A, Molina PE. Alcohol use and dysglycemia among people living with human immunodeficiency virus (HIV) in the Alcohol & Metabolic Comorbidities in PLWH: Evidence Driven Interventions (ALIVE-Ex) study. Alcohol Clin Exp Res 2021; 45:1735-1746. [PMID: 34342022 PMCID: PMC8547613 DOI: 10.1111/acer.14667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND At-risk alcohol use is a common and costly form of substance misuse that is highly prevalent among people living with HIV (PLWH). The goal of the current analysis was to test the hypothesis that PLWH with at-risk alcohol use are more likely to meet the clinical criteria for prediabetes/diabetes than PLWH with low-risk alcohol use. METHODS A cross-sectional analysis was performed on measures of alcohol and glycemic control in adult PLWH (n = 105) enrolled in a prospective, interventional study (the ALIVE-Ex Study (NCT03299205)) that investigated the effects of aerobic exercise on metabolic dysregulation in PLWH with at-risk alcohol use. The Alcohol Use Disorders Identification Test (AUDIT), Timeline Followback, and phosphatidylethanol (PEth) level were used to measure alcohol use. Participants were stratified into low-risk (AUDIT score < 5) and at-risk alcohol use (AUDIT score ≥ 5). All participants underwent an oral glucose tolerance test and measures of glycemic control- the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and Matsuda Index - were correlated with alcohol measures and compared by AUDIT score group using mixed-effects linear and logistic regression models, adjusting for age, sex, race, body mass index (BMI), and viral load. RESULTS In response to the glucose challenge, participants with at-risk alcohol use (n = 46) had higher glucose levels and were five times more likely to meet criteria for prediabetes/diabetes (OR: 5.3 (1.8, 15.9)) than participants with an AUDIT score < 5. Two-hour glucose values were positively associated with AUDIT score and PEth level and a higher percentage of PLWH with at-risk alcohol use had glucose values ≥140 mg/dl than those with low-risk alcohol use (34.8% vs. 10.2%, respectively). CONCLUSION In this cohort of PLWH, at-risk alcohol use increased the likelihood of meeting the clinical criteria for prediabetes/diabetes (2-h glucose level ≥140 mg/dl). Established determinants of metabolic dysfunction (e.g., BMI, waist-hip ratio) were not associated with greater alcohol use and dysglycemia, suggesting that other mechanisms may contribute to the impaired glycemic control observed in this cohort.
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Affiliation(s)
- Stefany D. Primeaux
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112
- Joint Diabetes, Endocrinology & Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, LA 70808
| | - Liz Simon
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, LA 70112
| | - Tekeda F. Ferguson
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, LA 70112
- Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans, 70112
| | - Danielle E. Levitt
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, LA 70112
| | - Meghan M. Brashear
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, LA 70112
| | - Alice Yeh
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112
| | - Patricia E. Molina
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, LA 70112
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Gali B, Eyawo O, Hull MW, Samji H, Zhang W, Sereda P, Lima VD, McGrail K, Montaner JSG, Hogg RS, Moore D. Incidence of select chronic comorbidities among a population-based cohort of HIV-positive individuals receiving highly active antiretroviral therapy. Curr Med Res Opin 2019; 35:1955-1963. [PMID: 31315470 DOI: 10.1080/03007995.2019.1645999] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: To characterize the incidence of select chronic comorbidities in the era of modern (pre-integrase-inhibitor) highly active antiretroviral therapy (HAART) in British Columbia, Canada. Methods: We used data from the Comparative Outcomes And Service Utilization Trends (COAST) study, a population-based cohort study of people living with HIV (PLWH), to determine incidence rates of six key chronic diseases among PLWH receiving HAART in BC from 2000 to 2012. The selected diseases included cardiovascular disease (CVD), diabetes mellitus (DM), hypertension (HTN), asthma/chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD) and chronic liver disease (CLD) defined using ICD-9 and -10 codes. Disease incidence was determined by number of new cases per year. We used Poisson regression to measure trends in incidence rates. Results: The study sample (n = 10,210) was predominantly male (83%), white (72%) and younger than 50 years of age at HAART initiation (88%). Incidence rates of HTN per 1000 person-years (PY) increased significantly between 2000 and 2012, after adjusting for age, sex, baseline-weighted Charlson Comorbidity Index, CD4 cell count and viral load (p < .001); incidence rates of CKD and CLD decreased significantly over time (p < .001). Unadjusted incidence rates of DM increased over time (p < .01), but remained stable in the adjusted model. Incidence rate patterns for CVD and COPD/asthma were stable over the study period. Conclusions: Population-level increases in incidence rates for HTN, and decreases for CLD and CKD, were observed among PLWH on modern (pre-integrase-inhibitor) HAART from 2000 to 2012. Overall, the increasing incidence of several of these chronic comorbidities in our study suggests that further efforts are needed to maximize the potential for healthy aging among PLWH receiving modern (pre-integrase-inhibitor) HAART.
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Affiliation(s)
- Brent Gali
- British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
- School of Population & Public Health, University of British Columbia , Vancouver , BC , Canada
| | - Oghenowede Eyawo
- British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
- Faculty of Health Sciences, Simon Fraser University , Burnaby , BC , Canada
| | - Mark W Hull
- British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Provincial Health Services Authority , Vancouver , BC , Canada
| | - Wendy Zhang
- British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
| | - Kimberlyn McGrail
- School of Population & Public Health, University of British Columbia , Vancouver , BC , Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
- Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia , Vancouver , BC , Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
- Faculty of Health Sciences, Simon Fraser University , Burnaby , BC , Canada
| | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada
- Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia , Vancouver , BC , Canada
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A Biopsychosocial Approach to Managing HIV-Related Pain and Associated Substance Abuse in Older Adults: a Review. AGEING INTERNATIONAL 2018. [DOI: 10.1007/s12126-018-9333-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Fazeli PL, Moore DJ, Franklin DR, Umlauf A, Heaton RK, Collier AC, Marra CM, Clifford DB, Gelman BB, Sacktor NC, Morgello S, Simpson DM, McCutchan JA, Grant I, Letendre SL. Lower CSF Aβ is Associated with HAND in HIV-Infected Adults with a Family History of Dementia. Curr HIV Res 2017; 14:324-30. [PMID: 26673902 DOI: 10.2174/1570162x14666151221145926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/17/2015] [Accepted: 12/18/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Both family history of dementia (FHD) and lower levels of Aβ-42 are indepentently associated with worse neurocognitive functioning in HIVinfected patients. OBJECTIVE To examine the relationships between cerebrospinal fluid (CSF) Aβ-42 and FHD with HIV-associated neurocognitive disorders (HAND). METHODS One hundred eighty-three HIV+ adults underwent neuropsychological and neuromedical assessments, and determination of CSF Aβ-42 concentration and FHD (defined as a self-reported first or second-degree relative with a dementia diagnosis). Univariate analyses and multivariable logistic regressions were used. RESULTS FHD was not associated with HAND (p = 0.24); however, CSF Aβ-42 levels were lower (p = 0.03) in the HAND group, but were not associated with FHD (p = 0.89). Multivariable models showed a main effect of CSF Aβ-42 (p = 0.03) and a trend-level (p = 0.06) interaction between FHD and CSF Aβ-42, such that lower CSF Aβ-42 was associated with HAND in those with FHD (p < 0.01) compared to those without FHD (p = 0.83). An analysis in those with follow-up data showed that higher baseline CSF Aβ-42 was associated with lower risk of neurocognitive decline (p = 0.02). While we did not find an FHD X CSF Aβ-42 interaction (p = 0.83), when analyses were stratified by FHD, lower CSF Aβ-42 was associated at the trend-level with neurocognitive decline in the FHD group (p = 0.08) compared to the no FHD group (p = 0.15). CONCLUSION FHD moderates the relationship between of CSF Aβ-42 and HAND. The findings highlight the complexities in interpreting the relationships between biomarkers of age-related neurodegeneration and HAND.
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Affiliation(s)
| | - David J Moore
- University of California, San Diego, 220 Dickinson St, Ste B, San Diego, CA 92103, USA.
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Older adults living with HIV: a valuable resource? AGEING & SOCIETY 2016. [DOI: 10.1017/s0144686x16001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTSubjective wellbeing was examined amongst 274 adults living with HIV in Australia and the United States of America. There were 164 adults aged 49 years and under, and 110 adults aged 50 years and over. Participants completed a composite questionnaire comprising the Personal Wellbeing Index-Adult (PWI-A), the HIV-Unsupportive Social Interactions Inventory (USII), and demographic and health-related items. Participants reported mean PWI-A scores of 54.7 points, considerably below the Western population normative range of 70–80 points. Older adults reported significantly greater subjective wellbeing compared to younger adults, but still below the normative range. Experiences of unsupportive social interactions were a significant predictor of reduced subjective wellbeing amongst all participants. Qualitative comments provided a greater understanding of the characteristics and psychological devices that enable some older adults to maintain and/or increase subjective wellbeing, even in the face of negative stressors such as unsupportive social interactions. This provides valuable information for service providers and clinicians as HIV increasingly becomes recognised as a disease affecting older adults in developed nations. Rather than positioning the ageing HIV-population as a potential burden, it is proposed that learning more about the coping mechanisms employed by older adults with HIV could prove beneficial for the HIV-population as a whole.
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Chow EP, Gao L, Chen L, Jing J, Zhang L. Shifting Patterns of the HIV Epidemic in Southwest China: A Case Study Based on Sentinel Surveillance, 1995-2012. AIDS Patient Care STDS 2015; 29:314-20. [PMID: 25928866 DOI: 10.1089/apc.2014.0307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The HIV epidemic is experiencing a rapid shift in transmission profile in China. This study aims to examine the changes in magnitude, transmission pattern, and trend of the HIV epidemic in a typical Southwest Chinese prefecture over the period of 1995-2012. HIV surveillance data from the web-based reporting system were analyzed during this period. We investigated the temporal trends in the changing characteristics of HIV transmission, the HIV disease burden in key affected populations, and assessed the impacts on HIV disease progression due to scale-up of antiretroviral treatment. A total of 3556 HIV/AIDS cases were reported in Yuxi prefecture, Yunnan, over the study period. The number of HIV tests conducted has dramatically increased from 1041 in 1995 to 247,859 in 2012, resulting in a substantial increase in HIV diagnoses from 11 cases to 327 cases over the same period. Since 2005, cumulatively 1250 eligible people living with HIV (PLHIV) have received combination antiretroviral therapy which reduced AIDS disease progression from 9.0% (95% CI: 6.7-11.4%) in 1995 to 0.1% (0-0.3%) in 2012 (ptrend=0.0002). The primary mode of HIV transmission has been shifted from injection sharing (71.9% diagnoses in 1995-2004) to unsafe sexual contacts (82.6% diagnoses in 2012). Yuxi prefecture is experiencing a concentrated but shifting HIV epidemic. Scale-up of HIV testing is essential to effective sentinel surveillance and enhancing early diagnosis and treatment in PLHIV.
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Affiliation(s)
- Eric P.F. Chow
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- The Kirby Institute, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Liangmin Gao
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Liang Chen
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Jun Jing
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Lei Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- The Kirby Institute, University of New South Wales Australia, Sydney, New South Wales, Australia
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Halkitis PN, Kapadia F, Ompad DC, Perez-Figueroa R. Moving toward a holistic conceptual framework for understanding healthy aging among gay men. JOURNAL OF HOMOSEXUALITY 2015; 62:571-587. [PMID: 25492304 DOI: 10.1080/00918369.2014.987567] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In the last four decades, we have witnessed vast and important transitions in the social, economic, political, and health contexts of the lived experiences of gay men in the United States. This dynamic period, as evidenced most prominently by the transition of the gay rights movement to a civil rights movement, has shifted the exploration of gay men's health from one focusing primarily on HIV/AIDS into a mainstream consideration of the overall health and wellbeing of gay men. Against this backdrop, aging gay men in the United States constitute a growing population, for whom further investigations of health states and health-related disparities are warranted. In order to advance our understanding of the health and wellbeing of aging gay men, we outline here a multilevel, ecosocial conceptual framework that integrates salient environmental, social, psychosocial, and sociodeomgraphic factors into sets of macro-, meso-, and micro-level constructs that can be applied to comprehensively study health states and health care utilization in older gay men.
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Affiliation(s)
- Perry N Halkitis
- a Center for Health, Identity, Behavior and Prevention Studies , New York University , New York , New York , USA
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Arnold MP, Evans D, Vergel N. Recruitment and ethical considerations in HIV cure trials requiring treatment interruption. J Virus Erad 2015; 1:43-8. [PMID: 27482394 PMCID: PMC4946671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Relative to antiretroviral treatment (ART), early HIV cure-related trials (HCRTs) carry limited therapeutic benefits and unknown risks. In HCRTs requiring treatment interruption (TI) the health risks and burdens may create a barrier to study enrolment and increase the possibility for unintentional ethical violations in recruitment. METHODS An online survey was administered to over 2,000 HIV-positive ART users in the US. Using multivariable ordinal regression we assessed effects of research participation attitudes, health and demographic traits on willingness to participate in treatment interruption studies (WtP-TI). RESULTS WtP-TI was greatest among those who were highly motivated to participate in research studies for the benefit of science, society and, to a lesser extent, personal benefit. Personal benefit was less of an influence on WtP-TI among persons with higher viral loads or a history of multiple ART regimens. WtP-TI was greater among respondents who were more likely to consider personal health in making decisions about trial participation. WtP-TI had no association with perceptions of the importance of compensation to research participation. After accounting for attitudes, health status and demographic traits were generally not significantly related to WtP-TI. Notable exceptions included viral suppression status and race/ethnicity. CONCLUSION Recruitment strategies in TI studies can benefit from a focus on the long-term scientific and social benefits of study participation. Strategies targeted to particular demographic groups may have little impact on accrual, and in some cases will need to be accompanied by strategies to improve the quality of researcher-community relationships. Findings also suggest that informing communities about the health impacts of trial participation may positively impact participation decisions. However, more research is needed to interpret the impact of health messaging on recruitment and therapeutic expectations. Future work should explore the implications of altruism-based expectations on the strategic and ethical appropriateness of TI study recruitment efforts.
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Affiliation(s)
- Michael P Arnold
- Department of Health Behavior and Health Education,
University of Michigan School of Public Health,
Ann Arbor,
MI,
USA,Vaccine and Infectious Disease Division,
Fred Hutchinson Cancer Research Center,
Seattle,
WA,
USA,Corresponding author: Michael P Arnold,
9825 Lyon Dr.Brighton,
MI48114,
USA
| | - David Evans
- Research Advocacy, Project Inform,
San Francisco,
CA,
USA
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10
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Recruitment and ethical considerations in HIV cure trials requiring treatment interruption. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)31148-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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HIV and Menopause: A Systematic Review of the Effects of HIV Infection on Age at Menopause and the Effects of Menopause on Response to Antiretroviral Therapy. Obstet Gynecol Int 2013; 2013:340309. [PMID: 24454386 PMCID: PMC3880754 DOI: 10.1155/2013/340309] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/08/2013] [Accepted: 10/22/2013] [Indexed: 11/17/2022] Open
Abstract
More than half of persons living with HIV infection in the United States (U.S.) will be ≥50 years of age by 2020, including postmenopausal women. We conducted a systematic literature review about the effects of (1) HIV infection on age at menopause and (2) menopause on antiretroviral therapy (ART) response, in order to inform optimal treatment strategies for menopausal women living with HIV infection. We used the Ovid Medline database from 1980 to 2012. We included studies that focused on HIV-infected persons, included postmenopausal women, and reported outcome data for either age at menopause or response to ART across menopause. We identified six original research articles for age at menopause and five for response to ART across menopause. Our review revealed that current data were conflicting and inconclusive; more rigorous studies are needed. Disentangling the effects of menopause requires well-designed studies with adequate numbers of HIV-infected and HIV-uninfected women, especially disproportionately affected women of color. Future studies should follow women from premenopause through menopause, use both surveys and laboratory measurements for menopause diagnoses, and control for confounders related to normal aging processes, in order to inform optimal clinical management for menopausal women living with HIV.
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Hsu LC, Truong HHM, Vittinghoff E, Zhi Q, Scheer S, Schwarcz S. Trends in early initiation of antiretroviral therapy and characteristics of persons with HIV initiating therapy in San Francisco, 2007-2011. J Infect Dis 2013; 209:1310-4. [PMID: 24218501 DOI: 10.1093/infdis/jit599] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In 2010, the San Francisco Department of Public Health offered antiretroviral therapy (ART) to all its patients with human immunodeficiency virus (HIV) regardless of CD4 count. We assessed trends in time from diagnosis to ART initiation and factors associated with ART initiation among San Francisco residents living with HIV between 2007 and 2011. Time to ART initiation decreased among those diagnosed with higher CD4 count. ART initiation rate was significantly higher in recent years and lower among African Americans, men who have sex with men who also inject drugs, and persons aged ≥50 years. We found a trend toward early treatment. However, racial and social disparities persist.
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August EM, Daley E, Kromrey J, Baldwin J, Romero-Daza N, Salmeron J, Lazcano-Ponce E, Villa LL, Bryant CA, Giuliano AR. Age-related variation in sexual behaviours among heterosexual men residing in Brazil, Mexico and the USA. ACTA ACUST UNITED AC 2013; 40:261-9. [PMID: 24099979 DOI: 10.1136/jfprhc-2012-100564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the prevalence of demographic characteristics and sexual behaviours across age groups and to estimate their significance in predicting sexual risk factors by age cohort. METHODS This cohort study examined sexually transmitted infection (STI) prevalence among heterosexual men in Brazil, Mexico and the USA (N=3047). Participants completed a sexual risk factor questionnaire and were tested for chlamydia, gonorrhoea, syphilis and genital herpes. We examined sexual risk in the study population through a composite measure of STI positivity by age cohort (young: 18-30 years; middle-aged: 31-44 years; older: 45-70 years). Multivariable logistic regression models were used to generate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). RESULTS We found that STI positivity varied significantly by age group among heterosexual men by a number of covariates. In younger men, having more advanced education had a protective effect (16 years: AOR=0.37, 95% CI 0.15- 0.92), whereas higher numbers of sexual partners elevated the risk for STIs (20-49 partners: AOR=2.06, 95% CI 1.04-4.06; ≥ 50 partners: AOR=4.33, 95% CI 1.74-10.76). Middle-aged men who were black (AOR=1.64, 95% CI 1.10-2.42) and divorced/separated/widowed (AOR=1.91, 95% CI 1.21-3.02) had an increased risk for a positive STI test. Among older men, a younger age at first vaginal sexual encounter (AOR=3.75, 95% CI 1.45-9.74) and a history of exchanging sex for money or drugs heightened STI risk (AOR=2.30, 95% CI 1.0-5.04). CONCLUSIONS These findings demonstrate that age-related life experiences among heterosexual men influence sexual risk and STI transmission. This topic warrants further investigation to support the development and implementation of targeted interventions that may potentially reduce adverse sexual health outcomes.
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Affiliation(s)
- Euna M August
- Research Coordinator, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Ellen Daley
- Associate Professor, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Jeffrey Kromrey
- Professor, Department of Educational Measurement and Research, College of Education, University of South Florida, Tampa, FL, USA
| | - Julie Baldwin
- Professor, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Nancy Romero-Daza
- Associate Professor, Department of Anthropology, College of Arts and Sciences, University of South Florida, Tampa, FL, USA
| | - Jorge Salmeron
- Professor, Unidad de Investigación Epidemiológica en Servicios de Salud, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, México
| | - Eduardo Lazcano-Ponce
- Director, Centro de Investigación Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Luisa L Villa
- Professor, Faculty of Medical Sciences of Santa Casa of São Paulo, São Paulo, Brazil
| | - Carol A Bryant
- Distinguished Professor, Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Anna R Giuliano
- Director, Center for Infection Research in Cancer, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Socio-demographic Profile of Older Adults with HIV/AIDS: Gender and Sexual Orientation Differences. Can J Aging 2013; 32:31-43. [DOI: 10.1017/s0714980813000068] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RÉSUMÉUtilisant des données recueillies par Ontario HIV Treatment Network Cohort Study (OCS), l’objectif principal de cette étude était de décrire les caractéristiques socio-demographiques d’un échantillon de personnes âgées (50 ans et plus) de l’Ontario (n = 1 129) vivant avec le VIH /SIDA. L’objectif secondaire était de comparer quatre sous-echantillons de PVVIH : les femmes (10,6%), les hommes heterosexuels (16,7%), les hommes homosexuels (65,8%), et les hommes bisexuels (6,9%). Ces groupes diffèrent d’une manière significative dans l’âge, l’éducation, le revenu, la nationalité, la race, et le temps passé atteints du VIH. En comparaison à d’autres groupes, les hommes gais et bisexuels (HGB) ont déclaré une stigmatisation plus baisse associée au VIH, et aussi à la stigmatisation sur la divulgation, à la stigmatisation associée à l’image negative de soi, et la stigmatisation associée aux attitudes publiques. HGB ont également signalé une meilleure qualité de vie en ce qui concerne la santé mentale, les scores plus baisses pour la dépression et des scores plus faibles pour l’ inadaptation face à la vie. Ces résultats suggèrent que les services pour les PVVIH plus âgées, y compris la formation sur le VIH pour les prestataires des services pour VIH et les gérontologues, peuvent avoir besoin de répondre aux besoins spécifiques de ces sous-populations.
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Cancer and the 'other' noncommunicable chronic diseases in older people living with HIV/AIDS in resource-limited settings: a challenge to success. AIDS 2012; 26 Suppl 1:S65-75. [PMID: 22781178 DOI: 10.1097/qad.0b013e328355ab72] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE There is considerable research around the morbidity and mortality related to noncommunicable diseases (NCDs), particularly cardiovascular disease and diabetes, among people living with HIV/AIDS (PLWHA) in resource-richer settings. Less is known about the burden and appropriate management of NCDs, particularly 'other' NCDs including cancer, renal, pulmonary, neurocognitive and mental health conditions, among older PLWHA in resource-limited settings (RLSs). We undertook a literature review of these other NCDs to explore what is currently known about them and identify areas of further research. METHODS Systematic literature review of published manuscripts and selected conference abstracts and reports. RESULTS Although there is growing recognition of the importance of these NCDs among the aging population of PLWHA in RLSs, significant gaps remain in understanding the epidemiology and risk factors among older PLWHA in these settings. Even more concerning is the limited available evidence for effective and feasible approaches to prevention, screening and treatment of these conditions. The burden of these NCDs is related to both the aging of the population of PLWHA and an increased risk due to HIV infection, other comorbidities associated with HIV infection or transmission risk and underlying risk factors in the general community. Results from resource-richer settings and RLSs highlight malignancies, neurocognitive and mental health as well as renal disease as the most significant challenges currently and likely to increase in the future. CONCLUSION Although some lessons can be taken from the growing experience with NCDs in older PLWHA in resource-richer settings, additional research is needed to better understand their risk and impact and identify optimal models of care to effectively address this challenge in the areas where the majority of older PLWHA will be receiving care.
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Hutton VE, Misajon R, Collins FE. Subjective wellbeing and ‘felt’ stigma when living with HIV. Qual Life Res 2012; 22:65-73. [DOI: 10.1007/s11136-012-0125-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2012] [Indexed: 11/24/2022]
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Mutevedzi PC, Newell ML. A missing piece in the puzzle: HIV in mature adults in sub-Saharan Africa. Future Virol 2011; 6:755-767. [PMID: 22427781 PMCID: PMC3303125 DOI: 10.2217/fvl.11.43] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Healthcare and social needs for mature adults aged 50 years or older differ from those of younger adults due to stigma concerning HIV in older people, beliefs that engagement in sexual activity no longer applies, age driven comorbidities and responses to antiretroviral treatment, which complicate HIV diagnosis and management. In the face of a growing HIV epidemic in mature adults, mostly due to infected people aging with HIV, but also due to new infections in this age group, HIV services, which mostly cater for HIV in young adults and children, and HIV education messages and interventions, which mainly target young adults, leave the mature adult exposed and vulnerable to HIV transmission and to a lack of care and treatment thereafter.
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Affiliation(s)
- Portia C Mutevedzi
- Africa Centre for Health & Population Studies, PO Box 198, Mtubatuba KwaZulu Natal 3935, South Africa
- University College London, Department of Infection & Population Health, London, UK
| | - Marie-Louise Newell
- Africa Centre for Health & Population Studies, PO Box 198, Mtubatuba KwaZulu Natal 3935, South Africa
- University College London, Institute of Child Health, London, UK
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Gibson K, Rueda S, Rourke SB, Bekele T, Gardner S, Fenta H, Hart and the OHTN Cohort Study TA. Mastery and coping moderate the negative effect of acute and chronic stressors on mental health-related quality of life in HIV. AIDS Patient Care STDS 2011; 25:371-81. [PMID: 21492004 DOI: 10.1089/apc.2010.0165] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Acute and chronic life stressors have a detrimental effect on the health of people living with HIV. Psychosocial resources such as mastery, coping, and social support may play a critical role in moderating the negative effects of stressors on health-related quality of life. A total of 758 participants provided baseline enrolment data on demographics (age, gender, ethnicity, sexual orientation, education, employment, income), clinical variables (CD4 counts, viral load, AIDS-defining condition, time since HIV diagnosis), psychosocial resources (mastery, coping, social support), life stressors (National Population Health Survey [NPHS] Stress Questionnaire), and health-related quality of life (SF-36). We performed hierarchical multivariate regression analyses to evaluate the potential moderating effects of psychosocial resources on the relationship between stressors and health-related quality of life. The top three stressors reported by participants were trying to take on too many things at once (51%), not having enough money to buy the things they needed (51%), and having something happen during childhood that scared them so much that they thought about it years later (42%). Life stressors were significantly and inversely associated with both physical and mental health-related quality of life. Mastery and maladaptive coping had significant moderating effects on mental health but not on physical health. These results suggest that developing interventions that improve mastery and reduce maladaptive coping may minimize the negative impact of life stressors on the mental health of people with HIV. They also highlight that it is important for clinicians to be mindful of the impact of life stressors on the health of patients living with HIV.
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Affiliation(s)
- Katherine Gibson
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sergio Rueda
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sean B. Rourke
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Research on Inner City Health and The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tsegaye Bekele
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
| | - Sandra Gardner
- The Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Haile Fenta
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Lyons A, Pitts M, Grierson J, Thorpe R, Power J. Ageing with HIV: health and psychosocial well-being of older gay men. AIDS Care 2011; 22:1236-44. [PMID: 20640956 DOI: 10.1080/09540121003668086] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Since the introduction of highly active antiretroviral therapy, people living with HIV/AIDS (PLWHA) are living longer, into older age, and therefore presenting a host of new challenges for health and social service providers. However, not all PLWHA are likely to experience similar transitions into older age. In particular, research has yet to fully investigate the health and psychosocial well-being of older HIV-positive gay men. Drawing from an Australian population-based sample of 693 HIV-positive gay men, the present study assesses the overall health and well-being of this older group compared to their younger counterparts. While older men reported greater comorbidity and were more likely to be living in poverty, other health and well-being indicators suggest this group to be coping comparatively well as they continue to age with HIV. These findings provide new directions for meeting the present and future needs and challenges of older HIV-positive gay men.
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Affiliation(s)
- Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia.
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Moore DJ, Arce M, Moseley S, McCutchan JA, Marquie-Beck J, Franklin DR, Vaida F, Achim CL, McArthur J, Morgello S, Simpson DM, Gelman BB, Collier AC, Marra CM, Clifford DB, Heaton RK, Grant I. Family history of dementia predicts worse neuropsychological functioning among HIV-infected persons. J Neuropsychiatry Clin Neurosci 2011; 23:316-23. [PMID: 21948893 PMCID: PMC3279193 DOI: 10.1176/jnp.23.3.jnp316] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
HIV-negative individuals with a family history of dementia (FHD) are more likely to develop dementia than those without FHD. Whether FHD increases risk for neuropsychological (NP) impairment in HIV+ persons is unknown. As part of a multisite study into HIV-associated neurocognitive disorders (HAND), the authors captured FHD with a free-response, self-report question, and assessed NP performance with a comprehensive battery of tests. The authors examined HIV+ persons with (N=190) and without (N=916) self-reported FHD. Despite the fact that the FHD group had factors typically associated with better NP performance (e.g., higher CD4 counts and estimated verbal IQ), persons with FHD had significantly worse NP ability than those without FHD as measured by a Global Deficit Score. Thus, FHD appears to be a risk factor for HAND; the mechanism(s) underlying how FHD contributes to NP impairment among HIV+ persons warrants study.
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Affiliation(s)
- David J. Moore
- University of California, San Diego (UCSD), Department of Psychiatry,UCSD, HIV Neurobehavioral Research Center (HNRC)
| | - Miguel Arce
- University of California, San Diego (UCSD), Department of Psychiatry,UCSD, HIV Neurobehavioral Research Center (HNRC)
| | - Suzanne Moseley
- University of California, San Diego (UCSD), Department of Psychiatry
| | - J. Allen McCutchan
- University of California, San Diego (UCSD), Department of Psychiatry,UCSD, HIV Neurobehavioral Research Center (HNRC),UCSD, Department of Medicine
| | - Jennifer Marquie-Beck
- University of California, San Diego (UCSD), Department of Psychiatry,UCSD, HIV Neurobehavioral Research Center (HNRC)
| | - Donald R. Franklin
- University of California, San Diego (UCSD), Department of Psychiatry,UCSD, HIV Neurobehavioral Research Center (HNRC)
| | - Florin Vaida
- UCSD, HIV Neurobehavioral Research Center (HNRC),UCSD, UCSD Division of Biostatistics and Bioinformatics
| | - Cristian L. Achim
- University of California, San Diego (UCSD), Department of Psychiatry
| | | | | | | | | | | | | | | | - Robert K. Heaton
- University of California, San Diego (UCSD), Department of Psychiatry,UCSD, HIV Neurobehavioral Research Center (HNRC)
| | - Igor Grant
- University of California, San Diego (UCSD), Department of Psychiatry,UCSD, HIV Neurobehavioral Research Center (HNRC)
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Resveratrol protects against protease inhibitor-induced reactive oxygen species production, reticulum stress and lipid raft perturbation. AIDS 2010; 24:1437-47. [PMID: 20539089 DOI: 10.1097/qad.0b013e32833a6114] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE HIV protease inhibitors have been successfully used in highly active antiretroviral therapy of HIV-1 infection, but their benefits are compromised by a number of clinically important adverse side-effects. Several studies showed that protease inhibitors induce sarco/endoplasmic reticulum stress and overproduction of reactive oxygen species (ROS), but the hierarchy of these events was never established in protease inhibitor-treated cells. Our objective was to determine whether ROS production and sarco/endoplasmic reticulum stress were co-induced by protease inhibitors in human primary skeletal myotubes and whether antioxidant treatment with resveratrol could protect against protease inhibitor-induced cellular damages. DESIGN AND METHODS We analyzed in cultures of primary human skeletal myotubes the effects of four protease inhibitors (atazanavir, lopinavir, ritonavir and saquinavir) on ROS production (by measuring the reduction of nitro blue tetrazolium and by fluorescence microscopy using CM-H2DCFDA), on sarco/endoplasmic reticulum stress induction (by immunofluorescence and electron microscopy) and on the expression and localization at lipid rafts of Caveolin 3 and Flotillin 1, two major components of lipid rafts (by immunoblotting and biochemical experiments). Cells were co-incubated with resveratrol to assess its protective effects. RESULTS In myotubes, protease inhibitors increased ROS production, altered sarco/endoplasmic reticulum morphology, increased expression of C/EBP homologous protein, a sarco/endoplasmic reticulum stress marker, and decreased expression and localization at lipid rafts of Caveolin 3 and Flotillin 1. Importantly, these deleterious protease inhibitor effects were inhibited by the antioxidant resveratrol. CONCLUSION Our findings demonstrate a protective effect of resveratrol against protease inhibitor-induced sarco/endoplasmic reticulum stress in human myotubes.
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Lazzarotto A, Reichert MT, Venker C, Kramer AS, Sprinz E. HIV/aids e meia idade: avaliação do conhecimento de indivíduos da região do Vale do Sinos (RS), Brasil. CIENCIA & SAUDE COLETIVA 2010; 15 Suppl 1:1185-90. [DOI: 10.1590/s1413-81232010000700027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 01/30/2008] [Indexed: 11/21/2022] Open
Abstract
O objetivo deste estudo é avaliar o nível de conhecimento sobre HIV/aids nos indivíduos de meia idade, participantes de grupos de convivência do Vale do Sinos (RS). O estudo caracterizou-se como transversal, obtendo-se uma amostra de 168 indivíduos, sendo 9,5% homens e 90,5% mulheres, na faixa etária entre 40 e 59 anos. Utilizou-se como instrumento um questionário composto pelos domínios "conceito", "transmissão", "vulnerabilidade", "prevenção" e "tratamento". O ensino fundamental caracterizou 61,3% da escolaridade dos participantes e a renda mensal situou-se entre um e três salários mínimos para 45,2%. No domínio "conceito", 65,2% desconheciam a fase assintomática da infecção e 34,5% apontaram o mosquito como transmissor da aids, no domínio "transmissão". Nos domínios "prevenção" e "vulnerabilidade", 19,5% desconheciam a existência do preservativo feminino e 29,2% acreditaram que a doença é característica de grupos específicos. Quanto ao "tratamento", 12,5% ignoraram a sua existência. De acordo com os achados, os indivíduos da meia idade participantes de grupos de convivência do Vale do Sinos tinham conceitos errôneos sobre HIV/aids que poderiam aumentar o risco à infecção. Sendo assim, é necessário proporcionar programas de saúde pública direcionados para esta população para prevenir ou diminuir o risco de transmissão do HIV.
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Terzian AS, Holman S, Nathwani N, Robison E, Weber K, Young M, Greenblatt RM, Gange SJ. Factors associated with preclinical disability and frailty among HIV-infected and HIV-uninfected women in the era of cART. J Womens Health (Larchmt) 2010; 18:1965-74. [PMID: 20044858 DOI: 10.1089/jwh.2008.1090] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND HIV-associated immune injury is hypothesized to increase the risk of preclinical disability and frailty via inflammatory pathways. We investigated the role of CD4+ T cell depletion and clinical AIDS on preclinical disability and frailty in HIV-positive women with a history of combination antiretroviral therapy (cART) and HIV-negative women. METHODS This was a cross-sectional study nested within the Women's Interagency HIV Study (WIHS), a prospective cohort study initiated in 1994 across five U.S. cities. Questionnaires and tests were performed by 573 HIV-negative and 1206 HIV-positive women. Prevalence ratios were computed using regression models. RESULTS Severe CD4+ cell depletion was an independent predictor of slowness, weakness, and frailty in HIV-positive women compared with HIV-negative women. Women with CD4+ counts<100 cells/mm3 were 0.13 seconds slower to complete 4 meters (95% CI 0.06-0.21), 1.25 kg weaker (95% CI -2.31--0.19), and had 2.7 times higher prevalence of frailty (95% CI 1.46-5.01). CONCLUSIONS This study is one of the largest studies to administer performance-based tests to investigate disability and frailty in HIV-positive women. HIV-positive women with intact immune systems and without a history of clinical AIDS were no different from HIV-negative women on tests of slowness, weakness, and frailty phenotype.
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Affiliation(s)
- Arpi S Terzian
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
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Murray JM, McDonald AM, Law MG. Rapidly ageing HIV epidemic among men who have sex with men in Australia. Sex Health 2009; 6:83-6. [PMID: 19254497 DOI: 10.1071/sh08063] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 01/15/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND Antiretroviral therapy has increased survival for individuals living with HIV and has led to an ageing of this population in developed countries. To date the rate of ageing has been unquantified, giving rise to uncertainty in the treatment emphasis and burden in this population. METHODS A mathematical model was used in conjunction with HIV/AIDS data from the Australian National HIV/AIDS Registry to estimate numbers and ages of Australian men who have sex with men (MSM) living with HIV infection from 1980 to 2005. RESULTS The average age of HIV-infected Australian MSM is estimated to exceed 44 years of age by the year 2010 and has increased by 1 year of age for each two calendar years since the mid-1980s. HIV-infected MSM over 60 years of age have been increasing in number by 12% per year since 1995. A consequence of successful therapy with subsequent ageing of those infected has meant that from 2001 estimated deaths from other causes exceed AIDS deaths in Australia. CONCLUSIONS In summary, our analyses indicate an increasing and rapidly ageing population living with HIV in Australia. This will inevitably lead to more serious non-AIDS conditions in ageing patients living with HIV, and to increased treatment complexity.
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Affiliation(s)
- John M Murray
- School of Mathematics and Statistics, University of New South Wales, Sydney, NSW 2052, Australia.
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Caron M, Auclair M, Vissian A, Vigouroux C, Capeau J. Contribution of Mitochondrial Dysfunction and Oxidative Stress to Cellular Premature Senescence Induced by Antiretroviral Thymidine Analogues. Antivir Ther 2008. [DOI: 10.1177/135965350801300103] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Treatment of HIV-infected patients is associated with early onset of aging-related comorbidities. Some of the adverse effects of antiretroviral therapy have been attributed to the mitochondrial toxicity of nucleoside reverse transcriptase inhibitors (NRTI), and it is of note that mitochondrial dysfunction and oxidative stress are involved in the aging processes. In this regard, we examined whether NRTIs could accelerate the senescence of cultured cells. Methods Human fibroblasts were exposed to NRTIs from culture passage 1 to 14. Cytochrome c-oxidase (COX) subunits 2 and 4, mitochondrial potential and mass, and reactive oxygen species (ROS) were quantified at each passage. Proliferation, cell-cycle arrest, senescence-associated β-galactosidase activity, and morphology were assessed in parallel. Mitochondrial and senescence markers were assessed in cultured murine preadipocytes and in fat samples from lipodystrophic HIV-infected patients. Results Stavudine and zidovudine induced mitochondrial dysfunction and increased ROS levels in fibroblasts at early culture passages, while cell division gradually slowed. At passages 8–12, fibroblasts exposed to stavudine or zidovudine but not abacavir, didanosine, lamivudine and tenofovir were senescent, on the basis of p16INK4 and p21WAF-1 protein expression, cell morphology and senescence-associated-β-galactosidase activity. Senescence markers and COX2 underexpression were also found in 3T3-F442A preadipocytes exposed for 7 weeks to stavudine or zidovudine, but not lamivudine, and in adipose tissue samples from lipodystrophic HIV-infected patients on antiretroviral regimens containing stavudine or zidovudine. Conclusions Mitochondrial changes and oxidative damage could partly explain the premature senescence of fibroblasts and adipose cells induced by stavudine and zidovudine. This suggests that thymidine analogues might be involved in the early aging-related diseases observed in some HIV-infected patients taking antiretroviral drugs.
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Affiliation(s)
- Martine Caron
- Inserm, U680, Paris, 75012 France
- Université Pierre et Marie Curie Paris6, UMR S680 Paris, 75012 France
| | - Martine Auclair
- Inserm, U680, Paris, 75012 France
- Université Pierre et Marie Curie Paris6, UMR S680 Paris, 75012 France
| | - Anais Vissian
- Inserm, U680, Paris, 75012 France
- Université Pierre et Marie Curie Paris6, UMR S680 Paris, 75012 France
| | - Corinne Vigouroux
- Inserm, U680, Paris, 75012 France
- Université Pierre et Marie Curie Paris6, UMR S680 Paris, 75012 France
- AP-HP, Hôpital Tenon, Service de Biochimie et Hormonologie, Paris, 75020 France
| | - Jacqueline Capeau
- Inserm, U680, Paris, 75012 France
- Université Pierre et Marie Curie Paris6, UMR S680 Paris, 75012 France
- AP-HP, Hôpital Tenon, Service de Biochimie et Hormonologie, Paris, 75020 France
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