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Conroy AA, Hahn JA, Neilands TB, Darbes LA, Tebbetts S, Mulauzi N, Mkandawire J, Ssewamala FM. Pilot Trial Results of Mlambe: An Economic and Relationship-Strengthening Intervention to Address Heavy Drinking and Adherence to Antiretroviral Therapy in Malawi. AIDS Behav 2024; 28:2296-2306. [PMID: 38551718 DOI: 10.1007/s10461-024-04326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/01/2024]
Abstract
We evaluated the feasibility, acceptability, and preliminary efficacy of an economic and relationship-strengthening intervention to reduce heavy alcohol use among couples living with HIV in Malawi (Mlambe). Mlambe consisted of training on financial literacy and relationship skills, combined with 1:1 matched savings accounts to invest in an income-generating activity. In a randomized controlled trial, we compared Mlambe to enhanced usual care (EUC). We enrolled 78 married couples having a partner on antiretroviral therapy (ART) who reported heavy alcohol use based on the AUDIT-C. Using targets of 75%, primary outcomes included retention rates at 10 and 15-months, session attendance rates, and satisfaction with Mlambe. Exploratory outcomes were heavy alcohol use (AUDIT-C and/or PEth positive), number of drinking days in the past month, AUDIT-C score, optimal adherence to ART (95% or higher), and viral suppression. We exceeded our targets for feasibility and acceptability metrics. Retention rates were 96% at 15-months. Session attendance and satisfaction levels were both 100%. From baseline to 15-months, Mlambe participants reported decreases in mean number of drinking days (from 6.8 to 2.1) and AUDIT-C scores (from 7.5 to 3.1); while ART adherence rates improved across the same period (from 63.2 to 73.9%). Participants in Mlambe, as compared to those in EUC, had lower rates of heavy alcohol use (89.5% vs. 97.2%) and higher rates of viral suppression (100% vs. 91.9%) at 10-months. Differences between arms were not statistically significant in this small pilot study. Mlambe was highly feasible and acceptable, and shows promise for reducing heavy alcohol use and viral non-suppression among couples with HIV in a larger efficacy study.
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Affiliation(s)
- Amy A Conroy
- Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA.
| | - Judith A Hahn
- Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | - Torsten B Neilands
- Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Scott Tebbetts
- Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
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Månsson A, Danielsson AK, Sjöqvist H, Glatz T, Lundin A, Wallhed Finn S. Pharmacotherapy for alcohol use disorder among adults with medical disorders in Sweden. Addict Sci Clin Pract 2024; 19:41. [PMID: 38764075 PMCID: PMC11103816 DOI: 10.1186/s13722-024-00471-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/06/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Alcohol-attributable medical disorders are prevalent among individuals with alcohol use disorder (AUD). However, there is a lack of research on prescriptions of pharmacological treatment for AUD in those with comorbid conditions. This study aims to investigate the utilization of pharmacological treatment (acamprosate, disulfiram and naltrexone) in specialist care among patients with AUD and comorbid medical diagnoses. METHODS This was a descriptive register-based Swedish national cohort study including 132,728 adults diagnosed with AUD (N = 270,933) between 2007 and 2015. The exposure was alcohol-attributable categories of comorbid medical diagnoses. Odds ratios (OR) were calculated using mixed-effect logistic regression analyses for any filled prescription of acamprosate, disulfiram or oral naltrexone within 12 months post AUD diagnosis. RESULTS Individuals with comorbid alcohol-attributable medical diagnoses had lower odds of filling prescriptions for any type of AUD pharmacotherapy compared to those without such comorbidities. Cardiovascular (OR = 0.41 [95% CI: 0.39-0.43]), neurological (OR = 0.52 [95% CI: 0.48-0.56]) and gastrointestinal (OR = 0.57 [95% CI: 0.54-0.60]) diseases were associated with the lowest rates of prescription receipt. The presence of diagnoses which are contraindications to AUD pharmacotherapy did not fully explain the low prescription rate. CONCLUSION There is a substantial underutilization of AUD pharmacotherapy in patients with AUD and comorbid medical disorders in specialist care. Increasing the provision of pharmacotherapy to this group of patients is essential and may prevent morbidity and mortality. There is a need to further understand barriers to medical treatment both from the patient and prescriber perspective.
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Affiliation(s)
- Anastasia Månsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, 171 77, Sweden.
| | - Anna-Karin Danielsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, 171 77, Sweden
| | - Hugo Sjöqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, 171 77, Sweden
| | - Toivo Glatz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Public Health, Charitéplatz 1, Berlin, 10117, Germany
| | - Andreas Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, 171 77, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm Region, Stockholm, 171 77, Sweden
| | - Sara Wallhed Finn
- Department of Global Public Health, Karolinska Institutet, Stockholm, 171 77, Sweden
- Mottagningen för alkohol och hälsa, Stockholm Center for Dependency Disorders, Health Care Services, Riddargatan 1, 114 35, Stockholm, Sweden
- Unit of Clinical Alcohol Research (UCAR), University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark
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Fuster D, Zuluaga P, Muga R. [Substance use disorder: Epidemiology, medical consequences and treatment]. Med Clin (Barc) 2024; 162:431-438. [PMID: 38218656 DOI: 10.1016/j.medcli.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 01/15/2024]
Abstract
Substance use is a common health problem, and substance use disorder, which is its most severe presentation, is associated with multiple medical consequences and a negative impact on individual and on population health. Substance use disorder needs to be addressed as any chronic medical condition; therefore, it has to be detected at the early stages and has to be properly treated to prevent drug-related harm. Internists should be able to recognize and treat intoxication and abstinence. Internists should also be able to refer the patient to state of the art long term treatment, aimed to detoxification and treatment induction to promote abstinence and prevent relapse. In this narrative review we will discuss substance use epidemiology, its main medical consequences and its treatment, with a focus on alcohol, opiates, cocaine and other stimulants, cannabis and benzodiazepines.
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Affiliation(s)
- Daniel Fuster
- Unidad de Adicciones, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
| | - Paola Zuluaga
- Unidad de Adicciones, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - Robert Muga
- Unidad de Adicciones, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
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Ajumobi O, Itanyi IU, Ogidi AG, Slinkard SA, Ezeanolue EE. Potential risk factors for cardiovascular diseases and associated sociodemographic characteristics: A cross-sectional evaluation of a large cohort of women living with HIV in north-central Nigeria. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002667. [PMID: 38051752 PMCID: PMC10697517 DOI: 10.1371/journal.pgph.0002667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/03/2023] [Indexed: 12/07/2023]
Abstract
Males have a higher prevalence of cardiovascular (CVD) risk factors such as alcohol use, hypercholesterolemia, hypertension, obesity, and smoking based on limited data available from two tertiary health centers in Nigeria. Increasing age and lower educational level influence smoking among the same population in northeastern and northwestern Nigeria. Specifically in women living with HIV (WLHIV), the association between demographic characteristics and CVD risk factors has not been described. In a multi-center cross-sectional study, we documented the association of sociodemographic characteristics with potential CVD risk factors among a large cohort of WLHIV attending five treatment sites in north-central Nigeria. This was a cross-sectional study among 5430 women of reproductive age who received antiretrovirals at five selected treatment sites in Benue State, Nigeria. We performed multivariable regression of sociodemographic characteristics on potential cardiovascular risk factors, namely, smoking, alcohol consumption, and contraceptive use. We found participants' mean age was 33.2 (standard deviation: 6.1) years. Prevalence of smoking, alcohol consumption, and contraceptive use were 0.6%, 11%, and 7% respectively. Older WLHIV (≥ 40 years) had a negative association with contraceptive use (aOR: 0.58, 95%CI: 0.42-0.81). Being educated WLHIV had a positive association with contraceptive use (aOR: 1.34, 95%CI: 1.02-1.76) and a negative association with tobacco smoking (aOR: 0.37, 95%CI: 0.16-0.83). Being a farmer had a negative association with alcohol consumption (aOR: 0.43, 95%CI: 0.35-0.52) and contraceptive use (aOR: 0.61, 95%CI: 0.48-0.76). Compared to being married, being in a single relationship had positive association with alcohol consumption (aOR: 1.30, 95%CI: 1.08-1.56) while parenting was associated with 165% higher odds of contraceptive use (aOR: 2.65, 95%CI: 1.73-4.06). In conclusion, the low prevalence of smoking exists among women living with HIV on antiretroviral treatment. Older age, farming and being married are potential deterrents to lifestyle risk factors for cardiovascular diseases among this population. To improve HIV-related treatment efforts and outcomes, implementing interventions aimed at lifestyle behavioral modification among this population has the potential to reduce cardiovascular disease risks.
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Affiliation(s)
- Olufemi Ajumobi
- School of Public Health, University of Nevada, Reno, Nevada, United States of America
| | - Ijeoma Uchenna Itanyi
- Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu, Nigeria
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Amaka Grace Ogidi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Samantha A. Slinkard
- South Carolina Center for Rural and Primary Healthcare, Columbia, South Carolina, United States of America
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McLaughlin A, Lin N, Jiang W, Lodi S, Lioznov D, Patts G, Gnatienko N, Blokhina E, Bendiks S, Freiberg MS, Tindle HA, Krupitsky E, Hahn JA, Samet JH, So-Armah K. Association of Alcohol Consumption With CD4 Recovery After Antiretroviral Therapy Initiation in St. Petersburg, Russia. J Acquir Immune Defic Syndr 2023; 94:244-252. [PMID: 37850982 PMCID: PMC10593489 DOI: 10.1097/qai.0000000000003250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/21/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Delayed CD4 recovery after initiating antiretroviral therapy (ART) is a novel potential mechanism by which alcohol consumption leads to increased morbidity and mortality in people with HIV. We hypothesized that alcohol consumption at ART initiation is associated with slower CD4 recovery. METHODS We retrospectively analyzed 2 pooled longitudinal alcohol/HIV cohorts (2014-2019) in St. Petersburg, Russia. Eligible participants initiated the first ART during parent studies; had alcohol consumption assessed by the blood biomarker, phosphatidylethanol (PEth), at the last research visit before ART initiation; and had ≥1 CD4 count measurement before and after initiating ART. Participants were stratified by low, moderate, and high PEth (<8, 8-80, and >80 ng/mL, respectively). We used random-effects piecewise linear regression models to estimate CD4 recovery, defined as CD4 count change per 30 days after ART initiation, by the alcohol group. RESULTS Of 60 eligible participants, median age was 34 years and 28% were female. The median pre-ART PEth in the low, moderate, and high PEth groups were <8, 23, and 232 ng/mL, respectively. After starting ART, the CD4 count increased by 13.60 cells/mm3/mo (95% CI: 0.33 to 26.87) with low PEth, 0.93 cells/mm3/mo (95% CI: -6.18 to 8.04) with moderate PEth, and 2.33 cells/mm3/mo (95% CI: -3.44 to 8.09) with high PEth. CONCLUSIONS Among Russians with HIV, we observed faster CD4 recovery after ART initiation in those with low alcohol consumption compared with those with moderate and high alcohol consumption, as assessed by PEth. This analysis provides further evidence for the possible value of alcohol reduction interventions for people with HIV who are initiating ART.
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Affiliation(s)
- Angela McLaughlin
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Nina Lin
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Wenqing Jiang
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Dmitry Lioznov
- Department of Infectious Diseases and Epidemiology, First Pavlov State Medical University, St. Petersburg, Russia
| | - Gregory Patts
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Natalia Gnatienko
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Elena Blokhina
- First Pavlov State Medical University, St. Petersburg, Russia
| | - Sally Bendiks
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Matthew S. Freiberg
- Department of Medicine, Vanderbilt University School of Medicine, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Hilary A. Tindle
- Department of Medicine, Vanderbilt University School of Medicine, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University, St. Petersburg, Russia
- V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Judith A. Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey H. Samet
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Kaku So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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Conroy AA, Tebbetts S, Darbes LA, Hahn JA, Neilands TB, McKenna SA, Mulauzi N, Mkandawire J, Ssewamala FM. Development of an Economic and Relationship-Strengthening Intervention for Alcohol Drinkers Living with HIV in Malawi. AIDS Behav 2023; 27:2255-2270. [PMID: 36520335 PMCID: PMC9753077 DOI: 10.1007/s10461-022-03956-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
Heavy alcohol use among people with HIV in sub-Saharan Africa is driven by household economics such as poverty and unemployment and has negative impacts on couple relationships. Multilevel interventions have the potential to reduce alcohol use and improve relationship outcomes by addressing the web of co-occurring economic, social, and dyadic factors. This objective of this study was to develop an economic and relationship-strengthening intervention for couples in Malawi, consisting of matched savings accounts with financial literacy training and a couples counseling component to build relationship skills. Informed by the ADAPT-ITT framework, we collected multiple rounds of focus group data with key stakeholders and couples to gain input on the concept, session content, and procedures, held team meetings with field staff and an international team of researchers to tailor the intervention to couples in Malawi, and refined the intervention manual and components. The results describe a rigorous adaptation process based on the eight steps of ADAPT-ITT, insights gained from formative data and modifications made, and a description of the final intervention to be evaluated in a pilot randomized clinical trial. The economic and relationship-strengthening intervention shows great promise of being feasible, acceptable, and efficacious for couples affected by HIV and heavy alcohol use in Malawi.
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Affiliation(s)
- Amy A Conroy
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA.
| | - Scott Tebbetts
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Judith A Hahn
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | | | | | - James Mkandawire
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
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Pachuau LN, Tannous C, Chawngthu RL, Agho KE. HIV and its associated factors among people who inject drugs in Mizoram, Northeast India. PLoS One 2023; 18:e0286009. [PMID: 37216389 DOI: 10.1371/journal.pone.0286009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
AIM To estimate the prevalence and associated factors with the human immune-deficiency virus (HIV) among people who inject drugs (PWID) in Mizoram, Northeast India. METHODS The data source for the analysis was the 2019-2020 Mizoram State AIDS Control Society (MSACS) survey from 2695 PWID registered for the Targeted Intervention (TI) services. Logistic regression analysis was conducted to examine the factors associated with HIV among PWID after adjusting for sociodemographic characteristics, injection, and sexual behaviours. RESULTS 21.19% of the participants tested positive for HIV and the prevalence of HIV among male and female participants were 19.5% and 38.6%, respectively. Multiple logistic regression analysis revealed that female (AOR 1.74; 95% CI 1.26-2.41), 35 years or older (AOR 1.45; 95% CI 1.06-1.99), married (AOR 1.41; 95% CI1.08-1.83), divorced/separated/widowed (AOR 2.12; 95% CI 1.59-2.82) and sharing of needle/syringe (AOR 1.62; 95% CI 1.30-2.00) were all positively associated with HIV infection. We also found that concomitant alcohol use was reduced by 35% (AOR 0.65; 95% CI 0.51-0.82) among HIV positive PWID, and HIV infection was also reduced by 46% (AOR 0.54; 95% CI 0.44-0.67) among those PWID who use a condom with a regular partner. CONCLUSION The findings of this study suggested that there is a high prevalence of HIV among PWID with 1 in 5 PWID reported to have HIV. HIV among PWID was significantly higher among those over 35 years of age, females and divorced/separated/widowed participants. Needle/syringe sharing behaviour is an important determinant of HIV infection. The high prevalence of HIV among PWID population is multifactorial. To reduce HIV among PWID in Mizoram, interventions should target those sharing needles/syringes, females, especially those over 35 years of age and unmarried participants.
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Affiliation(s)
| | - Caterina Tannous
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | | | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Westville Campus, Durban, South Africa
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Cinque F, Cespiati A, Lombardi R, Guaraldi G, Sebastiani G. Nutritional and Lifestyle Therapy for NAFLD in People with HIV. Nutrients 2023; 15:nu15081990. [PMID: 37111209 PMCID: PMC10140991 DOI: 10.3390/nu15081990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
HIV infection and nonalcoholic fatty liver disease (NAFLD) are two major epidemics affecting millions of people worldwide. As people with HIV (PWH) age, there is an increased prevalence of metabolic comorbidities, along with unique HIV factors, such as HIV chronic inflammation and life-long exposure to antiretroviral therapy, which leads to a high prevalence of NAFLD. An unhealthy lifestyle, with a high dietary intake of refined carbohydrates, saturated fatty acids, fructose added beverages, and processed red meat, as well as physical inactivity, are known to trigger and promote the progression of NAFLD to nonalcoholic steatohepatitis, liver fibrosis, and hepatocellular carcinoma. Furthermore, with no currently approved pharmacotherapy and a lack of clinical trials that are inclusive of HIV, nutritional and lifestyle approaches still represent the most recommended treatments for PWH with NAFLD. While sharing common features with the general population, NAFLD in PWH displays its own peculiarities that may also reflect different impacts of nutrition and exercise on its onset and treatment. Therefore, in this narrative review, we aimed to explore the role of nutrients in the development of NAFLD in PWH. In addition, we discussed the nutritional and lifestyle approaches to managing NAFLD in the setting of HIV, with insights into the role of gut microbiota and lean NAFLD.
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Affiliation(s)
- Felice Cinque
- Division of Gastroenterology and Hepatology, and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Annalisa Cespiati
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Rosa Lombardi
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
- Medicine and Metabolic Disease Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria di Modena, 41124 Modena, Italy
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, and Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
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Bertholet N, Saitz R, Hahn JA, Heeren TC, Emenyonu NI, Freiberg M, Winter MR, Kim TW, Magane K, Lloyd-Travaglini C, Fatch R, Bryant K, Forman LS, Rateau L, Blokhina E, Muyindike WR, Gnatienko N, Samet JH. Impact of alcohol use disorder severity on human immunodeficiency virus (HIV) viral suppression and CD4 count in three international cohorts of people with HIV. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:704-712. [PMID: 36799302 PMCID: PMC10198460 DOI: 10.1111/acer.15031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/02/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Alcohol use has been linked to worse human immunodeficiency virus (HIV) immunologic/virologic outcomes, yet few studies have explored the effects of alcohol use disorder (AUD). This study assessed whether AUD severity is associated with HIV viral suppression and CD4 count in the three cohorts of the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Consortium. METHODS People with HIV (PWH) in Uganda (n = 301), Russia (n = 400), and Boston (n = 251), selected in-part based on their alcohol use, were included in analyses. Logistic and linear regressions were used to assess the cross-sectional associations between AUD severity (number of DSM-5 diagnostic criteria) and (1) HIV viral suppression, and (2) CD4 count (cells/mm3 ) adjusting for covariates. Analyses were conducted separately by site. RESULTS The proportion of females was 51% (Uganda), 34% (Russia), and 33% (Boston); mean age (SD) was 40.7 (9.6), 38.6 (6.3), and 52.1 (10.5), respectively. All participants in Uganda and all but 27% in Russia and 5% in Boston were on antiretroviral therapy. In Uganda, 32% met criteria for AUD, 92% in Russia, and 43% in Boston. The mean (SD) number of AUD criteria was 1.6 (2.4) in Uganda, 5.6 (3.3) in Russia, and 2.4 (3.1) in Boston. Most participants had HIV viral suppression (Uganda 92%, Russia 57%, Boston 87%); median (IQR) CD4 count was 673 (506, 866), 351 (201, 542), and 591 (387, 881), respectively. In adjusted models, there were no associations between AUD severity and HIV viral suppression: adjusted odds ratios (AOR) (95%CI) per 1 additional AUD criterion in Uganda was 1.08 (0.87, 1.33); Russia 0.98 (0.92, 1.04); and Boston 0.95 (0.84, 1.08) or CD4 count: mean difference (95%CI) per 1 additional criterion: 5.78 (-7.47, 19.03), -3.23 (-10.91, 4.44), and -8.18 (-24.72, 8.35), respectively. CONCLUSIONS In three cohorts of PWH, AUD severity was not associated with HIV viral suppression or CD4 count. PWH with AUD in the current era of antiretroviral therapy can achieve virologic control.
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Affiliation(s)
- Nicolas Bertholet
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Richard Saitz
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Judith A. Hahn
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Timothy C. Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Nneka I. Emenyonu
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Matthew Freiberg
- Vanderbilt Center for Clinical Cardiovascular Trials Evaluation (V-C3REATE), Vanderbilt University Medical Center, Cardiovascular Division, Nashville, TN, USA
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Theresa W. Kim
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
| | - Kara Magane
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Christine Lloyd-Travaglini
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Robin Fatch
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kendall Bryant
- HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Leah S. Forman
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Lindsey Rateau
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Elena Blokhina
- First Pavlov State Medical University of Saint Petersburg, St. Petersburg, Russia
| | - Winnie R. Muyindike
- Mbarara University of Science and Technology Department of Internal Medicine, Mbarara, Uganda
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
| | - Jeffrey H. Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center Boston, MA, USA
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10
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Estimating the changing burden of disease attributable to alcohol use in South Africa for 2000, 2006 and 2012. S Afr Med J 2022; 112:662-675. [DOI: 10.7196/samj.2022.v112i8b.16487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background. Alcohol use was one of the leading contributors to South Africa (SA)’s disease burden in 2000, accounting for 7% of deaths and disability-adjusted life years (DALYs) in the first South African Comparative Risk Assessment Study (SACRA1). Since then, patterns of alcohol use have changed, as has the epidemiological evidence pertaining to the role of alcohol as a risk factor for infectious diseases, most notably HIV/AIDS and tuberculosis (TB).Objectives. To estimate the burden of disease attributable to alcohol use by sex and age group in SA in 2000, 2006 and 2012.Methods. The analysis follows the World Health Organization (WHO)’s comparative risk assessment methodology. Population attributable fractions (PAFs) were calculated from modelled exposure estimated from a systematic assessment and synthesis of 17 nationally representative surveys and relative risks based on the global review by the International Model of Alcohol Harms and Policies. PAFs were applied to the burden of disease estimates from the revised second South African National Burden of Disease Study (SANBD2) to calculate the alcohol-attributable burden for deaths and DALYs for 2000, 2006 and 2012. We quantified the uncertainty by observing the posterior distribution of the estimated prevalence of drinkers and mean use among adult drinkers (≥15 years old) in a Bayesian model. We assumed no uncertainty in the outcome measures.Results. The alcohol-attributable disease burden decreased from 2000 to 2012 after peaking in 2006, owing to shifts in the disease burden, particularly infectious disease and injuries, and changes in drinking patterns. In 2012, alcohol-attributable harm accounted for an estimated 7.1% (95% uncertainty interval (UI) 6.6 - 7.6) of all deaths and 5.6% (95% UI 5.3 - 6.0) of all DALYs. Attributable deaths were split three ways fairly evenly across major disease categories: infectious diseases (36.4%), non-communicable diseases (32.4%) and injuries (31.2%). Top rankings for alcohol-attributable DALYs for specific causes were TB (22.6%), HIV/AIDS (16.0%), road traffic injuries (15.9%), interpersonal violence (12.8%), cardiovascular disease (11.1%), cancer and cirrhosis (both 4%). Alcohol remains an important contributor to the overall disease burden, ranking fifth in terms of deaths and DALYs.Conclusion. Although reducing overall alcohol use will decrease the burden of disease at a societal level, alcohol harm reduction strategies in SA should prioritise evidence-based interventions to change drinking patterns. Frequent heavy episodic (i.e. binge) drinking accounts for the unusually large share of injuries and infectious diseases in the alcohol-attributable burden of disease profile. Interventions should focus on the distal causes of heavy drinking by focusing on strategies recommended by the WHO’s SAFER initiative.
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11
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Concordance Between Point-of-Care Urine Ethyl Glucuronide Alcohol Tests and Self-Reported Alcohol Use in Persons with HIV in Uganda. AIDS Behav 2022; 26:2539-2547. [PMID: 35103888 PMCID: PMC9256760 DOI: 10.1007/s10461-022-03597-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/01/2022]
Abstract
Screening and assessing alcohol use accurately to maximize positive treatment outcomes remain problematic in regions with high rates of alcohol use and HIV and TB infections. In this study, we examined the concordance between self-reported measures of alcohol use and point-of-care (POC) urine ethyl glucuronide (uEtG) test results among persons with HIV (PWH) in Uganda who reported drinking in the prior 3 months. For analyses, we used the screening data of a trial designed to examine the use of incentives to reduce alcohol consumption and increase medication adherence to examine the concordance between POC uEtG (300 ng/mL cutoff) and six measures of self-reported alcohol use. Of the 2136 participants who completed the alcohol screening, 1080 (50.6%) tested positive in the POC uEtG test, and 1756 (82.2%) self-reported using alcohol during the prior 72 h. Seventy-two percent of those who reported drinking during the prior 24 h had a uEtG positive test, with lower proportions testing uEtG positive when drinking occurred 24-48 h (64.7%) or 48-72 h (28.6%) prior to sample collection. In multivariate models, recency of drinking, number of drinks at last alcohol use, and Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) score were associated with uEtG positivity. The highest area under the curve (AUC) for a uEtG positive test was for recency of drinking. Overall, we concluded that several measures of drinking were associated with POC uEtG positivity, with recency of drinking, particularly drinking within the past 24 h, being the strongest predictor of uEtG positivity.
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12
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Self-Management Frameworks for Youth Living with Human Immunodeficiency Virus. Pediatr Clin North Am 2022; 69:759-777. [PMID: 35934498 DOI: 10.1016/j.pcl.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
HIV is now a chronic condition that can be managed. Adolescents and emerging adults represent a large proportion of new diagnoses, but struggle with many aspects of HIV-related self-management. Self-management of HIV is critical to maintaining health and involves retention in HIV care, medication adherence to achieve viral suppression, managing substance use, and sexual and general health-related behaviors. This article describes theoretic frameworks for HIV self-management as adapted for youth and reviews self-management interventions developed to improve health outcomes in youth living with HIV identified from a recent systematic review.
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13
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Prenatal and adolescent alcohol exposure programs immunity across the lifespan: CNS-mediated regulation. Pharmacol Biochem Behav 2022; 216:173390. [PMID: 35447157 DOI: 10.1016/j.pbb.2022.173390] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/28/2022] [Accepted: 04/11/2022] [Indexed: 12/31/2022]
Abstract
For many individuals, first exposure to alcohol occurs either prenatally due to maternal drinking, or during adolescence, when alcohol consumption is most likely to be initiated. Prenatal Alcohol Exposure (PAE) and its associated Fetal Alcohol Spectrum Disorders (FASD) in humans is associated with earlier initiation of alcohol use and increased rates of Alcohol Use Disorders (AUD). Initiation of alcohol use and misuse in early adolescence correlates highly with later AUD diagnosis as well. Thus, PAE and adolescent binge drinking set the stage for long-term health consequences due to adverse effects of alcohol on subsequent immune function, effects that may persist across the lifespan. The overarching goal of this review, therefore, is to determine the extent to which early developmental exposure to alcohol produces long-lasting, and potentially life-long, changes in immunological function. Alcohol affects the whole body, yet most studies are narrowly focused on individual features of immune function, largely ignoring the systems-level interactions required for effective host defense. We therefore emphasize the crucial role of the Central Nervous System (CNS) in orchestrating host defense processes. We argue that alcohol-mediated disruption of host immunity can occur through both (a) direct action of ethanol on neuroimmune processes, that subsequently disrupt peripheral immune function (top down); and (b) indirect action of ethanol on peripheral immune organs/cells, which in turn elicit consequent changes in CNS neuroimmune function (bottom up). Recognizing that alcohol consumption across the entire body, we argue in favor of integrative, whole-organism approaches toward understanding alcohol effects on immune function, and highlight the need for more work specifically examining long-lasting effects of early developmental exposure to alcohol (prenatal and adolescent periods) on host immunity.
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14
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Conroy AA, Jain JP, Sheira L, Frongillo EA, Neilands TB, Cohen MH, Wilson TE, Chandran A, Adimora AA, Kassaye S, Sheth AN, Fischl MA, Adedimeji A, Turan JM, Tien PC, Weiser SD. Mental Health Mediates the Association Between Gender-Based Violence and HIV Treatment Engagement in US Women. J Acquir Immune Defic Syndr 2022; 89:151-158. [PMID: 34723926 PMCID: PMC8752473 DOI: 10.1097/qai.0000000000002848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gender-based violence (GBV) is associated with poorer engagement in HIV care and treatment. However, there is a dearth of research on the psychological (eg, mental health) and structural (eg, food insecurity) factors that mediate and moderate this association. GBV could lead to poor mental health, which in turn affects adherence, whereas food insecurity could worsen the effect of GBV on engagement in care. This study uses data from the Women's Interagency HIV Study to address these gaps. METHODS Women completed 6 assessments from 2013 to 2016 on GBV, mental health, food insecurity, adherence to antiretroviral therapy, and missed HIV care appointments in the past 6 months. Multilevel logistic regression models estimated associations between GBV and engagement in care and whether associations were mediated by depression, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) and moderated by food insecurity. RESULTS GBV was associated with higher odds of suboptimal adherence (adjusted odds ratio: 1.88; 95% confidence interval: 1.24 to 2.87) and missed appointments (adjusted odds ratio: 1.76; 95% confidence interval: 1.16 to 2.67). The association between GBV and adherence was mediated by depressive symptoms, GAD, and PTSD, accounting for 29.7%, 15.0%, and 16.5%, respectively, of the total association. The association between GBV and missed appointments was mediated by depression and GAD, but not PTSD, with corresponding figures of 25.2% and 19.7%. Associations did not differ by food insecurity. CONCLUSIONS GBV is associated with suboptimal engagement in care, which may be explained by mental health. Interventions should address women's mental health needs, regardless of food insecurity, when improving engagement in HIV care.
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Affiliation(s)
- Amy A Conroy
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA
| | - Jennifer P Jain
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA
| | - Lila Sheira
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, CA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
| | - Torsten B Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA
| | | | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Health Sciences University, School of Public Health, Brooklyn, NY
| | - Aruna Chandran
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Seble Kassaye
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC
| | - Anandi N Sheth
- School of Medicine, Emory University, Grady Health System, Atlanta, GA
| | | | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL; and
| | - Phyllis C Tien
- Department of Medicine, Department of Veteran Affairs Medical Center, UCSF and Medical Service, San Francisco, CA
| | - Sheri D Weiser
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, CA
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15
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Kane JC, Sharma A, Murray LK, Chander G, Kanguya T, Skavenski S, Chitambi C, Lasater ME, Paul R, Cropsey K, Inoue S, Bosomprah S, Danielson CK, Chipungu J, Simenda F, Vinikoor MJ. Efficacy of the Common Elements Treatment Approach (CETA) for Unhealthy Alcohol Use Among Adults with HIV in Zambia: Results from a Pilot Randomized Controlled Trial. AIDS Behav 2022; 26:523-536. [PMID: 34328570 PMCID: PMC8322829 DOI: 10.1007/s10461-021-03408-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 01/04/2023]
Abstract
This randomized controlled trial tested the efficacy of a multi-session, evidence-based, lay counselor-delivered transdiagnostic therapy, the Common Elements Treatment Approach (CETA), in reducing unhealthy alcohol use and comorbidities among persons living with HIV (PLWH) in Zambia. Adult PLWH with (a) unhealthy alcohol use plus mental health or substance use comorbidities, or (b) severe unhealthy alcohol use were randomized to receive a single-session alcohol brief intervention (BI) alone or BI plus referral to CETA. Outcomes were measured at baseline and a 6-month follow-up and included Alcohol Use Disorders Identification Test (AUDIT) score (primary), depression and trauma symptoms, and other substance use (secondary). We enrolled 160 participants; 78 were randomized to BI alone and 82 to BI plus CETA. Due to COVID-19, the trial ended early before 36 participants completed. Statistically and clinically significant reductions in mean AUDIT score from baseline to 6-month follow-up were observed in both groups, however, participants assigned to BI plus CETA had significantly greater reductions compared to BI alone (− 3.2, 95% CI − 6.2 to − 0.1; Cohen’s d: 0.48). The CETA effect size for AUDIT score increased in line with increasing mental health/substance use comorbidity (0 comorbidities d = 0.25; 1–2 comorbidities d = 0.36; 3+ comorbidities d = 1.6). Significant CETA treatment effects were observed for depression, trauma, and several other substances. BI plus referral to CETA was feasible and superior to BI alone for unhealthy alcohol use among adults with HIV, particularly among those with comorbidities. Findings support future effectiveness testing of CETA for HIV outcomes among PLWH with unhealthy alcohol use. Clinical Trials Number: NCT03966885
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Affiliation(s)
- Jeremy C Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W. 168th Street, Room 519, New York, NY, 10032, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Tukiya Kanguya
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Stephanie Skavenski
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chipo Chitambi
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Molly E Lasater
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ravi Paul
- School of Medicine, University of Zambia, University Teaching Hospital, Lusaka, Zambia
| | - Karen Cropsey
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Sachi Inoue
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W. 168th Street, Room 519, New York, NY, 10032, USA
| | - Samuel Bosomprah
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Carla Kmett Danielson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jenala Chipungu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Michael J Vinikoor
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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16
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Garett R, Young SD. Digital Public Health Surveillance Tools for Alcohol Use and HIV Risk Behaviors. AIDS Behav 2021; 25:333-338. [PMID: 33730254 PMCID: PMC7966886 DOI: 10.1007/s10461-021-03221-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
There is a need for real-time and predictive data on alcohol use both broadly and specific to HIV. However, substance use and HIV data often suffer from lag times in reporting as they are typically measured from surveys, clinical case visits and other methods requiring extensive time for collection and analysis. Social big data might help to address this problem and be used to provide near real-time assessments of people's alcohol use and/or alcohol. This manuscript describes three types of social data sources (i.e., social media data, internet search data, and wearable device data) that might be used in surveillance of alcohol and HIV, and then discusses the implications and potential of implementing them as additional tools for public health surveillance.
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Affiliation(s)
- Renee Garett
- ElevateU, LLC; and Department of Informatics, University of California, Irvine, CA, USA
| | - Sean D Young
- Department of Emergency Medicine, University of California, Irvine, Irvine, CA, USA.
- University of California Institute for Prediction Technology, Department of Informatics, University of California, Irvine, Bren Hall, Irvine, CA, 6091, USA.
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17
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Canidate SS, Schrimshaw EW, Schaefer N, Gebru NM, Powers N, Maisto S, Parisi C, Leeman RF, Fields S, Cook RL. The Relationship of Alcohol to ART Adherence Among Black MSM in the U.S.: Is it Any Different Among Black MSM in the South? AIDS Behav 2021; 25:302-313. [PMID: 34741688 PMCID: PMC8610946 DOI: 10.1007/s10461-021-03479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/30/2022]
Abstract
Alcohol-using Black MSM (Men who have sex with men) are disproportionately impacted by HIV in the U.S.-particularly in the southern U.S.-despite the availability of antiretroviral therapy (ART). The purpose of this study was to summarize the current evidence on alcohol use and ART adherence among Black MSM in the U.S. and in the South and to identify future research needs. A systematic review was conducted using eight databases to identify relevant peer-reviewed articles published between January 2010 and April 2021. The authors also snowballed remaining studies and hand-searched for additional studies. Including both quantitative and qualitative studies, five published studies examined alcohol and ART adherence among Black MSM in the U.S. The search identified 240 articles, the study team reviewed 114 in full-text and determined that only five met the inclusion criteria. Three of the five included studies identified alcohol use as a barrier to ART adherence. In conclusions, the general lack of literature on HIV disparities among alcohol-using Black MSM in the U.S. (specifically in the South) indicates a critical need for research on this population's unique risks and needs to inform the development of tailored interventions.
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Affiliation(s)
- Shantrel S Canidate
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0182, USA.
| | - Eric W Schrimshaw
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, 32827, USA
| | - Nancy Schaefer
- UF Health Science Center Libraries, University of Florida, Gainesville, FL, 32610, USA
| | - Nioud Mulugeta Gebru
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, 32611, USA
| | - Noelani Powers
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0182, USA
| | - Stephen Maisto
- Department of Psychiatry, College of Arts and Sciences, Syracuse University, Syracuse, NY, 13244, USA
| | - Christina Parisi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0182, USA
| | - Robert F Leeman
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, 32611, USA
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, 06511, USA
| | - Sheldon Fields
- College of Nursing, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610-0182, USA
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18
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Nyongesa MK, Mwangi P, Kinuthia M, Hassan AS, Koot HM, Cuijpers P, Newton CRJC, Abubakar A. Alcohol and illicit drug use among young people living with HIV compared to their uninfected peers from the Kenyan coast: prevalence and risk indicators. Subst Abuse Treat Prev Policy 2021; 16:86. [PMID: 34819121 PMCID: PMC8613997 DOI: 10.1186/s13011-021-00422-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, there is paucity of research on substance use patterns among young people living with HIV (YLWH). To address the gap, we sought to: i) determine the prevalence of substance use, specifically alcohol and illicit drug use, among YLWH compared to their HIV-uninfected peers; ii) investigate the independent association between young people's HIV infection status and substance use; iii) investigate the risk indicators for substance use among these young people. METHODS Between November 2018 and September 2019, a cross-sectional study was conducted at the Kenyan coast recruiting 819 young people aged 18-24 years (407 HIV-positive). Alcohol and drug use disorders identification tests (AUDIT and DUDIT) were administered via audio computer-assisted self-interview alongside other measures. Logistic regression was used to determine substance use risk indicators. RESULTS The point prevalence of current substance use was significantly lower among YLWH than HIV-uninfected youths: current alcohol use, 13% vs. 24%, p < 0.01; current illicit drug use, 7% vs. 15%, p < 0.01; current alcohol and illicit drug use comorbidity, 4 vs. 11%, p < 0.01. Past-year prevalence estimates for hazardous substance use were generally low among young people in this setting (< 10%) with no significant group differences observed. Being HIV-positive independently predicted lower odds of current substance use, but not hazardous substance use. There was overlap of some risk indicators for current substance use between young people with and without HIV including male sex, khat use and an experience of multiple negative life events, but risk indicators unique to either group were also identified. Among YLWH, none of the HIV-related factors was significantly associated with current substance use. CONCLUSIONS At the Kenyan coast, substance use is a reality among young people. The frequency of use generally appears to be low among YLWH compared to the HIV-uninfected peers. Substance use prevention initiatives targeting young people, regardless of HIV infection status, are warranted in this setting to avert their potential risk for developing substance use disorders, including dependence. The multifaceted intrapersonal and interpersonal factors that place young people at risk of substance use need to be addressed as part of the substance use awareness and prevention initiatives.
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Affiliation(s)
- Moses K Nyongesa
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya.
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Paul Mwangi
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Michael Kinuthia
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Amin S Hassan
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Hans M Koot
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charles R J C Newton
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Amina Abubakar
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
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19
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Miller AP, Pitpitan EV, Kiene SM, Raj A, Jain S, Zúñiga ML, Nabulaku D, Nalugoda F, Ssekubugu R, Nantume B, Kigozi G, Sewankambo NK, Kagaayi J, Reynolds SJ, Grabowski K, Wawer M, Wagman JA. Alcohol use and alcohol-related consequences are associated with not being virally suppressed among persons living with HIV in the Rakai region of Uganda. Drug Alcohol Depend 2021; 228:109005. [PMID: 34600249 PMCID: PMC8628865 DOI: 10.1016/j.drugalcdep.2021.109005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Alcohol use is common among persons living with HIV (PWH) in Uganda and associated with poor HIV care outcomes; findings regarding the relationship between alcohol use and viral suppression (VS) have been inconclusive. METHODS Data from two rounds (2017-2020) of the Rakai Community Cohort Study, an open population-based cohort study in the Rakai region, Uganda, were analyzed. Two alcohol exposures were explored: past year alcohol use and alcohol-related consequences. Multivariable models (GEE) were used to estimate associations between alcohol exposures and VS for the overall sample and stratified by sex, adjusting for repeated measurement. Causal mediation by ART use was explored. RESULTS Over half (55 %) of participants (n = 3823 PWH) reported alcohol use at baseline; 37.8 % of those reporting alcohol use reported alcohol-related consequences. ART use and VS at baseline significantly differed by alcohol use with person reporting alcohol use being less likely to be on ART or VS. Alcohol use was significantly associated with decreased odds of VS among women but not men (adj. OR 0.72 95 % CI 0.58-0.89, p = 0.0031). However, among males who use alcohol, experiencing alcohol-related consequences was significantly associated with decreased odds of VS (adj. OR 0.69 95 % CI 0.54-0.88, p = 0.0034). The relationships between both alcohol exposures and VS were not significant in models restricted to persons on ART. CONCLUSIONS We provide sex-stratified estimates of associations between two alcohol measures and VS in the context of current HIV treatment guidelines. This study confirms that alcohol use is adversely associated with VS but ART use mediates this pathway, suggesting that initiation and retention on ART are critical steps to addressing alcohol-related disparities in VS.
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Affiliation(s)
- Amanda P Miller
- University of California, San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, La Jolla, CA, 92093, United States; San Diego State University School of Public Health, San Diego, CA, United States.
| | - Eileen V Pitpitan
- San Diego State University School of Social Work, San Diego, CA, United States
| | - Susan M Kiene
- San Diego State University School of Public Health, San Diego, CA, United States
| | - Anita Raj
- University of California, San Diego School of Medicine, Division of Infectious Diseases and Global Public Health, La Jolla, CA, 92082, United States
| | - Sonia Jain
- University of California, San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, La Jolla, CA, 92093, United States
| | - María Luisa Zúñiga
- San Diego State University School of Social Work, San Diego, CA, United States
| | | | | | | | | | | | - Nelson K Sewankambo
- Rakai Health Sciences Program, Entebbe, Uganda; Makerere University School of Medicine, Kampala, Uganda
| | | | - Steven J Reynolds
- Rakai Health Sciences Program, Entebbe, Uganda; Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, United States; Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Kate Grabowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States; Department of Pathology, Johns Hopkins School of Medicine, Baltimore, United States
| | - Maria Wawer
- Rakai Health Sciences Program, Entebbe, Uganda; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States; Department of Medicine, Johns Hopkins School of Medicine, United States
| | - Jennifer A Wagman
- University of California, Los Angeles Fielding School of Public Health, Department of Community Health Sciences, Los Angeles, CA, United States
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20
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Rogers AH, Neighbors C, Sharp C, Giordano TP, Woods SP, Zvolensky MJ. The relationship between sex-related alcohol expectancies and hazardous drinking among persons with HIV disease. AIDS Care 2021; 33:1475-1481. [PMID: 33225738 DOI: 10.1080/09540121.2020.1845290] [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: 02/01/2023]
Abstract
Hazardous drinking is a clinically significant problem among persons with HIV (PWH) disease, and is associated with a number of poor outcomes. Hazardous drinking among PWH is associated with risky substance use and sexual behavior, but little work has examined factors that may be associated with greater hazardous drinking and subsequent risky sexual behaviors among PWH. Research among the general population suggests that sex-related alcohol expectancies, defined as drinking to enhance sexual experience, increase sexual risk-taking, and disinhibition of sexual behavior, are associated with greater hazardous alcohol use and risky sexual behavior, but these relations have not been explored among PWH. Therefore, the current study examined the associations of sex-related alcohol expectancies with hazardous alcohol consumption, dependence, and problems among 146 PWH (Mage = 50.99, SD = 9.41) \ enrolled in a clinical trial examining a personalized feedback intervention to reduce hazardous drinking in primary HIV care. Results showed that only sexual disinhibition-related alcohol expectancies were significantly associated with the criterion variables, such that greater drinking alcohol for sexual disinhibition was associated with greater hazardous drinking behaviors. These results sit on the backdrop of a larger literature documenting the links between disinhibition and hazardous alcohol use and provide explanatory specificity to PWH who are hazardous drinkers.
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Affiliation(s)
- Andrew H Rogers
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Clayton Neighbors
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Carla Sharp
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Thomas P Giordano
- Health Services Research Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Steven P Woods
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Michael J Zvolensky
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,HEALTH Institute, University of Houston, Houston, TX, USA
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21
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Heavy Alcohol Use is Associated with Lower CD4 Counts among Russian Women Living with HIV: A Multilevel Analysis. AIDS Behav 2021; 25:3734-3742. [PMID: 34014428 DOI: 10.1007/s10461-021-03270-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
Alcohol use remains prevalent among Russian women with HIV infection. Multilevel mixed effects models were used to estimate the association of heavy drinking and HIV outcomes among women (N = 250 at baseline; N = 207 at follow-up), aged 18-35, engaged in HIV care in Saint Petersburg. Alcohol use was assessed at baseline and 3 months by self-report and by the biomarker phosphatidylethanol (PEth). Overall, 35% of women were heavy drinkers, defined as women reporting ≥ 1 past-30-day heavy drinking episode (≥ 4 standard drinks on one occasion) or with PEth blood levels ≥ 80 ng/mL. Women who engaged in heavy drinking had an average 41 CD4 cells/mm3 (95% CI = - 81, - 2; z = - 2.04; P = 0.042) fewer than those who did not. Heavy drinking was associated with higher HIV symptom burden (IRR = 1.20; 95% CI = 1.05, 1.36; z = 2.73; P = 0.006) and suboptimal antiretroviral adherence (OR = 3.04; 95% CI = 1.27, 7.28; χ2 = 2.50; P = 0.013), but not with viral load. Findings support the integration of alcohol treatment interventions as part of routine HIV care in Russia.
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Morojele NK, Shenoi SV, Shuper PA, Braithwaite RS, Rehm J. Alcohol Use and the Risk of Communicable Diseases. Nutrients 2021; 13:3317. [PMID: 34684318 PMCID: PMC8540096 DOI: 10.3390/nu13103317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/12/2023] Open
Abstract
The body of knowledge on alcohol use and communicable diseases has been growing in recent years. Using a narrative review approach, this paper discusses alcohol's role in the acquisition of and treatment outcomes from four different communicable diseases: these include three conditions included in comparative risk assessments to date-Human Immunodeficiency Virus (HIV)/AIDS, tuberculosis (TB), and lower respiratory infections/pneumonia-as well as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) because of its recent and rapid ascension as a global health concern. Alcohol-attributable TB, HIV, and pneumonia combined were responsible for approximately 360,000 deaths and 13 million disability-adjusted life years lost (DALYs) in 2016, with alcohol-attributable TB deaths and DALYs predominating. There is strong evidence that alcohol is associated with increased incidence of and poorer treatment outcomes from HIV, TB, and pneumonia, via both behavioral and biological mechanisms. Preliminary studies suggest that heavy drinkers and those with alcohol use disorders are at increased risk of COVID-19 infection and severe illness. Aside from HIV research, limited research exists that can guide interventions for addressing alcohol-attributable TB and pneumonia or COVID-19. Implementation of effective individual-level interventions and alcohol control policies as a means of reducing the burden of communicable diseases is recommended.
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Affiliation(s)
- Neo K. Morojele
- Department of Psychology, University of Johannesburg, Johannesburg 2006, South Africa
| | - Sheela V. Shenoi
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, USA;
- Yale Institute for Global Health, Yale University, New Haven, CT 06520, USA
| | - Paul A. Shuper
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Toronto, ON M5S 2S1, Canada; (P.A.S.); (J.R.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT 06269, USA
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
| | - Ronald Scott Braithwaite
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY 10013, USA;
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Toronto, ON M5S 2S1, Canada; (P.A.S.); (J.R.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, 01187 Dresden, Germany
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Program on Substance Abuse, Public Health Agency of Catalonia, 08005 Barcelona, Spain
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
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23
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Edsall A, Hoffman KA, Thuy DT, Mai PP, Hang NT, Khuyen TT, Trang NT, Kunkel LE, Giang LM, Korthuis PT. Use of methamphetamine and alcohol among people with opioid use disorder and HIV in Vietnam: a qualitative study. BMC Public Health 2021; 21:1718. [PMID: 34548042 PMCID: PMC8456677 DOI: 10.1186/s12889-021-11783-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heroin use continues to drive HIV transmission in Vietnam, but methamphetamine and alcohol use are growing rapidly and, as in other countries, polysubstance use is widespread. The objective of this study was to understand the interplay between heroin, methamphetamine, and alcohol use among people with opioid use disorder (OUD) and HIV in Vietnam. METHODS We conducted 44 in-depth, face-to-face qualitative interviews with people with OUD and HIV who participated in the BRAVO trial of buprenorphine versus methadone in five Vietnam HIV clinics. Interviews probed participants' experiences of heroin, methamphetamine, and alcohol use and their interplay with HIV/OUD treatment. Interviews were professionally transcribed and analyzed using a thematic analysis approach. RESULTS Of 44 participants interviewed 42 were male, on average 38.8 years of age, with 30 reporting a history of methamphetamine use and 33 reporting a history of alcohol use. Several themes emerged: 1) Methamphetamine and alcohol were perceived to have lower addiction potential than heroin 2) Social settings were key facilitators of alcohol and methamphetamine use 3) Some participants, but not all, used methamphetamine to help quit heroin 4) Consuming alcohol blunted the effects of heroin, while paradoxically serving as a catalyst for heroin use 5) Use of methamphetamine was perceived by many participants to be incompatible with treatment for HIV. CONCLUSIONS Participant experiences reflected a significant impact of polysubstance use on treatment of HIV and OUD. Patterns of polysubstance use are subject to common preconceptions of alcohol and methamphetamine as having a low addictive potential, and these substances are deeply enmeshed in the social life of many people with OUD in Vietnam. Interventions to address complex social norms and potential harms of polysubstance use are urgently needed as the population of people receiving medication for OUD (MOUD) increases in Vietnam and globally. TRIAL REGISTRATION BRAVO - NCT01936857 , September 2013.
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Affiliation(s)
- Andrew Edsall
- Oregon Health & Science University School of Medicine, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Kim A Hoffman
- Oregon Health & Science University - Portland State University School of Public Health, 840 SW Gaines St, Room 230, Portland, OR, 97239, USA
| | - Dinh Thanh Thuy
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - Pham Phuong Mai
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - Nguyen Thu Hang
- Oregon Health & Science University - Portland State University School of Public Health, 840 SW Gaines St, Room 230, Portland, OR, 97239, USA
| | - Tong Thi Khuyen
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - Nguyen Thu Trang
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - Lynn E Kunkel
- Oregon Health & Science University - Portland State University School of Public Health, 840 SW Gaines St, Room 230, Portland, OR, 97239, USA
| | - Le Minh Giang
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - P Todd Korthuis
- Oregon Health & Science University School of Medicine, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- Oregon Health & Science University - Portland State University School of Public Health, 840 SW Gaines St, Room 230, Portland, OR, 97239, USA
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
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24
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Mazzitelli M, Branca Isabel P, Muramatsu T, Chirwa M, Mandalia S, Moyle G, Marta B, Milinkovic A. FRAX assessment in people ageing with HIV. HIV Med 2021; 23:103-108. [PMID: 34541758 DOI: 10.1111/hiv.13170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Current British HIV Association (BHIVA) guidelines recommend the use of FRAX for the routine assessment of bone fracture risk in people living with HIV over 50 years of age every 3 years. Bone mineral density measurement with dual-energy X-ray absorptiometry (DXA) scan is recommended for those with increased fracture risk (FRAX major > 10%). Our objectives were to estimate the prevalence of and risk factors for osteoporosis in a population of PLWH aged > 50 years and assess the utility of FRAX in predicting the presence of DXA-proven osteoporosis in this cohort. METHODS This was a cross-sectional study of a cohort of PLWH aged > 50 years attending the Chelsea and Westminster Hospital and who had a DXA scan between January 2009 and December 2018. FRAX scores were calculated using the Sheffield algorithm. Multiple regression models and Cohen's kappa values were used to assess risk factors for osteoporosis and agreement between FRAX and DXA scan results, respectively. RESULTS In all, 744 patients were included (92.9% male, mean age 56 ± 5 years). The prevalence rates of osteoporosis (at DXA scans) and osteopenia were 12.2% and 63.7%, respectively. FRAX major was > 10% in only two patients, while 90/91 (98.9%) patients with osteoporosis had a normal FRAX score. The presence of osteoporosis was significantly associated with low body mass index and estimated glomerular filtration rate (p < 0.05). CONCLUSION Our results indicate that FRAX scores did not predict the presence of osteoporosis in our population of PLWH over 50 years of age and therefore FRAX scores may not be the appropriate tool to define eligibility to perform DXA scans in PLWH.
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Affiliation(s)
- Maria Mazzitelli
- Research and Development Department, Chelsea and Westminster Hospital, London, UK.,Medical and Surgical Sciences Department, "Magna Graecia" University, Catanzaro, Italy
| | | | - Takashi Muramatsu
- Department of Laboratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Mimie Chirwa
- Research and Development Department, Chelsea and Westminster Hospital, London, UK
| | - Sundhiya Mandalia
- Research and Development Department, Chelsea and Westminster Hospital, London, UK
| | - Graeme Moyle
- Research and Development Department, Chelsea and Westminster Hospital, London, UK
| | - Boffito Marta
- Research and Development Department, Chelsea and Westminster Hospital, London, UK.,Division of Infectious Diseases, Imperial College, London, UK
| | - Ana Milinkovic
- Research and Development Department, Chelsea and Westminster Hospital, London, UK
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25
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Kekibiina A, Adong J, Fatch R, Emenyonu NI, Marson K, Beesiga B, Lodi S, Muyindike WR, Kamya M, Chamie G, McDonell MG, Hahn JA. Post-traumatic stress disorder among persons with HIV who engage in heavy alcohol consumption in southwestern Uganda. BMC Psychiatry 2021; 21:457. [PMID: 34535103 PMCID: PMC8449437 DOI: 10.1186/s12888-021-03464-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/01/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We aimed to describe the prevalence of PTSD symptoms and its associated factors in persons living with HIV (PLWH) in Uganda who engage in heavy alcohol use. METHODS We analyzed baseline data from the Drinkers Intervention to Prevent Tuberculosis study which enrolls PLWH with latent tuberculosis who engage in heavy alcohol consumption. Using the primary care Post Traumatic Stress Disorder (PTSD) screening scale from the DSM-5 (PC-PTSD-5), probable PTSD was defined as reporting ≥3 of 5 assessed symptoms. We conducted the Alcohol Use Disorders Identification Test-Consumption and assessed demographics, smoking, symptoms of depression, and spirituality/religiosity. RESULTS Of 421 participants enrolled from 2018 through 2020, the majority (68.2%) were male, median age was 40 years (interquartile range [IQR]: 32-47), and median AUDIT-C score was 6 [IQR: 4-8]. Half (50.1%) of the participants reported ever experiencing a traumatic event, and 20.7% reported ≥3 symptoms of PTSD. The most commonly reported PTSD symptoms in the past 1 month in the entire sample were avoidance (28.3%), nightmares (27.3%), and being constantly on guard (21.6%). In multivariable logistic regression analyses, level of alcohol use was not associated with probable PTSD (adjusted odds ratio [AOR] for each AUDIT-C point: (1.02; 95% CI: 0.92-1.14; p = 0.69); however, lifetime smoking (AOR 1.89; 95% CI: 1.10-3.24) and reporting symptoms of depression (AOR 1.89; 95% CI: 1.04-3.44) were independently associated with probable PTSD. CONCLUSIONS AND RECOMMENDATIONS A history of traumatic events and probable PTSD were frequently reported among persons who engage in heavy drinking, living with HIV in Uganda. Level of alcohol use was not associated with probable PTSD in this sample of PLWH with heavy alcohol use, however other behavioral and mental health factors were associated with probable PTSD. These data highlight the high prevalence of PTSD in this group, and the need for screening and interventions for PTSD and mental health problems.
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Affiliation(s)
- Allen Kekibiina
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Julian Adong
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robin Fatch
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Nneka I. Emenyonu
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Kara Marson
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Brian Beesiga
- grid.463352.5Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Sara Lodi
- grid.189504.10000 0004 1936 7558Boston University School of Public Health, Boston, MA USA
| | - Winnie R. Muyindike
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda ,grid.459749.20000 0000 9352 6415Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Moses Kamya
- grid.463352.5Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Gabriel Chamie
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA
| | - Michael G. McDonell
- grid.30064.310000 0001 2157 6568Elson S Floyd College of Medicine, Washington State University, Spokane, WA USA
| | - Judith A. Hahn
- grid.266102.10000 0001 2297 6811Department of Medicine, University of California, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
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26
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HIV and antiretroviral treatment knowledge gaps and psychosocial burden among persons living with HIV in Lima, Peru. PLoS One 2021; 16:e0256289. [PMID: 34411156 PMCID: PMC8376082 DOI: 10.1371/journal.pone.0256289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 08/03/2021] [Indexed: 11/19/2022] Open
Abstract
This study aims to describe knowledge on HIV and antiretroviral (ARV) treatment and psychosocial factors among people living with HIV (PLWH) in Lima, Perú, to explore characteristics associated to this knowledge, and determine its impact on sustained viral suppression. A cross-sectional survey was conducted among 171 PLWH at the largest referral health care center in Lima. The psychosocial factors measured were depression, risk of alcoholism, use of illegal drugs and disclosure. A participant had "poor knowledge" when less than 80% of replies were correct. Sustained viral suppression was defined as two consecutive viral loads under 50 copies/mL. A total of 49% and 43% had poor HIV and ARV knowledge respectively; 48% of the study population screened positive for depression and 27% reported feeling unsupported by the person they disclosed to. The largest gaps in HIV and ARV knowledge were among 98 (57%) that did not recognize that HIV increased the risk of cancer and among 57 (33%) participants that did not disagree with the statement that taking a double dose of ARV if they missed one. Moderate depression was significantly associated to poor HIV and ARV knowledge. Non-disclosure and being on ARVs for less than 6 months were associated with not achieving sustained viral suppression. Our findings highlight important HIV and ARV knowledge gaps of PLWH and a high burden of psychosocial problems, especially of depression, among PLWH in Lima, Peru. Increasing knowledge and addressing depression and disclosure could improve care of PLWH.
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Possible mechanisms of HIV neuro-infection in alcohol use: Interplay of oxidative stress, inflammation, and energy interruption. Alcohol 2021; 94:25-41. [PMID: 33864851 DOI: 10.1016/j.alcohol.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/05/2021] [Accepted: 04/01/2021] [Indexed: 11/21/2022]
Abstract
Alcohol use and HIV-1 infection have a pervasive impact on brain function, which extends to the requirement, distribution, and utilization of energy within the central nervous system. This effect on neuroenergetics may explain, in part, the exacerbation of HIV-1 disease under the influence of alcohol, particularly the persistence of HIV-associated neurological complications. The objective of this review article is to highlight the possible mechanisms of HIV/AIDS progression in alcohol users from the perspective of oxidative stress, neuroinflammation, and interruption of energy metabolism. These include the hallmark of sustained immune cell activation and high metabolic energy demand by HIV-1-infected cells in the central nervous system, with at-risk alcohol use. Here, we discussed the point that the increase in energy supply requirement by HIV-1-infected neuroimmune cells as well as the deterrence of nutrient uptake across the blood-brain barrier significantly depletes the energy source and neuro-environment homeostasis in the CNS. We also described the mechanistic idea that comorbidity of HIV-1 infection and alcohol use can cause a metabolic shift and redistribution of energy usage toward HIV-1-infected neuroimmune cells, as shown in neuropathological evidence. Under such an imbalanced neuro-environment, meaningless energy waste is expected in infected cells, along with unnecessary malnutrition in non-infected neuronal cells, which is likely to accelerate HIV neuro-infection progression in alcohol use. Thus, it will be important to consider the factor of nutrients/energy imbalance in formulating treatment strategies to help impede the progression of HIV-1 disease and associated neurological disorders in alcohol use.
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28
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Alcohol Consumption and Hepatitis C Virus (HCV) RNA Levels in HIV/HCV Coinfected Patients. Viruses 2021; 13:v13050716. [PMID: 33919027 PMCID: PMC8142976 DOI: 10.3390/v13050716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The impact of Hepatitis C virus (HCV) RNA levels on the evolution of chronic HCV infection-related liver damage is controversial. Heavy alcohol use is believed to have a deleterious impact on the course of HCV disease, but current knowledge about the possible effect of alcohol use on HCV RNA levels in HIV/HCV coinfected patients is limited. METHODS We examined 107 HIV/HCV-infected individuals with current or past unhealthy alcohol use to assess the association between alcohol consumption (any drinking vs. abstinent) and HCV RNA levels. RESULTS Participants were 75% male, with a mean age of 43 years, and 63% were on antiretroviral therapy. Mean (SD) log HIV RNA was 3.1 (1.4) and mean (SD) log HCV RNA was 6.1 (0.8). Past-month alcohol use was present in 38% of participants. In a multivariable linear regression analysis we found no significant differences in mean log HCV RNA levels between those reporting alcohol use and those who were abstinent [β (95%CI): -0.04 (-0.34, 0.26), p = 0.79)]. There was no significant association between any heavy drinking day and HCV RNA level (0.07, 95% CI: (-0.24, 0.38), p = 0.66). CONCLUSIONS We did not detect significant associations between alcohol use and HCV RNA levels among HIV/HCV coinfected patients.
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29
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Williams EC, McGinnis KA, Rubinsky AD, Matson TE, Bobb JF, Lapham GT, Edelman EJ, Satre DD, Catz SL, Richards JE, Bryant KJ, Marshall BDL, Kraemer KL, Crystal S, Gordon AJ, Skanderson M, Fiellin DA, Justice AC, Bradley KA. Alcohol Use and Antiretroviral Adherence Among Patients Living with HIV: Is Change in Alcohol Use Associated with Change in Adherence? AIDS Behav 2021; 25:203-214. [PMID: 32617778 DOI: 10.1007/s10461-020-02950-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Alcohol use increases non-adherence to antiretroviral therapy (ART) among persons living with HIV (PLWH). Dynamic longitudinal associations are understudied. Veterans Aging Cohort Study (VACS) data 2/1/2008-7/31/16 were used to fit linear regression models estimating changes in adherence (% days with ART medication fill) associated with changes in alcohol use based on annual clinically-ascertained AUDIT-C screening scores (range - 12 to + 12, 0 = no change) adjusting for demographics and initial adherence. Among 21,275 PLWH (67,330 observations), most reported no (48%) or low-level (39%) alcohol use initially, with no (55%) or small (39% ≤ 3 points) annual change. Mean initial adherence was 86% (SD 21%), mean annual change was - 3.1% (SD 21%). An inverted V-shaped association was observed: both increases and decreases in AUDIT-C were associated with greater adherence decreases relative to stable scores [p < 0.001, F (4, 21,274)]. PLWH with dynamic alcohol use (potentially indicative of alcohol use disorder) should be considered for adherence interventions.
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Affiliation(s)
- Emily C Williams
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA.
- Department of Health Services, University of Washington, Seattle, WA, USA.
| | - Kathleen A McGinnis
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Anna D Rubinsky
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA
- Kidney Health Research Collaborative, University of California, San Francisco and VA San Francisco Health Care System, San Francisco, CA, USA
| | - Theresa E Matson
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Gwen T Lapham
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - E Jennifer Edelman
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Derek D Satre
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA, USA
| | - Julie E Richards
- Department of Health Services, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kendall J Bryant
- National Institute On Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kevin L Kraemer
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Stephen Crystal
- Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - Adam J Gordon
- Division of Epidemiology, Department of Internal Medicine, Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Melissa Skanderson
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - David A Fiellin
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Amy C Justice
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Katharine A Bradley
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Center of Excellence in Substance Abuse Treatment and Education (CESATE) VA Puget Sound Healthcare System-Seattle Division, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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30
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Ventuneac A, Hecht G, Forcht E, Duah BA, Tarar S, Langenbach B, Gates J, Cain D, Rendina HJ, Aberg JA, Perlman DC. Chronic High Risk Prescription Opioid Use Among Persons With HIV. FRONTIERS IN SOCIOLOGY 2021; 6:645992. [PMID: 34095287 PMCID: PMC8176351 DOI: 10.3389/fsoc.2021.645992] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/26/2021] [Indexed: 05/07/2023]
Abstract
Persons with HIV (PWH) are a population at risk for adverse sequelae of opioid use. Yet, few studies have examined correlates of chronic high risk opioid use and its impact on HIV outcomes. Trends in prescribing patterns and identification of factors that impact the use of opioid prescriptions among PWH are crucial to determine prevention and treatment interventions. This study examined electronic medical records (EMR) of patients receiving HIV care to characterize prescribing patterns and identify risk factors for chronic high risk prescription opioid use and the impact on HIV outcomes among PWH in primary care from July 1, 2016-December 31, 2017. EMR were analyzed from 8,882 patients who were predominantly male and ethnically and racially diverse with half being 50 years of age or older. The majority of the 8,744 prescriptions (98% oral and 2% transdermal preparations) given to 1,040 (12%) patients were oxycodone (71%), 8% were morphine, 7% tramadol, 4% hydrocodone, 4% codeine, 2% fentanyl, and 4% were other opioids. The number of monthly prescriptions decreased about 14% during the study period. Bivariate analyses indicated that most demographic and clinical variables were associated with receipt of any opioid prescription. After controlling for patient socio-demographic characteristics and clinical factors, the odds of receipt of any prescription were higher among patients with pain diagnoses and opioid use and mental health disorders. In addition, the odds of receipt of high average daily morphine equivalent dose (MED) prescriptions were higher for patients with pain diagnoses. Lastly, patients with substance use disorders (SUD) had an increased likelihood of detectable viral load compared to patients with no SUD, after adjusting for known covariates. Our findings show that despite opioid prescribing guidelines and monitoring systems, additional efforts are needed to prevent chronic high risk prescriptions in patients with comorbid conditions, including pain-related, mental health and substance use disorders. Evidence about the risk for chronic high risk use based on prescribing patterns could better inform pain management and opioid prescribing practices for patients receiving HIV care.
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Affiliation(s)
- Ana Ventuneac
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
- *Correspondence: Ana Ventuneac,
| | - Gavriella Hecht
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Emily Forcht
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Bianca A. Duah
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Shafaq Tarar
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Blanche Langenbach
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Jay Gates
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Demetria Cain
- Department of Psychology, Hunter College, City University of New York, NY, NY, United States
| | - H. Jonathon Rendina
- Department of Psychology, Hunter College, City University of New York, NY, NY, United States
- Health Psychology and Clinical Science PhD Program, The Graduate Center, City University of New York, NY, NY, United States
| | - Judith A. Aberg
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - David C. Perlman
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
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Britton MK, Porges EC, Bryant V, Cohen RA. Neuroimaging and Cognitive Evidence for Combined HIV-Alcohol Effects on the Central Nervous System: A Review. Alcohol Clin Exp Res 2020; 45:290-306. [PMID: 33296091 DOI: 10.1111/acer.14530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/29/2020] [Indexed: 12/27/2022]
Abstract
Alcohol use disorder (AUD) among people living with HIV (PLWH) is a significant public health concern. Despite the advent of effective antiretroviral therapy, up to 50% of PLWH still experience worsened neurocognition, which comorbid AUD exacerbates. We report converging lines of neuroimaging and neuropsychological evidence linking comorbid HIV/AUD to dysfunction in brain regions linked to executive function, learning and memory, processing speed, and motor control, and consequently to impairment in daily life. The brain shrinkage, functional network alterations, and brain metabolite disruption seen in individuals with HIV/AUD have been attributed to several interacting pathways: viral proteins and EtOH are directly neurotoxic and exacerbate each other's neurotoxic effects; EtOH reduces antiretroviral adherence and increases viral replication; AUD and HIV both increase gut microbial translocation, promoting systemic inflammation and HIV transport into the brain by immune cells; and HIV may compound alcohol's damaging effects on the liver, further increasing inflammation. We additionally review the neurocognitive effects of aging, Hepatitis C coinfection, obesity, and cardiovascular disease, tobacco use, and nutritional deficiencies, all of which have been shown to compound cognitive changes in HIV, AUD, and in their comorbidity. Finally, we examine emerging questions in HIV/AUD research, including genetic and cognitive protective factors, the role of binge drinking in HIV/AUD-linked cognitive decline, and whether neurocognitive and brain functions normalize after drinking cessation.
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Affiliation(s)
- Mark K Britton
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
| | - Eric C Porges
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
| | - Vaughn Bryant
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA.,Department of Epidemiology, (VB), University of Florida, Gainesville, Florida, USA
| | - Ronald A Cohen
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
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Kane JC, Sharma A, Murray LK, Chander G, Kanguya T, Lasater ME, Skavenski S, Paul R, Mayeya J, Kmett Danielson C, Chipungu J, Chitambi C, Vinikoor MJ. Common Elements Treatment Approach (CETA) for unhealthy alcohol use among persons with HIV in Zambia: Study protocol of the ZCAP randomized controlled trial. Addict Behav Rep 2020; 12:100278. [PMID: 32637558 PMCID: PMC7330869 DOI: 10.1016/j.abrep.2020.100278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/23/2022] Open
Abstract
AIMS Prevalence of unhealthy alcohol use and co-occurring mental health problems is high among persons living with HIV (PLWH) in sub-Saharan Africa (SSA). Yet, there is a dearth of evidence-based treatment options that can address both unhealthy alcohol use and comorbidities in SSA HIV care settings. Recent studies testing single-session alcohol brief interventions (BIs) among PLWH in SSA have suggested that more robust treatments are needed. This paper describes the protocol of a pilot randomized controlled superiority trial that will test the effectiveness of an evidence-based transdiagnostic multi-session psychotherapy, the Common Elements Treatment Approach (CETA), compared to a control condition consisting of a single session brief alcohol intervention (BI) based on CETA, at reducing unhealthy alcohol use, mental health problems, and other substance use among PLWH in urban Zambia. METHODS The study is a single-blind, parallel, individually randomized trial conducted in HIV treatment centers in Lusaka. 160 PLWH who meet criteria for unhealthy alcohol use + mental health or substance use comorbidities and/or have a more severe alcohol use disorder are eligible. Participants are randomized 1:1 to receive the single-session BI or CETA. Outcomes are assessed at baseline and a six-month follow-up and include unhealthy alcohol use, depression, trauma symptoms, and other substance use. CONCLUSIONS The trial is a first step in establishing the effectiveness of CETA at reducing unhealthy alcohol use and comorbidities among PLWH in SSA. If effectiveness is demonstrated, a larger trial featuring long-term follow-ups and HIV treatment outcomes will be undertaken.
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Affiliation(s)
- Jeremy C. Kane
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Anjali Sharma
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K. Murray
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Tukiya Kanguya
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Molly E. Lasater
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ravi Paul
- University of Zambia, School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | | | | | - Jenala Chipungu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Chipo Chitambi
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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33
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Sileo KM, Miller AP, Huynh TA, Kiene SM. A systematic review of interventions for reducing heavy episodic drinking in sub-Saharan African settings. PLoS One 2020; 15:e0242678. [PMID: 33259549 PMCID: PMC7707537 DOI: 10.1371/journal.pone.0242678] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 11/08/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Assess the effect of non-pharmacological alcohol interventions on reducing heavy episodic drinking (HED) outcomes in sub-Saharan Africa. METHODS A systematic review of the available literature through August 19, 2020 was conducted. Randomized and non-randomized controlled trials testing non-pharmacological interventions on alcohol consumption in sub-Saharan Africa were eligible for inclusion. Eligible outcomes included measures of HED/binge drinking, and measures indicative of this pattern of drinking, such as high blood alcohol concentration or frequency of intoxication. Three authors extracted and reconciled relevant data and assessed risk of bias. The review protocol is available on PROSPERO (registration number: CRD42019094509). The Cochrane Handbook recommendations for the review of interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines guided all methodology. RESULTS Thirteen intervention trials were identified that met our inclusion criteria and measured change in HED. Studies were judged of moderate quality. A beneficial effect of non-pharmacological interventions on HED was reported in six studies, three of which were deemed clinically significant by the review authors; no statistically significant effects were identified in the other seven studies. Interventions achieving statistical and/or clinical significance had an intervention dose of two hours or greater, used an array of psychosocial approaches, including Motivational Interviewing integrated in Brief Intervention, cognitive behavioral therapy and integrated risk reduction interventions, and were delivered both individually and in groups. CONCLUSIONS Evidence for the effectiveness of non-pharmacological interventions to reduce HED in sub-Saharan African settings was limited, demonstrating the need for more research. To strengthen the literature, future research should employ more rigorous study designs, improve consistency of HED measurement, test interventions developed specifically to address HED, and explore structural approaches to HED reduction.
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Affiliation(s)
- Katelyn M. Sileo
- Department of Public Health, University of Texas at San Antonio, San Antonio, Texas, United States of America
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California, United States of America
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, United States of America
| | - Amanda P. Miller
- Division of Infectious Disease and Global Public Health, Department of Medicine, The University of California, San Diego, La Jolla, California, United States of America
| | - Tina A. Huynh
- Department of Public Health, University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California, United States of America
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34
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Ferguson TF, Rosen E, Carr R, Brashear M, Simon L, Theall KP, Ronis MJ, Welsh DA, Molina PE. Associations of Liver Disease with Alcohol Use among People Living with HIV and the Role of Hepatitis C: The New Orleans Alcohol Use in HIV Study. Alcohol Alcohol 2020; 55:28-36. [PMID: 31812989 DOI: 10.1093/alcalc/agz089] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/19/2019] [Accepted: 10/11/2019] [Indexed: 02/06/2023] Open
Abstract
AIM This cross-sectional analysis of the New Orleans Alcohol Use in HIV (NOAH) study assesses whether current and lifetime alcohol use in people living with HIV (PLWH) are associated with greater liver disease and how hepatitis C-viral (HCV) co-infection (HIV/HCV+) modifies the association. METHODS Alcohol use was measured by Lifetime Drinking History (LDH), a 30-day Timeline Followback calendar, the Alcohol Use Disorder Identification Test, and phosphatidylethanol. Liver disease was estimated by alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST platelet ratio-index (APRI), fibrosis-4 index (FIB-4) and nonalcoholic fatty liver disease-fibrosis score. Associations between alcohol consumption and liver disease were estimated with multivariable logistic regression. Models were adjusted for age, sex, body-mass index, hepatitis B and HIV viral load. RESULTS Participants (N = 353) were majority male (69%) and black (84%) with a mean age of 48.3 ± 10 years. LDH was significantly associated with advanced liver fibrosis (FIB-4 aOR = 22.22 [1.22-403.72]) only among HIV/HCV+ participants with an LDH of 100-600 kg. HIV/HCV+ participants had a higher prevalence of intermediate and advanced liver disease markers than HIV/HCV- (P < 0.0001). Advanced markers of liver disease were most strongly associated with hazardous drinking (≥40(women)/60(men) grams/day) (APRI aOR = 15.87 (3.22-78.12); FIB-4 aOR = 6.76 (1.81-7.16)) and PEth ≥400 ng/ml (APRI aOR = 17.52 (2.55-120.54); FIB-4 aOR = 17.75 (3.30-95.630). CONCLUSION Results indicate a greater association of current alcohol use with liver disease than lifetime alcohol use, which varied by HCV status. These findings stress the importance of reducing alcohol use in PLWH to decrease risk of liver disease and fibrosis.
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Affiliation(s)
- Tekeda F Ferguson
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Public Health, Department of Epidemiology, School of Public Health, 2020 Gravier Street, LEC - 3rd Floor, New Orleans, Louisiana 70112, LA, USA
| | - Erika Rosen
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Public Health, Department of Epidemiology, School of Public Health, 2020 Gravier Street, LEC - 3rd Floor, New Orleans, Louisiana 70112, LA, USA
| | - Rotonya Carr
- University of Pennsylvania, Perelman School of Medicine, Division of Gastroenterology, 421 Curie Boulevard, 907 Biomedical Research Building II/III, Philadelphia, Pennsylvania 19104, PA, USA
| | - Meghan Brashear
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences, 1440 Canal Street, Suite 2210, New Orleans, LA 70112, USA
| | - Liz Simon
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Medicine, Physiology, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA
| | - Katherine P Theall
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences, 1440 Canal Street, Suite 2210, New Orleans, LA 70112, USA
| | - Martin J Ronis
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Medicine, Pharmacology, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA, and
| | - David A Welsh
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Medicine, Pulmonology, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA
| | - Patricia E Molina
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Medicine, Physiology, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA
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35
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Drug Use Among Adolescents and Young Adults with Unsuppressed HIV Who Use Alcohol: Identifying Patterns of Comorbid Drug Use and Associations with Mental Health. AIDS Behav 2020; 24:2975-2983. [PMID: 32246358 DOI: 10.1007/s10461-020-02848-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Youth living with HIV (YLWH; aged 16-24) are at elevated risk of alcohol and drug use. Studies in older populations have identified patterns or profiles of multiple substance use differentially associated with mental health and anti-retroviral therapy (ART) adherence. No studies of YLWH have yet examined such patterns. A sample of 179 YLWH, reporting ART non-adherence and alcohol use, were recruited at five Adolescent Trials Network clinics in urban areas of the US between November 2014 and August 2017. Participants completed the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) to assess substance use involvement scores, and the Brief Symptom Inventory. Latent Profile Analysis identified three substance use patterns: minimal illicit drug use (15.1%), cannabis only (56.4%), and global polysubstance use (28.5%). Global polysubstance users experienced more mental health problems compared to the minimal illicit drug use group. The co-occurrence of drug use with alcohol was common among these YLWH-all of whom reported ART adherence problems-indicating the importance of interventions capable of addressing multiple substance use rather than alcohol alone.
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36
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Naar S, Robles G, MacDonell KK, Dinaj-Koci V, Simpson KN, Lam P, Parsons JT, Sizemore KM, Starks TJ. Comparative Effectiveness of Community-Based vs Clinic-Based Healthy Choices Motivational Intervention to Improve Health Behaviors Among Youth Living With HIV: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2014650. [PMID: 32845328 PMCID: PMC7450347 DOI: 10.1001/jamanetworkopen.2020.14650] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Youth living with HIV make up one-quarter of new infections and have high rates of risk behaviors but are significantly understudied. Effectiveness trials in real-world settings are needed to inform program delivery. OBJECTIVE To compare the effectiveness of the Healthy Choices intervention delivered in a home or community setting vs a medical clinic. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from November 1, 2014, to January 31, 2018, with 52 weeks of follow-up. Participants, recruited from 5 adolescent HIV clinics in the United States, were youths and young adults living with HIV aged 16 to 24 years who were fluent in English, were currently prescribed HIV medication, had a detectable viral load, and had used alcohol in the past 12 weeks. Individuals with an active psychosis that resulted in an inability to complete questionnaires were excluded. Data were analyzed from May to December, 2019. INTERVENTIONS Participants were randomized to receive the Healthy Choices intervention in either a home or clinic setting. Four 30-minute individual sessions based on motivational interviewing to improve (1) medication adherence and (2) drinking behavior were delivered during 10 weeks by trained community health workers. In session 1, participants chose which behavior to discuss first. Using motivational interviewing strategies, the community health worker elicited motivational language, guided the development of an individualized change plan while supporting autonomy, delivered feedback, and addressed knowledge gaps. Session 2 focused on the second target behavior. In subsequent sessions, community health workers reviewed the individualized change plan, monitored progress, guided problem solving, and helped maintain changes made. MAIN OUTCOMES AND MEASURES Primary outcomes were viral load and alcohol use change trajectories during 52 weeks of follow-up. Alcohol use severity and frequency were measured using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) (scores range from 0 to 33, with higher scores indicating greater severity of alcohol-related problems) and number of drinks consumed each day over a 30-day period, with timeline followback. RESULTS A total of 183 young people living with HIV (145 male [79.2%]; mean [SD] age, 21.4 [1.9] y) were randomized to the home setting (n = 90) or clinical setting (n = 93). Using growth-curve analysis, both groups showed declines in viral load after the intervention: among participants with available viral load information, in the home group, 12 participants (21%) had an undetectable viral load at 16 weeks, 12 (22%) at 28 weeks, and 10 (20%) at 52 weeks; in the clinic group, 16 participants (24%) had an undetectable viral load at 16 weeks, 20 (39%) at 28 weeks, and 18 (35%) at 52 weeks. However, the clinic group maintained gains, whereas those counseled at home had a significantly different and increasing trajectory during follow-up (unstandardized β = -0.07; 95% CI,-0.14 to -0.01; P = .02). A similar pattern was observed in ASSIST scores during follow-up, with reduced ASSIST scores in the clinic group (unstandardized β = -0.44; 95% CI,-0.81 to -0.07; P = .02). CONCLUSIONS AND RELEVANCE In this trial, the Healthy Choices intervention resulted in improvements in viral load and alcohol use over 12 months. Unexpectedly, the clinic setting outperformed home-based delivery for viral suppression. Although cross-sectional differences in ASSIST scores were nonsignificant, clinic delivery did improve the trajectory of ASSIST scores during follow-up. Thus, clinics may be the more effective site for interventions aimed at viral load reduction for young people living with HIV. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01969461.
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Affiliation(s)
- Sylvie Naar
- Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee
| | - Gabriel Robles
- School of Social Work, Rutgers University, New Brunswick, New Jersey
| | - Karen Kolmodin MacDonell
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | - Veronica Dinaj-Koci
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan
| | - Kit N. Simpson
- College of Health Professions, Medical University of South Carolina, Charleston
| | - Phebe Lam
- University of Windsor, Faculty of Arts, Humanities and Social Sciences, Windsor, Ontario, Canada
| | | | - K. Marie Sizemore
- Department of Psychology, Hunter College, City University of New York, New York
| | - Tyrel J. Starks
- Health Psychology and Clinical Science Program, The Graduate Center, City University of New York, New York
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37
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Conroy AA, Ruark A, McKenna SA, Tan JY, Darbes LA, Hahn JA, Mkandawire J. The Unaddressed Needs of Alcohol-Using Couples on Antiretroviral Therapy in Malawi: Formative Research on Multilevel Interventions. AIDS Behav 2020; 24:1599-1611. [PMID: 31456201 PMCID: PMC7044068 DOI: 10.1007/s10461-019-02653-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Alcohol use among HIV-positive individuals in sub-Saharan Africa directly impacts adherence to antiretroviral therapy and HIV outcomes. Few studies have examined approaches to reduce alcohol use among HIV-affected couples, despite evidence that alcohol use is a couple-level concern. We conducted a qualitative study with 23 alcohol-using couples to identify multilevel barriers and facilitators of alcohol use, and potential intervention options with couples. Data were analyzed at individual and dyadic levels using framework analysis. All couples were married and had at least one partner on ART. Men were the primary alcohol drinkers with few women reporting alcohol use. Most women tried to persuade their partners to reduce their alcohol intake and when unsuccessful, enlisted help from relatives and HIV care providers. Effective couple negotiation around men's alcohol use was constrained by negative peer influence and men's desire for friendship to cope with life stressors. Women were primarily concerned about the expense of alcohol and described how alcohol prevented the family from meeting basic needs and investing in the future. Alcohol use was described as a major barrier to ART adherence, but was also viewed as the cause of couple and family violence, extramarital partnerships, food insecurity, and poverty. We conclude that multilevel interventions based on couples' needs and preferences are urgently needed. Couple-based intervention approaches could include provider-led alcohol counseling with couples, alcohol reduction support groups for couples, couples' counseling to bolster couple communication and problem-solving around alcohol, and economic-strengthening interventions for couples.
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Affiliation(s)
- Amy A Conroy
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA.
| | - Allison Ruark
- Department of Medicine, Brown University, Providence, RI, USA
| | | | - Judy Y Tan
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Judith A Hahn
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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38
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Ferguson TF, Theall KP, Brashear M, Maffei V, Beauchamp A, Siggins RW, Simon L, Mercante D, Nelson S, Welsh DA, Molina PE. Comprehensive Assessment of Alcohol Consumption in People Living with HIV (PLWH): The New Orleans Alcohol Use in HIV Study. Alcohol Clin Exp Res 2020; 44:1261-1272. [PMID: 32441814 DOI: 10.1111/acer.14336] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND High frequency of alcohol use among people living with HIV (PLWH) warrants careful assessment and screening to better understand its impact on HIV disease progression and development of comorbidities. Due to the limitations of the tools used to measure alcohol use, the links to health consequences are not fully understood. METHODS We completed a cross-sectional analysis to examine the prevalence of alcohol consumption using multiple alcohol assessment tools and their correlation and consistency in a cohort of PLWH (N = 365) enrolled in the New Orleans Alcohol Use in HIV (NOAH) Study. Alcohol use was assessed with the Alcohol Use Disorders Identification Test (AUDIT), timeline followback (TLFB) Calendar, lifetime drinking history, Alcohol and Drug Addiction Severity Index, and blood levels of phosphatidylethanol (PEth). Spearman's correlations were estimated for continuous measures of alcohol consumption; Wilcoxon rank-sum tests were used to compare means; and logistic regression was used to estimate odds of alcohol use by demographic characteristics. RESULTS Self-report of current alcohol use varied from 58.9 to 73.7% depending on the assessment. All the self-reported alcohol measures showed statistically significant correlations with the biological marker PEth. The highest correlation was with TLFB grams (r = 0.67, p < 0.001). Using TLFB, 73.7% of the cohort reported using alcohol in the last 30 days, and 61.6% had a positive PEth value. The prevalence of risky drinkers, meeting the TLFB > 3 (women) or >4 (men) drinks/day or>7 (women) or>14 (men) drinks/week, was 49.0%. Medium-risk drinking defined as an AUDIT score ≥ 8 was reported in 40.3%, and high-risk drinkers/probable AUD (AUDIT score ≥ 16) was met by 17.0% of the cohort. CONCLUSIONS Our results demonstrate the importance of comprehensive assessments for alcohol use, including self-report via multiple assessment tools administered by trained staff, as well as the addition of biomarkers for improved classification of subjects into different drinking categories.
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Affiliation(s)
- Tekeda F Ferguson
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Katherine P Theall
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Meghan Brashear
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Vincent Maffei
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Microbiology, Immunology, & Parasitology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans,, Louisiana
| | - Alaina Beauchamp
- Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Robert W Siggins
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Liz Simon
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Donald Mercante
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Steve Nelson
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Pulmonology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - David A Welsh
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Pulmonology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Patricia E Molina
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Ladak F, Socias E, Nolan S, Dong H, Kerr T, Wood E, Montaner J, Milloy MJ. Substance use patterns and HIV-1 RNA viral load rebound among HIV-positive illicit drug users in a Canadian setting. Antivir Ther 2020; 24:19-25. [PMID: 30230474 DOI: 10.3851/imp3265] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Active illicit drug use can present a barrier to the medical management of HIV infection by complicating adherence to antiretroviral therapy (ART). Plasma HIV-1 RNA viral load (VL) rebound, defined as a period of detectable HIV VL following ART and VL suppression, can lead to the generation of viral resistance and potential treatment failure. We sought to investigate the contribution of substance use patterns on rates of VL rebound. METHODS We used data from the ACCESS study, a long-running community-recruited prospective cohort of HIV-positive people who use illicit drugs in Vancouver, Canada, a setting of universal no-cost HIV treatment. We analysed time to VL rebound (that is, two consecutive observations ≥1,000 copies/ml) after ART initiation and sustained viral suppression (that is, two consecutive observations <50 copies/ml) using extended Cox regression models with a recurrent events framework. RESULTS Between May 1996 and November 2013, 564 ART-exposed participants achieved at least one instance of VL suppression and contributed 1,893.8 person-years of observation. Over follow-up, 198 (35.1%) participants experienced ≥ one instance of VL rebound. In adjusted analyses, VL rebound was associated with younger age (adjusted hazard ratio [AHR] =0.97, 95% CI: 0.95, 0.98), heroin injection (≥ daily versus < daily, AHR =1.52, 95% CI: 1.01, 2.30), crack use (≥ daily versus < daily, AHR = 1.73, 95% CI: 1.08, 1.92) and heavy alcohol use (≥ four versus < four drinks/day, AHR =1.97, 95% CI: 1.17, 3.31). CONCLUSIONS The present study suggests that in addition to heavy alcohol use, high-intensity illicit drug use, particularly ≥ daily heroin injection and ≥ daily crack smoking are risk factors for VL rebound. In addition to the impact of high-intensity drug use on health-care engagement and ART adherence, some evidence exists on the direct impact of psychoactive substances on ART metabolism and the natural progression of HIV disease. At-risk individuals should be provided additional supports to preserve virological control and maintain the benefits of ART.
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Affiliation(s)
- Farah Ladak
- Department of General Surgery, University of Alberta, Edmonton, AB, Canada
| | - Eugenia Socias
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Evan Wood
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julio Montaner
- British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M-J Milloy
- Department of General Surgery, University of Alberta, Edmonton, AB, Canada.,British Columbia Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada
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Fuster D. Cocaine Use: A Threat for the HIV-Infected Liver. J Womens Health (Larchmt) 2020; 29:1141-1142. [PMID: 32027220 DOI: 10.1089/jwh.2019.8284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Daniel Fuster
- Addiction Unit, Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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41
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So-Armah K, Freiberg M, Cheng D, Lim JK, Gnatienko N, Patts G, Doyle M, Fuster D, Lioznov D, Krupitsky E, Samet J. Liver fibrosis and accelerated immune dysfunction (immunosenescence) among HIV-infected Russians with heavy alcohol consumption - an observational cross-sectional study. BMC Gastroenterol 2019; 20:1. [PMID: 31892306 PMCID: PMC6938606 DOI: 10.1186/s12876-019-1136-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 12/05/2019] [Indexed: 12/23/2022] Open
Abstract
Background The multifactorial mechanisms driving negative health outcomes among risky drinkers with HIV may include immunosenescence. Immunosenescence, aging of the immune system, may be accentuated in HIV and leads to poor outcomes. The liver regulates innate immunity and adaptive immune tolerance. HIV-infected people have high prevalence of liver-related comorbidities. We hypothesize that advanced liver fibrosis/cirrhosis is associated with alterations in T-cell subsets consistent with immunosenescence. Methods ART-naïve people with HIV with a recent history of heavy drinking were recruited into a clinical trial of zinc supplementation. Flow cytometry was used to characterize T-cell subsets. The two primary dependent variables were CD8+ and CD4+ T-cells expressing CD28-CD57+ (senescent cell phenotype). Secondary dependent variables were CD8+ and CD4+ T-cells expressing CD45RO + CD45RA- (memory phenotype), CD45RO-CD45RA+ (naïve phenotype), and the naïve phenotype to memory phenotype T-cell ratio (lower ratios associated with immunosenescence). Advanced liver fibrosis/cirrhosis was defined as FIB-4 > 3.25, APRI≥1.5, or Fibroscan measurement ≥10.5 kPa. Analyses were conducted using multiple linear regression adjusted for potential confounders. Results Mean age was 34 years; 25% female; 88% hepatitis C. Those with advanced liver fibrosis/cirrhosis (N = 25) had higher HIV-1 RNA and more hepatitis C. Advanced liver fibrosis/cirrhosis was not significantly associated with primary or secondary outcomes in adjusted analyses. Conclusions Advanced liver fibrosis/cirrhosis was not significantly associated with these senescent T-cell phenotypes in this exploratory study of recent drinkers with HIV. Future studies should assess whether liver fibrosis among those with HIV viral suppression and more advanced, longstanding liver disease is associated with changes in these and other potentially senescent T-cell subsets.
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Affiliation(s)
- Kaku So-Armah
- Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Building, 2nd Floor, Boston, MA, 02118, USA.
| | - Matthew Freiberg
- Department of Medicine, Vanderbilt University School of Medicine; Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.
| | - Debbie Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Joseph K Lim
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Gregory Patts
- Department of Biostatistics and Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Margaret Doyle
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, USA
| | - Daniel Fuster
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Dmitry Lioznov
- Department of Infectious Diseases and Epidemiology, Smorodintsev Research Institute of Influenza, First Pavlov State Medical University, St. Petersburg, Russia
| | - Evgeny Krupitsky
- First Pavlov State Medical University, V. M. Bekhterev National Research Medical Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Jeffrey Samet
- Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Kuteesa MO, Seeley J, Weiss HA, Cook S, Kamali A, Webb EL. Alcohol Misuse and Illicit Drug Use Among Occupational Groups at High Risk of HIV in Sub-Saharan Africa: A Systematic Review. AIDS Behav 2019; 23:3199-3225. [PMID: 30945031 DOI: 10.1007/s10461-019-02483-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Key occupational groups in sub-Saharan Africa (SSA) are at increased risk of HIV, and may be at increased risk of substance use. In January 2018, we systematically searched for studies reporting prevalence of, and risk factors for alcohol misuse or illicit drug use and their association with HIV incidence or prevalence among fisherfolk, uniformed personnel, truckers, miners, motorcycle taxi riders and sex workers in SSA. Seventy-one studies published between 1983 and 2017 were included: 35 reported on alcohol misuse (19 using AUDIT, 5 using CAGE) and 44 on illicit drug use (eight reported both). Median prevalence of alcohol misuse based on AUDIT/CAGE was 32.8% (IQR 20.8-48.5%). Prevalence of illicit drug use ranged from 0.1% (95% CI: 0.0-0.2%) for injection drug use to 97.1% (95% CI: 85.1-99.9%) for khat (among uniformed personnel). Among papers examining associations between substance use and HIV incidence (n = 3) or prevalence (n = 14), nine papers (53%) reported a significant positive association (2 with incidence, 7 with prevalence). Harm reduction interventions in occupational settings are urgently required to prevent new HIV infections.
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Affiliation(s)
- Monica O Kuteesa
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Cook
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Anatoli Kamali
- International AIDS Vaccine Initiative (IAVI), Nairobi, Kenya
| | - Emily L Webb
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
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Shanyinde M, Girardi E, Puoti M, De Luca A, Sighinolfi L, Caterina UF, Caramello P, Lampe FC, D'Arminio Monforte A, Cozzi-Lepri A. Is physician assessment of alcohol consumption useful in predicting risk of severe liver disease among people with HIV and HIV/HCV co-infection? BMC Public Health 2019; 19:1291. [PMID: 31615542 PMCID: PMC6794785 DOI: 10.1186/s12889-019-7608-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 09/10/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Alcohol consumption is a known risk factor for liver disease in HIV-infected populations. Therefore, knowledge of alcohol consumption behaviour and risk of disease progression associated with hazardous drinking are important in the overall management of HIV disease. We aimed at assessing the usefulness of routine data collected on alcohol consumption in predicting risk of severe liver disease (SLD) among people living with HIV (PLWHIV) with or without hepatitis C infection seen for routine clinical care in Italy. METHODS We included PLWHIV from two observational cohorts in Italy (ICONA and HepaICONA). Alcohol consumption was assessed by physician interview and categorized according to the National Institute for Food and Nutrition Italian guidelines into four categories: abstainer; moderate; hazardous and unknown. SLD was defined as presence of FIB4 > 3.25 or a clinical diagnosis of liver disease or liver-related death. Cox regression analysis was used to evaluate the association between level of alcohol consumption at baseline and risk of SLD. RESULTS Among 9542 included PLWHIV the distribution of alcohol consumption categories was: abstainers 3422 (36%), moderate drinkers 2279 (23%), hazardous drinkers 637 (7%) and unknown 3204 (34%). Compared to moderate drinkers, hazardous drinking was associated with higher risk of SLD (adjusted hazard ratio, aHR = 1.45; 95% CI: 1.03-2.03). After additionally controlling for mode of HIV transmission, HCV infection and smoking, the association was attenuated (aHR = 1.32; 95% CI: 0.94-1.85). There was no evidence that the association was stronger when restricting to the HIV/HCV co-infected population. CONCLUSIONS Using a brief physician interview, we found evidence for an association between hazardous alcohol consumption and subsequent risk of SLD among PLWHIV, but this was not independent of HIV mode of transmission, HCV-infection and smoking. More efforts should be made to improve quality and validity of data on alcohol consumption in cohorts of HIV/HCV-infected individuals.
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Affiliation(s)
- Milensu Shanyinde
- Institute of Global Health, University College London, Royal Free Hospital, London, UK.
| | - Enrico Girardi
- Lazzaro Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | | | | | - Laura Sighinolfi
- Division of Infectious Diseases, Hospital of Ferrara, Ferrara, Italy
| | | | - Pietro Caramello
- Infectious and Tropical Diseases Unit I, Department of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy
| | - Fiona C Lampe
- Institute of Global Health, University College London, Royal Free Hospital, London, UK
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Sorsdahl K, Morojele NK, Parry CD, Kekwaletswe CT, Kitleli N, Malan M, Shuper PA, Myers B. 'What will it take': addressing alcohol use among people living with HIV in South Africa. Int J STD AIDS 2019; 30:1049-1054. [PMID: 31451075 DOI: 10.1177/0956462419862899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Given that hazardous and harmful alcohol use has been identified as a significant barrier to adherence to antiretroviral therapy (ART) in South Africa, alcohol reduction interventions delivered within HIV treatment services are being investigated. Prior to designing and implementing an alcohol-focused screening and brief intervention (SBI), we explored patients’ perceptions of alcohol as a barrier to HIV treatment, the acceptability of providing SBIs for alcohol use within the context of HIV services and identifying potential barriers to patient uptake of this SBI. Four focus groups were conducted with 23 participants recruited from three HIV treatment sites in Tshwane, South Africa. Specific themes that emerged included: (1) barriers to ART adherence, (2) available services to address problematic alcohol use and (3) barriers and facilitators to delivering a brief intervention to address alcohol use within HIV care. Although all participants in the present study unanimously agreed that there was a great need for SBIs to address alcohol use among people living with HIV and AIDS, our study identified several areas that should be considered prior to implementing such a programme.
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Affiliation(s)
- K Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - N K Morojele
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa.,School of Public Health, University of the Witwatersrand, Witwatersrand, South Africa
| | - C D Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa.,Department of Psychiatry, Stellenbosch University, Tygerberg, South Africa
| | - C T Kekwaletswe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - N Kitleli
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - M Malan
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - P A Shuper
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - B Myers
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa.,Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
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Cook RL, Zhou Z, Miguez MJ, Quiros C, Espinoza L, Lewis JE, Brumback B, Bryant K. Reduction in Drinking was Associated With Improved Clinical Outcomes in Women With HIV Infection and Unhealthy Alcohol Use: Results From a Randomized Clinical Trial of Oral Naltrexone Versus Placebo. Alcohol Clin Exp Res 2019; 43:1790-1800. [PMID: 31373701 PMCID: PMC6684328 DOI: 10.1111/acer.14130] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/09/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Alcohol consumption is associated with poor health outcomes in women living with HIV (WLWH), but whether medication can help to reduce drinking in non-treatment-seeking women or whether reduction in drinking improves HIV outcomes is unclear. We conducted a randomized clinical trial (RCT) of daily oral naltrexone (50 mg) versus placebo in WLWH who met criteria for current unhealthy alcohol use. METHODS WLWH with current unhealthy alcohol use (>7 drinks/wk or >3 drinks/occasion) were randomly assigned to daily oral naltrexone 50 mg (n = 96) or placebo (n = 98) for 4 months. Drinking outcomes, including the proportion of women who reduced ( RESULTS The participants' mean age was 48 years, 86% were African American, and 94% were receiving HIV antiretroviral therapy. Among all participants, 89% and 85% completed the 4-month and 7-month follow-ups, respectively. Participants in both groups substantially reduced drinking over time. At 1 and 3 months, naltrexone was associated with a greater reduction in drinking (p < 0.05), but the proportion who reduced/quit drinking at 4 months (52% vs. 45%, p = 0.36) or 7 months (64% in both groups) was not different. HIV viral suppression at follow-up was significantly better in participants who reduced/quit drinking versus those continuing unhealthy alcohol use at 4 months (72% vs. 53%, p = 0.02) and 7 months (74% vs. 54%, p = 0.02). CONCLUSIONS Participating in an RCT to reduce drinking was associated with significant drinking reduction regardless of medication assignment, suggesting that nonmedication aspects of research study participation (e.g., repeated assessments and support from research staff) could be important interventions to help reduce drinking outside of research studies. Drinking reduction was associated with improved HIV viral suppression, providing evidence to support recommendations to avoid unhealthy alcohol use among WLWH.
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Affiliation(s)
- Robert L. Cook
- Department of Epidemiology, (RLC, ZZ), University of Florida, Gainesville
| | - Zhi Zhou
- Department of Epidemiology, (RLC, ZZ), University of Florida, Gainesville
| | - Maria Jose Miguez
- Florida, School of Integrated Science and Humanity, (MJM, CQ), Florida International University, Miami, Florida
| | - Clery Quiros
- Florida, School of Integrated Science and Humanity, (MJM, CQ), Florida International University, Miami, Florida
| | - Luis Espinoza
- Public Health & Medical Affairs, (LE), Gilead Sciences Inc., Miami, Florida
| | - John E. Lewis
- Psychiatry & Behavioral Sciences, (JEL), University of Miami School of Medicine, Miami, Florida
| | - Babette Brumback
- Biostatistics, (BB), University of Florida, Gainesville, Florida
| | - Kendall Bryant
- Alcohol and HIV/AIDS Research, (KB), National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
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Lipira L, Williams EC, Huh D, Kemp CG, Nevin PE, Greene P, Unger JM, Heagerty P, French AL, Cohn SE, Turan JM, Mugavero MJ, Simoni JM, Andrasik MP, Rao D. HIV-Related Stigma and Viral Suppression Among African-American Women: Exploring the Mediating Roles of Depression and ART Nonadherence. AIDS Behav 2019; 23:2025-2036. [PMID: 30343422 PMCID: PMC6815932 DOI: 10.1007/s10461-018-2301-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
We used baseline data from a sample of African-American women living with HIV who were recruited to participate in a stigma-reduction intervention in Chicago and Birmingham (2013-2015) to (1) evaluate the relationship between HIV-related stigma and viral suppression, and (2) assess the role of depression and nonadherence to antiretroviral therapy (ART) as mediators. Data from women were included in this secondary analysis if they were on ART, had viral load data collected within 8-weeks of study entry and had complete covariate data. We used logistic regression to estimate the total effect of HIV-related stigma (14-item Stigma Scale for Chronic Illness) on viral suppression (< 200 copies/mL), and serial mediation analysis to estimate indirect effects mediated by depressive symptoms (8-item Patient Health Questionnaire) and ART nonadherence (number of days with missed doses). Among 100 women who met study inclusion criteria, 95% reported some level of HIV-related stigma. In adjusted models, higher levels of HIV-related stigma were associated with lower odds of being virally suppressed (AOR = 0.93, 95% CI = 0.89-0.98). In mediation analysis, indirect effects through depression and ART nonadherence were not significant. Findings suggest that HIV-related stigma is common among African-American women living with HIV, and those who experience higher levels of stigma are less likely to be virally suppressed. However, the mechanisms remain unclear.
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Affiliation(s)
- Lauren Lipira
- Department of Health Services, University of Washington, Seattle, WA, USA.
- Department of Health Services, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA, 98195-7660, USA.
| | - Emily C Williams
- Department of Health Services, University of Washington, Seattle, WA, USA
- VA Puget Sound Health Care System, Seattle, WA, USA
| | - David Huh
- School of Social Work, University of Washington, Seattle, WA, USA
| | | | - Paul E Nevin
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Joseph M Unger
- Department of Health Services, University of Washington, Seattle, WA, USA
- Fred Hutch, Seattle, WA, USA
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Audrey L French
- Stroger Hospital of Cook County and Ruth M. Rothstein CORE Center, Chicago, IL, USA
| | - Susan E Cohn
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Michele P Andrasik
- Department of Global Health, University of Washington, Seattle, WA, USA
- Fred Hutch, Seattle, WA, USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA, USA
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Addressing unhealthy alcohol use among people living with HIV: recent advances and research directions. Curr Opin Infect Dis 2019; 31:1-7. [PMID: 29176446 DOI: 10.1097/qco.0000000000000422] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Unhealthy alcohol use is prevalent among people living with HIV (PLWH). We sought to identify the most current literature examining the impact of unhealthy alcohol on health outcomes and latest developments on how to best intervene. RECENT FINDINGS New research shows that PLWH have heightened morbidity and mortality at lower levels of alcohol consumption compared with HIV-uninfected persons. Studies published since 2016 have further elucidated the effects of persistent unhealthy alcohol use on HIV treatment outcomes over time. Screening and brief interventions, as well as pharmacologic treatment, can reduce unhealthy alcohol use among PLWH. SUMMARY Unhealthy alcohol use is an important and modifiable risk factor for poor health and HIV treatment outcomes among PLWH. More research is needed to encourage and maintain engagement in alcohol-related interventions and improve implementation.
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Chichetto NE, Mannes ZL, Allen MK, Cook RL, Ennis N. HIV care provider perceptions and approaches to managing unhealthy alcohol use in primary HIV care settings: a qualitative study. Addict Sci Clin Pract 2019; 14:21. [PMID: 31174601 PMCID: PMC6555986 DOI: 10.1186/s13722-019-0150-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 05/11/2019] [Indexed: 01/02/2023] Open
Abstract
Background HIV care providers often serve as the specialist and the primary care point-of-contact for persons living with HIV (PLWH) and unhealthy alcohol use. The purpose of the present qualitative study was to understand HIV care provider perceptions and approaches to managing unhealthy alcohol use in HIV primary care settings. Methods Using a semi-structured interview guide, in-depth interviews were conducted among 14 HIV care providers (5 medical doctors, 5 nurse practitioners/physician assistants, 2 medical assistants, 2 clinical administrative staff) in private and public HIV clinics, across urban and rural areas of Florida. Interviews were coded using a grounded theory approach with inter-rater consensus. Results Six themes were identified. In summary, providers reported (1) inconsistent assessment of alcohol consumption, as well as (2) varying levels of confidence in self-report of alcohol use which may be affected by patient provider rapport and trust. While providers (3) acknowledge potential negative impacts of alcohol use on health outcomes and HIV treatment, providers reported (4) inconsistent recommendations regarding alcohol use among their patients. Lastly, providers reported (5) limited resources for patients with unhealthy alcohol use and (6) low confidence in their ability to help patients reduce use. Conclusions Results from our study suggest salient differences in provider approaches to the assessment and management of unhealthy alcohol use in HIV primary care settings. Implementation of care for unhealthy alcohol use in these settings may be facilitated through use of clinically useful, validated alcohol use assessments and use of evidence-based recommendations of alcohol use/non-use among PLWH. Training in brief intervention techniques for alcohol reduction may increase provider confidence and support in the management of unhealthy alcohol use among PLWH.
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Affiliation(s)
- Natalie E Chichetto
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, Nashville, TN, 37203, USA.
| | - Zachary L Mannes
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Megan K Allen
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, USA
| | - Robert L Cook
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, USA
| | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Center for Translational Behavioral Science, Tallahassee, FL, USA
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Bensley KM, Fortney J, Chan G, Dombrowski JC, Ornelas I, Rubinsky AD, Lapham GT, Glass JE, Williams EC. Differences in Receipt of Alcohol-Related Care Across Rurality Among VA Patients Living With HIV With Unhealthy Alcohol Use. J Rural Health 2019; 35:341-353. [PMID: 30703856 PMCID: PMC6639081 DOI: 10.1111/jrh.12345] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE It is unknown whether receipt of evidence-based alcohol-related care varies by rurality among people living with HIV (PLWH) with unhealthy alcohol use-a population for whom such care is particularly important. METHODS All positive screens for unhealthy alcohol use (AUDIT-C ≥ 5) among PLWH were identified using Veterans Health Administration electronic health record data (10/1/09-5/30/13). Three domains of alcohol-related care were assessed: brief intervention (BI) within 14 days, and specialty addictions treatment or alcohol use disorder (AUD) medications (filled prescription for naltrexone, disulfiram, acamprosate, or topiramate) within 1 year of positive screen. Adjusted Poisson models and recycled predictions were used to estimate predicted prevalence of outcomes across rurality (urban, large rural, small rural), clustered on facility. Secondary analyses assessed outcomes in the subsample with documented AUD. FINDINGS 4,581 positive screens representing 3,458 PLWH (3,112 urban, 130 large rural, and 216 small rural) were included; 49.1% had diagnosed AUD. PLWH in large rural areas had highest receipt of BI (urban 56.6%, 95% CI: 55.0-58.2; large rural 66.0%, CI: 58.6-73.5; small rural 60.7%, CI: 54.6-67.0). PLWH in urban areas had highest receipt of specialty addictions treatment (urban 28.2%, CI: 26.7-29.8; large rural 19.7%, CI: 13.1-26.2; small rural 19.6%, CI: 14.1-25.0). There was no difference in receipt of AUD medications, although overall receipt was low (3%-4%). Results were similar in the subsample with AUD. CONCLUSION Among PLWH with unhealthy alcohol use, those in rural areas may be vulnerable to under-receipt of specialty addictions treatment. Targeted interventions may help ensure PLWH receive recommended care regardless of rurality.
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Affiliation(s)
- Kara M Bensley
- VA Health Services Research & Development, Denver Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - John Fortney
- VA Health Services Research & Development, Denver Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Gary Chan
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington
- Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington
| | - Julia C Dombrowski
- Department of Medicine and Allergy & Infectious Diseases, University of Washington School of Medicine, Seattle, Washington
| | - India Ornelas
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Anna D Rubinsky
- Kidney Health Research Collaborative, University of California San Francisco, and VA San Francisco Healthcare System, San Francisco, California
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Emily C Williams
- VA Health Services Research & Development, Denver Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington
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Seth A, Sherman KE. Fatty liver disease in persons with HIV infection. TOPICS IN ANTIVIRAL MEDICINE 2019; 27:75-82. [PMID: 31136997 PMCID: PMC6550355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Abstract
The leading cause of non-HIV-related mortality is liver disease. Fatty liver disease can be characterized as alcoholic or nonalcoholic in nature. Alcohol use is prevalent among individuals with HIV infection and can lead to medication nonadherence, lower CD4+ cell count, inadequate viral suppression, and disease progression. The pathogenesis of nonalcoholic fatty liver disease (NAFLD) in individuals with HIV infection includes metabolic syndrome, hyperuricemia, HIV-related lipodystrophy, genetic polymorphisms, medications, HIV itself, and the gut microbiome. The prevalence of NAFLD in persons with HIV infection ranges from 30% to 65% depending on the modality of diagnosis. Individuals with HIV infection and NAFLD are at higher risk of cardiovascular disease; however, there is a dearth of longitudinal outcomes studies on this topic. Current therapies for NAFLD, such as vitamin E and pioglitazone, have not been studied in persons with HIV infection. There are several drugs in phase II and III clinical trials that specifically target NAFLD in HIV, including CC chemokine receptor 5 inhibitors, growth hormone-releasing factor agonists, and stearoyl-CoA desaturase inhibitors. Persons with HIV should be screened for NAFLD while pursuing aggressive risk factor modification and lifestyle changes, given the increased risk of cardiovascular mortality.
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Affiliation(s)
| | - Kenneth E. Sherman
- Send correspondence to Kenneth E. Sherman, 231 Albert B Sabin Way, ML 0595, Cincinnati, OH 45267, or to
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