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Fu R, Jinnah H, Mckay JL, Miller AH, Felger JC, Farber EW, Sharma S, Whicker N, Moore RC, Franklin D, Letendre SL, Anderson AM. Cerebrospinal fluid levels of 5-HIAA and dopamine in people with HIV and depression. J Neurovirol 2023; 29:440-448. [PMID: 37289360 PMCID: PMC10766341 DOI: 10.1007/s13365-023-01142-2] [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: 02/13/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 06/09/2023]
Abstract
Depression is a common illness in people with HIV (PWH) and is associated with substantial morbidity and mortality. The mechanisms that underpin depression in PWH remain incompletely elucidated, and more research is therefore needed to develop effective treatments. One hypothesis is that neurotransmitter levels may be altered. These levels could be influenced by the chronic inflammation and viral persistence that occurs in PWH. We examined a panel of cerebrospinal fluid (CSF) neurotransmitters in PWH on suppressive antiretroviral therapy (ART), many of whom had a current depression diagnosis. CSF monoamine neurotransmitters and their metabolites were measured from participants in studies at the Emory Center for AIDS Research (CFAR). Only participants on stable ART with suppressed HIV RNA from both plasma and CSF were analyzed. Neurotransmitter levels were measured with high-performance liquid chromatography (HPLC). Neurotransmitters and their metabolites included dopamine (DA), homovanillic acid (HVA, a major metabolite of dopamine), serotonin (5-HT), 5-hydroxyindole-3-acetic acid (5-HIAA, a major metabolite of serotonin), and 4-hydroxy-3-methoxyphenylglycol (MHPG, a major metabolite of norepinephrine). Multivariable logistic regression was used to evaluate factors associated with depression. There were 79 PWH with plasma and CSF HIV RNA levels < 200 copies/mL at the time of the visit, and 25 (31.6%) carried a current diagnosis of depression. Participants with depression were significantly older (median age 53 years versus 47 years, P = 0.014) and were significantly less likely to be African American (48.0% versus 77.8%, P = 0.008). Participants with depression had significantly lower dopamine levels (median 0.49 ng/mL versus 0.62 ng/mL, P = 0.03) and significantly lower 5-HIAA levels (median 12.57 ng/mL versus 15.41 ng/mL, P = 0.015). Dopamine and 5-HIAA were highly correlated. In the multivariable logistic regression models, lower 5-HIAA was significantly associated with the depression diagnosis when accounting for other significant demographic factors. The associations between lower 5-HIAA, lower dopamine, and depression in PWH suggest that altered neurotransmission may contribute to these comorbid conditions. However, the effects of antidepressants on neurotransmitters cannot be ruled out as a factor in the 5-HIAA results.
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Affiliation(s)
- Rong Fu
- Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, USA
| | - Hyder Jinnah
- Department of Neurology, Human Genetics and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - J Lucas Mckay
- Department of Biomedical Informatics, Emory University, Atlanta, GA, USA
| | - Andrew H Miller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer C Felger
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Eugene W Farber
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sanjay Sharma
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Neil Whicker
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California at San Diego School of Medicine, La Jolla, San Diego, CA, USA
| | - Donald Franklin
- Department of Psychiatry, University of California at San Diego School of Medicine, La Jolla, San Diego, CA, USA
| | - Scott L Letendre
- Department of Medicine, University of California at San Diego School of Medicine, La Jolla, San Diego, CA, USA
| | - Albert M Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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Spies G, Konkiewitz EC, Seedat S. Incidence and Persistence of Depression Among Women Living with and Without HIV in South Africa: A Longitudinal Study. AIDS Behav 2018; 22:3155-3165. [PMID: 29476437 DOI: 10.1007/s10461-018-2072-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Depression and trauma are common among women living with HIV. This is the first study to track the longitudinal course of depression and examine the relationship between depression and trauma over time among women in South Africa. HIV-infected and uninfected women (N = 148) were assessed at baseline and one year later. Results of a path analysis show the multi-directional and entwined influence of early life stress, other life-threatening traumas across the lifespan, depression and PTSD over the course of HIV. We also observed higher rates of depressive symptomatology and more persistent cases among infected women compared to uninfected women, as well as a more consistent and enduring relationship between childhood trauma and depression among women living with HIV. The present study is unique in documenting the course of untreated depression and PTSD in women with and without HIV infection with a high prevalence of early childhood trauma.
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Affiliation(s)
- Georgina Spies
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
| | - Elisabete Castelon Konkiewitz
- Faculdade de Ciências Médicas e da Saúde, Universidade Federal da Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Soraya Seedat
- South African Research Chairs Initiative (SARChI), PTSD Program, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Huang YLA, Frazier EL, Sansom SL, Farnham PG, Shrestha RK, Hutchinson AB, Fagan JL, Viall AH, Skarbinski J. Nearly Half Of US Adults Living With HIV Received Federal Disability Benefits In 2009. Health Aff (Millwood) 2017; 34:1657-65. [PMID: 26438741 DOI: 10.1377/hlthaff.2015.0249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The effects of HIV infection on national labor-force participation have not been rigorously evaluated. Using data from the Medical Monitoring Project and the National Health Interview Survey, we present nationally representative estimates of the receipt of disability benefits by adults living with HIV receiving care compared with the general US adult population. We found that in 2009, adults living with HIV were nine times more likely than adults in the general population to receive disability benefits. The risk of being on disability is also greater for younger and more educated adults living with HIV compared to the general population, which suggests that productivity losses can result from HIV infection. To prevent disability, early diagnosis and treatment of HIV are essential. This study offers a baseline against which to measure the impacts of recently proposed or enacted changes to Medicaid and private insurance markets, including the Affordable Care Act and proposed revisions to the Social Security Administration's HIV Infection Listings.
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Affiliation(s)
- Ya-Lin A Huang
- Ya-Lin A. Huang is a health services researcher in the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia
| | - Emma L Frazier
- Emma L. Frazier is an epidemiologist in the Division of HIV/AIDS Prevention, CDC
| | - Stephanie L Sansom
- Stephanie L. Sansom is a health services researcher in the Division of HIV/AIDS Prevention, CDC
| | - Paul G Farnham
- Paul G. Farnham is an economist in the Division of HIV/AIDS Prevention, CDC
| | - Ram K Shrestha
- Ram K. Shrestha is an economist in the Division of HIV/AIDS Prevention, CDC
| | - Angela B Hutchinson
- Angela B. Hutchinson is an economist in the Division of HIV/AIDS Prevention, CDC
| | - Jennifer L Fagan
- Jennifer L. Fagan is a behavioral scientist in the Division of HIV/AIDS Prevention, CDC
| | - Abigail H Viall
- Abigail H. Viall is a public health analyst in the Division of HIV/AIDS Prevention, CDC
| | - Jacek Skarbinski
- Jacek Skarbinski is a medical officer in the Division of HIV/AIDS Prevention, CDC
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Hergenrather KC, Zeglin RJ, Conyers L, Misrok M, Rhodes SD. Persons Living With HIV/AIDS: Employment as a Social Determinant of Health. REHABILITATION RESEARCH POLICY AND EDUCATION 2016. [DOI: 10.1891/2168-6653.30.1.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: For persons living with HIV/AIDS (PLWHA), the advent of highly active antiretroviral therapy has increased their longevity and quality of life. As HIV progresses, many PLWHA present declined domains of functioning that impede their ability to work. The authors explore employment as a social determinant of health to identify issues impacting employment outcomes for PLWHA.Methods: The authors reviewed the literature addressing HIV across the domains of mental health functioning, neurocognitive functioning, and physical function and employment.Results: When providing employment services to PLWHA, considerations for rehabilitation practitioners and educators include HIV/AIDS education, functional assessment, social support, considerations for women with HIV, highly active antiretroviral therapy (HAART), HIV/AIDS stigma, and employment resources for PLWHA.Conclusion: With more than 1.2 million PLWHA in the United States, and most of new infections among persons 25–44 years of age, the prevalence of PLWHA seeking employment and inclusive of the U.S. workforce will continue to increase. Proving employment services for PLWHA is a complex process that is best served by an integrative service approach.
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Nomoto SH, Longhi RMP, de Barros BP, Croda J, Ziff EB, Castelon Konkiewitz E. Socioeconomic disadvantage increasing risk for depression among recently diagnosed HIV patients in an urban area in Brazil: cross-sectional study. AIDS Care 2015; 27:979-85. [PMID: 25741909 DOI: 10.1080/09540121.2015.1017442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Depression is the most common psychiatric co-morbidity among people living with HIV (PLHIV), with prevalence rates ranging from 25% to 36%. Depression impacts negatively upon adherence and response to combined antiretroviral therapy (CART) and the transmission of HIV infection through increased sexually risky behavior. This cross-sectional study presents data from a reference HIV-outpatient service in Dourados (Brazil) that evaluated the association between depressive symptoms, health-related quality of life, and clinical, socioeconomic, and demographic factors in newly diagnosed HIV/AIDS patients. Using the Beck Depression Inventory (BDI), the prevalence of depressive symptoms was 61% with a predominance of self-deprecating and cognitive-affective factors. Depressive symptoms were associated with lower income (p=0.019) and disadvantaged social class (p=0.005). Poorer quality of life was related to depressive symptoms (p<0.0001), low educational level (p=0.05), and lower income (p=0.03). These data suggest that socioeconomic factors, including level of income and education, are mediating the risk of depression and poor quality of life of PLHIV. Possible explanations for this effect are discussed, including the possible role of stigma.
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Affiliation(s)
- Silmara Harumi Nomoto
- a Department of Medicine , University Hospital, Federal University of Grande , Dourados , Brazil
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Ribeiro C, Sarmento E Castro R, Dinis-Ribeiro M, Fernandes L. Effectiveness of Psycho-Educational Intervention in HIV Patients' Treatment. Front Psychiatry 2014; 5:198. [PMID: 25642197 PMCID: PMC4295437 DOI: 10.3389/fpsyt.2014.00198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 12/26/2014] [Indexed: 11/16/2022] Open
Abstract
Adherence to Highly Active Antiretroviral Therapy (HAART) is the main prognostic factor associated with HIV disease progression and death. The aim was to evaluate the effectiveness of a psycho-educational program to promote adherence to HAART in HIV patients. A longitudinal study (n = 102) over 9 months in an Infectious Diseases Hospital was carried out. Adherence to HAART was measured with standardized scales and values of viral load. Two groups were defined: adherents and non-adherents. In the latter, a psycho-educational program was implemented and 6 months later measured adherence to HAART. Knowledge about the infection, CD4 T lymphocytes and HIV-ribonucleic acid values were measured before and after this program. The sample was predominantly male (70%), heterosexual (78%), with a mean age of 49 (SD = 12.7) years, and 48% of participants were not adhering to HAART. After the program, non-adherence decreased to 21.6%. Knowledge about the infection increased from 79 to 97%. A significant increase in CD4 T lymphocytes (mean 540-580) and a decrease in viral load (mean 5411-3052) were observed, the latter of statistical significance. This program seems to be feasible and efficient, improving adherence to HAART.
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Affiliation(s)
- Clarisse Ribeiro
- Hospital Joaquim Urbano (Centro Hospitalar do Porto, EPE) , Porto , Portugal
| | | | - Mário Dinis-Ribeiro
- Biostatistics and Medical Informatics Service and Centre for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto , Porto , Portugal
| | - Lia Fernandes
- Research and Education Unit on Ageing (UNIFAI) and Centre for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto , Porto , Portugal
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Animal models for depression associated with HIV-1 infection. J Neuroimmune Pharmacol 2013; 9:195-208. [PMID: 24338381 DOI: 10.1007/s11481-013-9518-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/02/2013] [Indexed: 01/12/2023]
Abstract
Antiretroviral therapy has greatly extended the lifespan of people living with human immunodeficiency virus (PLHIV). As a result, the long-term effects of HIV infection, in particular those originating in the central nervous system (CNS), such as HIV associated depression, have gained importance. Animal models for HIV infection have proved very useful for understanding the disease and developing treatment strategies. However, HIV associated depression remains poorly understood and so far there is neither a fully satisfactory animal model, nor a pathophysiologically guided treatment for this condition. Here we review the neuroimmunological, neuroendocrine, neurotoxic and neurodegenerative basis for HIV depression and discuss strategies for employing HIV animal models, in particular humanized mice which are susceptible to HIV infection, for the study of HIV depression.
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Althoff AL, Zelenev A, Meyer JP, Fu J, Brown SE, Vagenas P, Avery AK, Cruzado-Quiñones J, Spaulding AC, Altice FL. Correlates of retention in HIV care after release from jail: results from a multi-site study. AIDS Behav 2013; 17 Suppl 2:S156-70. [PMID: 23161210 PMCID: PMC3714328 DOI: 10.1007/s10461-012-0372-1] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Retention in care is key to effective HIV treatment, but half of PLWHA in the US are continuously engaged in care. Incarcerated individuals are an especially challenging population to retain, and empiric data specific to jail detainees is lacking. We prospectively evaluated correlates of retention in care for 867 HIV-infected jail detainees enrolled in a 10-site demonstration project. Sustained retention in care was defined as having a clinic visit during each quarter in the 6 month post-release period. The following were independently associated with retention: being male (AOR = 2.10, p ≤ 0.01), heroin use (AOR 1.49, p = 0.04), having an HIV provider (AOR 1.67, p = 0.02), and receipt of services: discharge planning (AOR 1.50, p = 0.02) and disease management session (AOR 2.25, p ≤ 0.01) during incarceration; needs assessment (AOR 1.59, p = 0.02), HIV education (AOR 2.03, p ≤ 0.01), and transportation assistance (AOR 1.54, p = 0.02) after release. Provision of education and case management services improve retention in HIV care after release from jail.
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Affiliation(s)
- Amy L Althoff
- AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA,
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Kako PM, Stevens PE, Karani AK. Where will this illness take me? Reactions to HIV diagnosis from women living with HIV in Kenya. Health Care Women Int 2011; 32:278-99. [PMID: 21409662 DOI: 10.1080/07399332.2010.530727] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The purpose of our study was to develop an in-depth understanding of the reactions of 40 urban and rural HIV-infected Kenyan women to HIV diagnosis. We employed narrative inquiry principles to guide this qualitative cross-sectional study. We conducted individual in-depth interviews using open-ended questions in April and May 2006. In this article we focus on women's reactions to HIV diagnosis, under which four subthemes emerged: immediate intense emotions; keeping HIV status secret; acceptance of HIV diagnosis; and finding liberation in disclosure. We offer important implications for health care professionals serving women in sub-Saharan Africa from the findings of our study.
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Affiliation(s)
- Peninnah M Kako
- College of Nursing, University of Wisconsin-Milwaukee, 53201, USA.
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Etienne M, Hossain M, Redfield R, Stafford K, Amoroso A. Indicators of Adherence to Antiretroviral Therapy Treatment Among HIV/AIDS Patients in 5 African Countries. ACTA ACUST UNITED AC 2010; 9:98-103. [DOI: 10.1177/1545109710361383] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As the HIV epidemic threatens the social fabric of countries struggling with HIV prevalence rates as high as 10% to 30%, access to antiretroviral therapy (ART) alone is only the beginning of the clinical challenge. There is a need to identify adherence indicators that will ensure long-term treatment success. A cross-sectional review of 921 adult patients on ART for at least 1 year was conducted. Through an administered adherence survey, key indicators were found to be highly correlated with patient adherence. The adherence rate in this sample was 72% after being on treatment for an average of 15 months. This data suggest that having a high perceived quality of care and owning one’s own home positively affected patients’ adherence. Indicators such as alcohol use in the last month and a high level of depression negatively affected patients’ adherence. Targeting specific indicators for specific interventions will guard against nonadherence, leading to treatment failure.
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Affiliation(s)
- Martine Etienne
- Institute of Human Virology of the University of Maryland School of Medicine, Baltimore, MD, USA,
| | - Mian Hossain
- Morgan State University School of Community Health and Policy, Baltimore, MD, USA
| | - Robert Redfield
- Institute of Human Virology of the University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristen Stafford
- Institute of Human Virology of the University of Maryland School of Medicine, Baltimore, MD, USA
| | - Anthony Amoroso
- Institute of Human Virology of the University of Maryland School of Medicine, Baltimore, MD, USA
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Nakimuli-Mpungu E, Mutamba B, Nshemerirwe S, Kiwuwa M, Musisi S. Effect of HIV infection on time to recovery from an acute manic episode. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2010; 2:185-9. [PMID: 22096397 PMCID: PMC3218699 DOI: 10.2147/hiv.s9978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Understanding factors affecting the time to recovery from acute mania is critical in the management of manic syndromes. The aim of this study was to determine the effect of HIV infection on time to recovery from acute mania. METHODS We performed a retrospective study in which medical charts of individuals who were treated for acute mania were reviewed. Survival analysis with Cox regression models were used to compare time to recovery from an acute manic episode between human immunodeficiency virus (HIV)-positive individuals and HIV-negative individuals. RESULTS Median survival time was one week for HIV-positive individuals and more than four weeks for HIV-negative individuals (χ(2) = 18.4, P value = 0.000). HIV infection was the only marginally significant independent predictor of survival probability on the acute admission ward (hazards ratio 2.87, P = 0.06). CONCLUSION Acute mania in HIV-infected persons responds faster to psychotropic drugs compared with that in HIV-negative persons.
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Affiliation(s)
- E Nakimuli-Mpungu
- Mental Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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