1
|
Paudel M, Prajapati G, Buysman EK, Goswami S, McNiff K, Kumar P, Tadese BK. Comorbidity and polypharmacy among people with HIV stratified by age, sex, and race. HIV Res Clin Pract 2024; 25:2361176. [PMID: 38869017 DOI: 10.1080/25787489.2024.2361176] [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: 03/20/2024] [Accepted: 05/24/2024] [Indexed: 06/14/2024]
Abstract
Background: With an increase in life expectancy of people with HIV, there is a corresponding rise in comorbidities and consequent increases in comedications. Objective: This study compared comorbidity and polypharmacy among people with HIV and people without HIV stratified by age, sex, and race. Methods: This retrospective study utilised administrative claims data to identify adult people with HIV with antiretroviral therapy (ART) claims and HIV diagnosis codes from 01 January 2018 to 31 December 2018. Index date was the earliest ART claim or HIV diagnosis in the absence of ART claims. Inclusion required continuous enrolment for ≥12-month pre-index and ≥30-day post-index, along with ≥1 HIV diagnosis during baseline or follow-up. People with HIV were matched 1:2 with people without HIV on sociodemographic. Results were compared using z-tests with robust standard errors in an ordinary least squares regression or Rao-Scott tests. Results: Study sample comprised 20,256 people with HIV and 40,512 people without HIV. Mean age was 52.3 years, 80.0% males, 45.9% Caucasian, and 28.5% African American. Comorbidities were significantly higher in younger age people with HIV than people without HIV. Female had higher comorbidity across all comorbidities especially younger age people with HIV. Polypharmacy was also significantly greater for people with HIV versus people without HIV across all age categories, and higher in females. Across races, multimorbidity and polypharmacy were significantly greater for people with HIV versus people without HIV. Conclusions: Comorbidities and polypharmacy may increase the risk for adverse drug-drug interactions and individualised HIV management for people with HIV across all demographics is warranted.
Collapse
Affiliation(s)
| | | | | | | | | | - Princy Kumar
- Georgetown University Medical Center, Washington, DC, USA
| | | |
Collapse
|
2
|
Rohr JK, Manne-Goehler J, Gómez-Olivé FX, Kahn K, Bärnighausen TW. The HIV Care Cascade for Older Adults in Rural South Africa: A Longitudinal Cohort Study (2014-2019). J Acquir Immune Defic Syndr 2024; 96:334-340. [PMID: 38916427 PMCID: PMC11207190 DOI: 10.1097/qai.0000000000003445] [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: 12/08/2023] [Accepted: 04/11/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND As people with HIV grow older, stable engagement in care is essential for healthy aging. We evaluate the HIV care cascade for older adults in rural South Africa at 2 time points cross-sectionally and assess movement in the cascade over time. SETTING We evaluated the cascade stage at waves 1 (2014-2015) and 2 (2018-2019) of Health and Aging in Africa: A Longitudinal Study of an INDPETH Community in South Africa, a population-based longitudinal cohort study in Mpumalanga Province, South Africa. METHODS Biomarker screening defined cascade stages [HIV+/no antiretroviral therapy (ART); ART+/unsuppressed viral load; ART+/suppressed viral load]. Between-wave probability of death, cascade progression, regression, cascade transitions, and sociodemographic predictors were assessed with Poisson regression. The impact of death was considered using the Fine and Gray competing risk model. RESULTS We observed a higher prevalence of antiretroviral therapy with viral suppression over time (50% in wave 1 vs. 70% in wave 2). Among those alive, the oldest age group (70+ years old) was most likely to have cascade progression [adjusted risk ratio for treatment initiation vs. 40-49 years old: 1.38 (95% confidence interval: 1.02 to 1.86)]. However, there was a significant risk of death and cascade regression. Death between waves reached 40% for 70+-year-olds who were ART+/unsuppressed. In competing risk models, older age was associated with equivalent or less cascade progression. CONCLUSION Older age groups who were unsuppressed on treatment and men had poorer cascade outcomes. Improvements observed in HIV treatment coverage over time for older adults must be interpreted in the context of the high risk of death for older HIV-positive adults, especially among those failing treatment.
Collapse
Affiliation(s)
- Julia K. Rohr
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, USA
- MRC/Wits Rural Public Health and Heath Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Heath Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Heath Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Till W. Bärnighausen
- MRC/Wits Rural Public Health and Heath Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
3
|
Linfield RY, Nguyen NN, Laprade OH, Holodniy M, Chary A. An update on drug-drug interactions in older adults living with human immunodeficiency virus (HIV). Expert Rev Clin Pharmacol 2024; 17:589-614. [PMID: 38753455 PMCID: PMC11233252 DOI: 10.1080/17512433.2024.2350968] [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: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION People with HIV are living longer due to advances in antiretroviral therapy. With improved life expectancy comes an increased lifetime risk of comorbid conditions - such as cardiovascular disease and cancer - and polypharmacy. Older adults, particularly those living with HIV, are more vulnerable to drug interactions and adverse effects, resulting in negative health outcomes. AREA COVERED Antiretrovirals are involved in many potential drug interactions with medications used to treat common comorbidities and geriatric conditions in an aging population of people with HIV. We review the mechanisms and management of significant drug-drug interactions involving antiretroviral medications and non-antiretroviral medications commonly used among older people living with HIV. The management of these interactions may require dose adjustments, medication switches to alternatives, enhanced monitoring, and considerations of patient- and disease-specific factors. EXPERT OPINION Clinicians managing comorbid conditions among older people with HIV must be particularly vigilant to side effect profiles, drug-drug interactions, pill burden, and cost when optimizing treatment. To support healthier aging among people living with HIV, there is a growing need for antiretroviral stewardship, multidisciplinary care models, and advances that promote insight into the correlations between an individual, their conditions, and their medications.
Collapse
Affiliation(s)
| | - Nancy N. Nguyen
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Olivia H. Laprade
- Department of Pharmacy, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA, USA
| | - Mark Holodniy
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
| | - Aarthi Chary
- Stanford University School of Medicine, Stanford, CA, USA
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- National Public Health Program Office, Veterans Health Administration, Palo Alto, CA, USA
| |
Collapse
|
4
|
Cantudo-Cuenca MD, Gutiérrez-Pizarraya A, García-Lloret P, Gabella-Bazarot E, Morillo-Verdugo R. Prevalence of compliance with PIMDINAC criteria among elderly people living with HIV and in non-infected outpatients with other chronic diseases. Eur J Hosp Pharm 2024; 31:339-343. [PMID: 36585218 PMCID: PMC11265553 DOI: 10.1136/ejhpharm-2022-003454] [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: 06/30/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND There is a high prevalence of multimorbidity and polypharmacy among older people, especially in people living with HIV (PLWH) with an increased life expectancy due to effective antiretroviral therapy (ART). Consequently, there is a higher risk of potentially inappropriate medications (PIM), potential drug-drug interactions (DI), and problems of non-adherence to treatment (NAC) in older PLWH. PIMDINAC criteria (potentially inappropriate medications (PIM), drug-drug interactions (DI), and non-adherence to treatment (NAC)) purport to jointly analyse these problems. The purpose of the study was to compare the prevalence of PIMDINAC criteria among elderly PLWH and non-infected patients with chronic diseases, and to determine whether HIV infection constitutes a predictor of the presence of PIMDINAC criteria, totally or partially. METHODS A cross sectional study was conducted between February and June 2020. HIV positive patients aged ≥65 years were compared with a group of patients with chronic conditions attending the outpatient hospital pharmacy service. RESULTS The study involved 140 patients: 47 HIV positive and 93 HIV negative, and mean age was 69 versus 73 years, respectively (p=0.062). The prevalence of total PIMDINAC criteria was similar between the groups (12.5 vs 10.8%, p=0.505). In relation to inappropriate medication, no differences were observed between groups (48.9 vs 55.9%, p=0434). Drug-drug interactions were higher in patients with chronic conditions (52.7 vs 25.5%, p=0.002) compared with non-adherence, which was higher in people with HIV (22.6 vs 65.6%, p<0.001). No differences in polypharmacy (≥6 and 11 drugs) rates were observed. CONCLUSIONS PIMDINAC criteria were highly prevalent in older PLWH, similar to non-infected patients. HIV infection in older people was associated with a lower risk of drug-drug interactions. However, non-adherence was a risk factor compared with age matched controls. Deprescribing strategies, including a capability-motivation-opportunity pharmaceutical care model based intervention should be implemented in clinical routines.
Collapse
|
5
|
Contreras Macías E, Espina Lozano JM, Cantudo-Cuenca MD, Robustillo-Cortés MDLA, Gabella-Bazarot E, Morillo-Verdugo R. Comparative analysis of the prevalence 3-HIT concept in people living with HIV and seronegative patients with chronic conditions. Cross-3HIT Project. Eur J Hosp Pharm 2024:ejhpharm-2023-004023. [PMID: 38697803 DOI: 10.1136/ejhpharm-2023-004023] [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: 10/23/2023] [Accepted: 04/16/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES This study aimed to assess and compare the occurrence of 3-HIT in people living with HIV (PLWH) and seronegative patients. Additionally, the study investigated whether HIV infection could serve as a predictor of the presence of 3-HIT. METHODS A cross-sectional study was conducted between December 2022 and January 2023 to compare PLWH with a group of seronegative patients with chronic diseases attending an outpatient hospital pharmacy service. The 3-HIT concept encompasses the simultaneous presence of non-adherence to concomitant treatment (NAC), drug-drug interactions (DDIs), and high pharmacotherapeutic complexity in polymedicated patients. The assessment of 3-HIT compliance included NAC, evaluated using both the Morisky-Green questionnaire and electronic pharmacy dispensing records. DDIs were analysed using the Liverpool University and Micromedex databases. Pharmacotherapeutic complexity was measured using the Medication Regimen Complexity Index (MRCI) tool. Logistic regression analysis was performed to identify independent factors related to 3-HIT. Additionally, an explanatory logistic model was created to investigate whether HIV infection, along with other adjustment variables, could predict compliance with the 3-HIT concept. RESULTS The study included 145 patients: 75 PLWH and 70 seronegative patients. The median age was 40 versus 39 years, respectively (p=0.22). Seronegative patients exhibited a higher prevalence of NAC (p<0.01). HIV infection was identified as a protective factor in the context of DDIs (p<0.01). Male sex (p<0.01) and age (p=0.01) were identified as being associated with an MRCI ≥11.25 points. A higher prevalence of 3-HIT was observed in seronegative patients (18.7% vs 48.6%, p<0.01). However, the developed regression model identified HIV infection as a risk factor associated with an increased likelihood of 3-HIT (OR 4.00, 95% CI 1.88 to 8.52, p<0.01). CONCLUSIONS The 3-HIT concept exhibited a high prevalence among seronegative patients with chronic diseases, with HIV infection identified as a predicted risk factor for NAC and the development of 3-HIT.
Collapse
|
6
|
Rubtsova AA, Taylor TN, Wingood G, Ofotokun I, Gustafson D, Vance DE, Holstad M. "As I Grew Older, My Life Got Better": Conceptions of Successful Aging among Older Women Living with or at Risk of HIV. AIDS Behav 2024; 28:1581-1593. [PMID: 38231362 DOI: 10.1007/s10461-024-04270-w] [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: 01/07/2024] [Indexed: 01/18/2024]
Abstract
Successful aging (SA) is an important target for HIV care. However, we have insufficient understanding of how older women living with HIV (OWLH) in the US define SA. We explored conceptions of SA by OWLH and older women at risk of HIV and examined whether SA conceptions differed by (1) HIV serostatus, and (2) participation in the Women's Interagency HIV Study (WIHS). These analyses were part of a larger mixed-methods study with a sequential design. Participants were recruited at two clinical WIHS sites. We enrolled both WIHS participants and non-WIHS clinic patients. Our sample was 84% Black and included 29 OWLH and 15 older women at risk of HIV. We conducted 21 semi-structured interviews and four focus groups. The dataset was analyzed using descriptive, comparative, and relational analysis. We found four interlinked themes: life course perspective, accepting and celebrating aging, taking care of yourself, and looking good. The life course perspective was a core theme: participants assessed their aging in comparison to their earlier life hardships. These themes were similarly present among OWLH and older women at risk of HIV, although OWLH emphasized taking care of HIV. SA conceptualizations by OWLH did not differ whether or not they participated in the WIHS. Women living with or at risk of HIV may experience severe hardships throughout their lives. Overcoming these hardships may be linked to SA. Assessing the needs and connecting women to resources and programs are critical for SA promotion.
Collapse
Affiliation(s)
- Anna A Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Tonya N Taylor
- College of Medicine, Division of Infectious Diseases, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ighovwerha Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - David E Vance
- The University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Marcia Holstad
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| |
Collapse
|
7
|
Fernández-Fradejas J, Delgado-Silveira E, González-Burgos E, Álvarez-Díaz AM, Vélez-Díaz-Pallarés M. Potentially inappropriate prescriptions and potential prescription omissions in older people living with HIV. HIV Med 2024; 25:587-599. [PMID: 38258538 DOI: 10.1111/hiv.13616] [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: 11/10/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES This study aimed to determine the prevalence of potentially inappropriate prescriptions (PIPs) and potential prescription omissions (PPOs) in a Spanish cohort of people living with HIV (PLWH) aged ≥65 years and to identify risk factors for the presence of PIPs and PPOs. METHODS This retrospective cross-sectional study was conducted across 10 public hospitals in the Autonomous Community of Madrid, Spain. Clinical and demographic data were cross-checked against hospital and community pharmacy dispensation registries. PIPs and PPOs were assessed using the American Geriatrics Society (AGS)/Beers and Screening Tool of Older Persons' Prescriptions (STOPP)/Screening Tool to Alert Doctors to Right Treatment (START) criteria. Risk factors for PIPs and PPOs and agreement between AGS/Beers and STOPP/START criteria were statistically analysed. RESULTS This study included 313 PLWH (median age 72 years), of whom 80.5% were men. PIP prevalence rates were 29.4% and 44.4% based on the AGS/Beers and STOPP criteria, respectively. The concordance between AGS/Beers and STOPP criteria was moderate. Benzodiazepines and proton pump inhibitors were the chronic comedications most commonly involved in PIPs. PPOs were observed in 61.4% of the patients. The leading omissions were insufficient influenza and pneumococcal vaccine coverage and inadequate bone health-related treatments. The number of chronic comedications, female sex, neuropsychiatric disorders, and cancer diagnosis were risk factors for PIPs, whereas osteopenia and osteoporosis were risk factors for PPOs. CONCLUSIONS A high prevalence of PIPs and PPOs was observed in our cohort of older PLWH. These findings emphasize the importance of comprehensive medication reviews in this population to reduce inappropriate medication use and address their specific and underserved therapeutic needs.
Collapse
Affiliation(s)
- Jorge Fernández-Fradejas
- Pharmacy Department, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Eva Delgado-Silveira
- Pharmacy Department, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Elena González-Burgos
- Department of Pharmacology, Pharmacognosy and Botany, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Ana María Álvarez-Díaz
- Pharmacy Department, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Manuel Vélez-Díaz-Pallarés
- Pharmacy Department, University Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| |
Collapse
|
8
|
Byrd KK, Buchacz K, Crim SM, Beer L, Lu JF, Dasgupta S. Unmet Needs for HIV Ancillary Services Among Persons With Diagnosed HIV Aged 55 years and Older. J Acquir Immune Defic Syndr 2024; 95:318-328. [PMID: 38133575 PMCID: PMC10988603 DOI: 10.1097/qai.0000000000003365] [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: 07/14/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Approximately 2 in 5 persons with HIV (PWH) in the United States are aged 55 years or older. HIV ancillary services, such as case management and transportation services, can help older PWH remain engaged in care. We used data from the Medical Monitoring Project (MMP) to describe the prevalence of unmet needs for ancillary services among persons with diagnosed HIV aged 55 years or older. SETTING MMP is an annual cross-sectional study that reports representative estimates on adults with diagnosed HIV in the United States. METHODS We used MMP data collected during June 2019-May 2021 to calculate weighted percentages of cisgender men and cisgender women with HIV aged 55 years or older with unmet needs for ancillary services, overall and by selected characteristics (N = 3200). Unmet need was defined as needing but not receiving a given ancillary service. We assessed differences between groups using prevalence ratios (PRs) and 95% confidence intervals with predicted marginal means. RESULTS Overall, 37.7% of cisgender men and women with HIV aged 55 years or older had ≥1 unmet need for ancillary services. Overall, 16.6% had ≥1 unmet need for HIV support services, 26.9% for non-HIV medical services, and 26.7% for subsistence services. There were no statistically significant differences in unmet needs for services by gender. The prevalence of ≥1 unmet need was higher among non-White persons (PR range: 1.35-1.63), persons who experienced housing instability (PR = 1.70), and those without any private insurance (PR range: 1.49-1.83). CONCLUSION A large percentage of older PWH have unmet needs for ancillary services. Given the challenges that older PWH face related to the interaction of HIV and aging-associated factors, deficits in the provision of ancillary services should be addressed.
Collapse
Affiliation(s)
- Kathy K Byrd
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Kate Buchacz
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Stacy M Crim
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Linda Beer
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | - Sharoda Dasgupta
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA; and
| |
Collapse
|
9
|
Yang C, Teh YE, Chua NGS, Lee KLS, Ng RQM. An overview of multimorbidity and polypharmacy in older people living with HIV. Geriatr Gerontol Int 2024; 24 Suppl 1:49-59. [PMID: 37940135 DOI: 10.1111/ggi.14717] [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: 09/06/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
The availability of effective antiretroviral therapy (ART) has revolutionized the care of people living with HIV (PLHIV). As a result, PLHIV now have a life expectancy comparable with that of the general population. PLHIV are increasingly confronted with age-related comorbidities and geriatric syndromes, including frailty and polypharmacy, which occur at a higher prevalence and set in at an earlier age compared with their uninfected counterparts. The underlying pathophysiology for multimorbidity and polypharmacy are multifactorial, multidimensional and complex. Therefore, regular review and optimization of risk factors to maintain physical function, social and psychological health is of utmost importance. With an ever-growing population of older PLHIV, there is a pressing need to provide holistic care to address these emerging issues. Accelerated aging observed in PLHIV suggests that early involvement of a multidisciplinary team, including geriatricians, and implementation of integrated models of care can potentially improve the care of older PLHIV, who are at increased risk of frailty and complex multimorbidity. This article reviews the current global situation, discusses the challenges involved and suggests approaches to deliver comprehensive care for older PLHIV. Geriatr Gerontol Int 2024; 24: 49-59.
Collapse
Affiliation(s)
- Chen Yang
- Department of Geriatric Medicine, Singapore General Hospital, Outram Road, Singapore
| | - Yii Ean Teh
- Department of Infectious Disease, Singapore General Hospital, Outram Road, Singapore
| | | | | | - Rachel Qiao Ming Ng
- Department of Geriatric Medicine, Singapore General Hospital, Outram Road, Singapore
| |
Collapse
|
10
|
Wei L, Zhao Y, Gan X, Zhao D, Wu Y, Dou Z, Ma Y. The burden of anemia among Chinese HIV-infected patients following the initiation of antiretroviral therapy in the treat-all era: a nationwide cohort study. BMC Infect Dis 2023; 23:704. [PMID: 37858044 PMCID: PMC10588238 DOI: 10.1186/s12879-023-08675-1] [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: 06/26/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND To assess the prevalence of anemia before and after antiretroviral therapy (ART) initiation and to identify impact of anemia on mortality among HIV-infected patients in China during the Treat-All era. METHODS All HIV-infected patients who newly initiated ART between January 1, 2017 and December 31, 2020 were enrolled and followed up to December 31, 2021 in China. We analyzed the prevalence of anemia before and after ART initiation. Generalized estimating equations were fitted to determine factors associated with anemia after ART. Time-dependent cox proportional hazards models were performed to estimate the effect of anemia on death. RESULTS Of 436,658 patients at the baseline of ART initiation, the overall prevalence of anemia was 28.6%. During a median 2.65 (IQR: 1.80-3.51) years of follow-up after ART initiation, 376,325 (86.2%) patients had at least one Hb measurement (a total of 955,300 hemoglobin measurements). The annual prevalence of anemia after ART was 17.0%, 14.1%, 13.4%, 12.6% and 12.7%, respectively. Being anemic at the baseline of ART initiation (adjusted odds ratio, aOR = 6.80, 95% confidence interval (CI): 6.67-6.92) was the strongest factor associated with anemia after ART. Anemia status after ART showed a strong association with death after multivariable adjustment (mild anemia: adjusted hazard ratio (aHR) = 2.65, 95% CI: 2.55-2.76; moderate anemia: aHR = 4.60; 95% CI:4.40-4.81; severe anemia: aHR = 6.41; 95% CI:5.94-6.91). CONCLUSIONS In the era of ART universal access, pre-ART anemia was common among HIV-infected patients. Notably, a certain proportion of anemia still persisted after ART, and was significantly associated with death. We recommend strengthening the monitoring of patients at risk of anemia, especially in patients with baseline anemia or during the first year of ART, and timely treatment for correcting anemia.
Collapse
Affiliation(s)
- Lai Wei
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Yan Zhao
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China.
| | - Xiumin Gan
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Decai Zhao
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Yasong Wu
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Zhihui Dou
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| | - Ye Ma
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, China
| |
Collapse
|
11
|
Taramasso L, Andreoni M, Antinori A, Bandera A, Bonfanti P, Bonora S, Borderi M, Castagna A, Cattelan AM, Celesia BM, Cicalini S, Cingolani A, Cossarizza A, D'Arminio Monforte A, D'Ettorre G, Di Biagio A, Di Giambenedetto S, Di Perri G, Esposito V, Focà E, Gervasoni C, Gori A, Gianotti N, Guaraldi G, Gulminetti R, Lo Caputo S, Madeddu G, Maggi P, Marandola G, Marchetti GC, Mastroianni CM, Mussini C, Perno CF, Rizzardini G, Rusconi S, Santoro M, Sarmati L, Zazzi M, Maggiolo F. Pillars of long-term antiretroviral therapy success. Pharmacol Res 2023; 196:106898. [PMID: 37648103 DOI: 10.1016/j.phrs.2023.106898] [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] [Received: 05/20/2023] [Revised: 08/26/2023] [Accepted: 08/27/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Meeting the challenge of antiretroviral therapy (ART) whose efficacy can last a lifetime requires continuous updating of the virological, pharmacological, and quality of life outcomes to be pursued and a continuous review of literature data on the efficacy and tolerability of new drugs and therapeutic strategies. METHODS With the aim of identifying open questions and answers about the current controversies in modern ART, we adapted the Design Thinking methodology to the needs of the design phase of a scientific article, involving a team of experts in HIV care. RESULTS Five main pillars of treatment success were discussed: sustained virologic suppression over time; immunological recovery; pharmacological attributes; long-term tolerability and safety of ART; and people's satisfaction and quality of life. The definition of the outcomes to be achieved in each thematic area and the tools to achieve them were reviewed and discussed. CONCLUSIONS Long-term treatment success should be intended as a combination of HIV-RNA suppression, immune recovery, and high quality of life. To achieve this, the regimen should be well-tolerated, with high potency, genetic barrier, and forgiveness, and should be tailored by a person-centered perspective, based on individual needs, preferences, and therapeutic history.
Collapse
Affiliation(s)
- Lucia Taramasso
- IRCCS Ospedale Policlinico San Martino di Genova, Genova, Italy.
| | | | - Andrea Antinori
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani IRCCS, Roma, Italy
| | - Alessandra Bandera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Paolo Bonfanti
- Università degli Studi di Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori - Monza, Monza, Italy
| | - Stefano Bonora
- Ospedale Amedeo di Savoia, Università degli Studi di Torino, Torino, Italy
| | - Marco Borderi
- Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Stefania Cicalini
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani IRCCS, Roma, Italy
| | | | | | | | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases AOU Policlinico Umberto I Sapienza, Rome, Italy
| | - Antonio Di Biagio
- Department of Health Sciences, Clinic of Infectious Diseases, University of Genoa, Genoa, Italy
| | | | - Giovanni Di Perri
- Ospedale Amedeo di Savoia, Università degli Studi di Torino, Torino, Italy
| | - Vincenzo Esposito
- UOC di Malattie infettive e Medicina di Genere P.O. Cotugno-A.O. dei Colli, Napoli, Italy
| | - Emanuele Focà
- Università degli Studi di Brescia e ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Andrea Gori
- Università degli Studi di Milano, Milano, Italy; ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milano, Italy
| | | | - Giovanni Guaraldi
- Azienda Ospedaliero-Universitaria Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | | | | | - Giordano Madeddu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Paolo Maggi
- Università degli Studi della Campania Luigi Vanvitelli, AORN S. Anna e S. Sebastiano Caserta, Caserta, Italy
| | | | - Giulia Carla Marchetti
- Department of Health Sciences, Clinic of Infectious Diseases, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Cristina Mussini
- Azienda Ospedaliero-Universitaria Policlinico di Modena, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | | | | | - Stefano Rusconi
- Ospedale Civile di Legnano ASST Ovest Milanese - Università degli Studi di Milano, Legnano, Italy
| | - Maria Santoro
- Università degli Studi di Roma "Tor Vergata", Roma, Italy
| | | | | | | |
Collapse
|
12
|
Park J, Dean LS, Heckl J, Gangcuangco LM, Pedro TK, Tallquist MD, Seto TB, Shiramizu B, Chow DC, Shikuma CM. Low-density granulocytes display immature cells with enhanced NET formation in people living with HIV. Sci Rep 2023; 13:13282. [PMID: 37587169 PMCID: PMC10432506 DOI: 10.1038/s41598-023-40475-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023] Open
Abstract
While the protective role of neutrophil extracellular traps (NETs) in limiting human immunodeficiency virus (HIV) spread to susceptible cells has been documented, there is comparatively little insight into whether NET formation is harmful in people living with HIV (PLWH). To gain insight into neutrophil dysregulation and the pathological role of NETs in HIV, we examined expressions of NET-associated markers [cell-free DNA (cfDNA) and citrullinated histone H3 (CitH3)] in the plasmas from a cohort of the Hawaii Aging with HIV-cardiovascular and HIV-seronegative (HIV-) individuals. In a subset of participants, circulating low-density granulocyte (LDG) levels and their maturation and activation status were analyzed via flow cytometry. We demonstrated higher plasma levels of CitH3 in PLWH compared to HIV- individuals. LDGs from PLWH had heightened CD66b, but reduced CD16 expression. The percentages and counts of CD10+ LDGs were significantly decreased in PLWH. In addition, the CD16Lo LDG subsets were enriched in PLWH, compared to HIV- group, indicating that immature LDGs are increased in PLWH. Moreover, LDGs from PLWH exhibited significantly higher NET forming capacity. In summary, our study presents evidence that LDGs from PLWH on ART display an immature and altered phenotype with increased NET formation. Among PLWH, plasma NET levels as well as LDG parameters correlated with blood markers for inflammation and coagulation, suggesting that neutrophil activation and NETs may exert proinflammatory and coagulation effects. Our data provide insights into the pathologic role of LDGs at least in part mediated through NET formation in PLWH.
Collapse
Affiliation(s)
- Juwon Park
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA.
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA.
| | - Logan S Dean
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA
| | - Jack Heckl
- Department of Cell and Molecular Biology, John A. Burns School Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA
| | - Louie Mar Gangcuangco
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA
| | - Te-Kie Pedro
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA
| | - Michelle D Tallquist
- Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, 96813, USA
| | - Todd B Seto
- The Queen's Medical Center, Honolulu, HI, 96813, USA
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA
| | - Bruce Shiramizu
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA
| | - Dominic C Chow
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA
| | - Cecilia M Shikuma
- Hawaii Center for AIDS, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI, 96813, USA
| |
Collapse
|
13
|
Zeuli JD, Rivera CG, Wright JA, Kasten MJ, Mahmood M, Ragan AK, Rizza SA, Temesgen Z, Vergidis P, Wilson JW, Cummins NW. Pharmacogenomic panel testing provides insight and enhances medication management in people with HIV. AIDS 2023; 37:1525-1533. [PMID: 37199600 DOI: 10.1097/qad.0000000000003598] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Our study aimed to assess the impact of pharmacogenomic panel testing in people with HIV (PWH). DESIGN Prospective, observational intervention assessment. METHODS One hundred PWH were provided a comprehensive pharmacogenomic panel during routine care visits within the HIV specialty clinic of a large academic medical center. The panel determined the presence of specific genetic variants that could predict response or toxicity to commonly prescribed antiretroviral therapy (ART) and non-ART medications. An HIV specialty pharmacist reviewed the results with participants and the care team. The pharmacist (1) recommended clinically actionable interventions based on the participants' current drug therapy, (2) assessed for genetic explanations for prior medication failures, adverse effects, or intolerances, and (3) advised on potential future clinically actionable care interventions based on individual genetic phenotypes. RESULTS Ninety-six participants (median age 53 years, 74% white, 84% men, 89% viral load <50 copies/ml) completed panel testing, yielding 682 clinically relevant pharmacogenomic results (133 major, 549 mild-moderate). Ninety participants (89 on ART) completed follow-up visits with 65 (72%) receiving clinical recommendations based on current medication profiles. Of the 105 clinical recommendations, 70% advised additional monitoring for efficacy or toxicity, and 10% advised alteration of drug therapy. Panel results offered explanation for prior ART inefficacy in one participant and ART intolerance in 29%. Genetic explanation for non-ART toxicity was seen in 21% of participants, with genetic contributors to inefficacy of non-ART therapy identified in 39% of participants. CONCLUSION Preliminary data in a small cohort of PWH demonstrates benefit of routine pharmacogenomic panel testing.
Collapse
Affiliation(s)
- John D Zeuli
- Department of Pharmacy
- Section of Infectious Diseases
| | | | - Jessica A Wright
- Department of Pharmacy
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Kokorelias KM, Grosse A, Zhabokritsky A, Sirisegaram L. Understanding geriatric models of care for older adults living with HIV: a scoping review and qualitative analysis. BMC Geriatr 2023; 23:417. [PMID: 37422631 PMCID: PMC10329351 DOI: 10.1186/s12877-023-04114-7] [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: 01/18/2023] [Accepted: 06/16/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Advances in Human Immunodeficiency Virus (HIV) treatment have reduced mortality rates and consequently increased the number of individuals with HIV living into older age. Despite this, people aged 50 years and older have been left behind in recent HIV treatment and prevention campaigns, and a gold-standard model of care for this population has not yet been defined. Developing evidence-based geriatric HIV models of care can support an accessible, equitable, and sustainable HIV health care system that ensures older adults have access to care that meets their needs now and in the future. METHODS Guided by Arksey & O'Malley (2005)'s methodological framework, a scoping review was conducted to determine the key components of, identify gaps in the literature about, and provide recommendations for future research into geriatric models of care for individuals with HIV. Five databases and the grey literature were systematically searched. The titles, abstracts and full texts of the search results were screened independently in duplicate. Data were analyzed using a qualitative case study and key component analysis approach to identify necessary model components. RESULTS 5702 studies underwent title and abstract screening, with 154 entering full-text review. 13 peer-reviewed and 0 grey literature sources were included. Most articles were from North America. We identified three primary model of care components that may improve the successful delivery of geriatric care to people living with HIV: Collaboration and Integration; Organization of Geriatric Care; and Support for Holistic Care. Most articles included some aspects of all three components. CONCLUSION To provide effective geriatric care to older persons living with HIV, health services and systems are encouraged to use an evidence-based framework and should consider incorporating the distinct model of care characteristics that we have identified in the literature. However, there is limited data about models in developing countries and long-term care settings, and limited knowledge of the role of family, friends and peers in supporting the geriatric care of individuals living with HIV. Future evaluative research is encouraged to determine the impact of optimal components of geriatric models of care on patient outcomes.
Collapse
Affiliation(s)
- Kristina Marie Kokorelias
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, ON, M5G 1X5, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 160 - 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Anna Grosse
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, ON, M5G 1X5, Canada
- Division of Geriatric Medicine, Department of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
| | - Alice Zhabokritsky
- Department of Medicine, Medical Sciences Building, The University of Toronto, King's College Cir, Toronto, ON, M5S 1A8, Canada
- Infectious Diseases, Department of Medicine, University Health Network, 610 University Ave, Toronto, Toronto, ON, M5G 2M9, Canada
- CIHR Canadian HIV Trails Network, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Luxey Sirisegaram
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Suite 475 - 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
- Division of Geriatric Medicine, Department of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada.
| |
Collapse
|
15
|
Massawe AT, Shayo GA, Mugusi SF. Polypharmacy and health related quality of life among older adults on antiretroviral therapy in a tertiary hospital in Tanzania: a hospital-based cross-sectional study. BMC Infect Dis 2023; 23:179. [PMID: 36973690 PMCID: PMC10041806 DOI: 10.1186/s12879-023-08150-x] [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: 12/17/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) chronicity in the midst of old age multiplies the risk for chronic non communicable diseases. The old are predisposed to drug-drug interactions, overlapping toxicities and impairment of the quality of life (QoL) due to age-related physiological changes. We investigated polypharmacy, QoL and associated factors among older HIV-infected adults at Muhimbili National hospitals in Dar es Salaam Tanzania. METHODS A hospital-based cross sectional study enrolled adults aged 50 years or older who were on antiretroviral therapy (ART) for ≥ 6 months. Participants' Information including the number and type of medications used in the previous one week were recorded. Polypharmacy was defined as concurrent use of five or more non-HIV medications. A World Health Organization QoL questionnaire for people living with HIV on ART (WHOQoL HIV BREF) was used to assess QoL. A score of ≤ 50 meant poor QoLwhile > 50 meant good QoL. Polypharmacy and QoL are presented as proportions and compared using Chi-square test. Association between various factors and polypharmacy or QoL was assessed using modified Poisson regression. A p-value of < 0.05 was considered significant. RESULTS A total of 285 patients were enrolled. The mean (SD) age was 57(± 6.88) years. Females were the majority (62.5%), and 42.5% were married. Polypharmacy was seen in 52 (18.2%) of participants. Presence of co-morbidities was independently associated with polypharmacy (p < 0.001). The mean(SD) score QoL for the study participants was 67.37 ± 11.Poor QoL was seen in 40 (14%) participants.All domains' mean score were above 50, however social domain had a relatively lowmean scoreof 68 (± 10.10). Having no formal or primary education was independently associated with poor QoL (p = 0.021). CONCLUSION The prevalence of polypharmacy was modestly high and was linked to the presence of co-morbidities. No formal and/or primary education was associated with poor QoL, where by social domain of QoL was the most affected.
Collapse
Affiliation(s)
- Antimon Tibursi Massawe
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar Es Salaam, Tanzania.
| | - Grace Ambrose Shayo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar Es Salaam, Tanzania
| | - Sabina Ferdinand Mugusi
- Department of Clinical Pharmacology, Muhimbili University of Health and Allied Sciences, P.O.BOX 65001, Dar Es Salaam, Tanzania
| |
Collapse
|
16
|
Enogela EM, Jones R, Buford TW, Vance DE, Fazeli PL. Cardiometabolic Diseases and Quality-of-Life Outcomes in Adults With HIV in the Deep South: A Cross-sectional Study. J Assoc Nurses AIDS Care 2023; 34:171-181. [PMID: 36576513 DOI: 10.1097/jnc.0000000000000387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/27/2022] [Indexed: 12/29/2022]
Abstract
ABSTRACT The role of cardiometabolic diseases (CMDs) on physical health-related quality of life (P-HRQoL) and quality of sleep was examined among 261 PLWH ≥40 years, recruited from a university-affiliated HIV clinic in the Deep U.S. South. Using a cross-sectional study design, participants completed the Medical Outcomes Study HIV Health Survey (MOS-HIV; P-HRQoL) and Pittsburgh Sleep Quality Index. The overall prevalence of self-reporting ≥1 CMD was 64.4%. P-HRQoL scores were lower in PLWH with ≥1 CMD compared with those with no CMDs (45.53 ± 11.54 vs. 49.67 ± 10.77, p <.01). Poor sleep quality was higher among participants with ≥1 CMD compared with those with no CMDs (9.28 ± 4.42 vs. 7.26 ± 4.17, p <.01). Each additional CMD resulted in a 1.83-point decrease in P-HRQoL and 0.74-point increase in poor sleep quality scores. Interventions that focus on targeting these quality-of-life domains in PLWH with CMDs are needed.
Collapse
Affiliation(s)
- Ene M Enogela
- Ene M. Enogela, MPH, is an Epidemiology PhD Student, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. Raymond Jones, PhD, is an Assistant Professor, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA. Thomas W. Buford, PhD, is a Professor, Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA, and is also affiliated with the Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA. David E. Vance, PhD, is a Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA. Pariya L. Fazeli, PhD, is an Associate Professor, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | | | | |
Collapse
|
17
|
Perello R, Losada A, Chen Qin J, Supervia A, Salgado E, Smithson A, Xipell M, Inciarte A, Vallecillo G. Amphetamine-related intoxications in people living with HIV: An observational study in an emergency department in Barcelona (Spain) from 2018 to 2020. HIV Med 2023; 24:260-266. [PMID: 35945158 DOI: 10.1111/hiv.13365] [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: 06/10/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stimulant drugs, particularly amphetamines, are more commonly implicated in drug-related deaths in people living with HIV; however, the clinical characteristics of amphetamine-related intoxication in people living with HIV are poorly described. MATERIAL AND METHODS We conducted a retrospective study in people living with HIV who were admitted for amphetamine-related intoxication to an emergency department of a teaching hospital between 2018 and 2021. Severe intoxication (SI) was arbitrarily defined as requiring admission to the emergency medical support unit and receiving medical treatment for ≥6 h. RESULTS In total, 170 male patients with a median age of 36.2 + 7.5 years were included in the study. A total of 77 (45.3%) individuals had mental disorders, and 120 (85.7%) had HIV-1 RNA suppression, with a median CD4 cell count of 696 (interquartile range 490-905). In total, 61 (37.9%) individuals were on ritonavir/cobicistat-based regimens. Presenting clinical syndromes included agitation in 60 (35.3%) subjects, anxiety in 37 (21.7%), psychosis in 27 (15.8%), chest pain in 26 (15.3%) and altered level of consciousness in 20 (11.7%). SI was observed in 48 (28.2%) individuals, 12 (7.1%) required admission to the intensive care unit, and two (1.2%) died. Altered level of consciousness (odds ratio [OR] 6.5; 95% confidence interval [CI] 2.2-18.9; p < 0.01), psychosis (OR 5.8; 95% CI 2.2-15.1; p < 0.01) and suicide attempt (OR 4.6; 95% CI 1.8-11.6; p 0.01) were associated with SI in the adjusted analysis. CONCLUSIONS Amphetamine-related intoxication causes high morbidity in people living with HIV. Healthcare providers serving these patients should consider incorporating harm-reduction measures in the prevention of amphetamine-related intoxication.
Collapse
Affiliation(s)
| | | | | | | | | | - Alex Smithson
- Emergency Department, Fundació Esperit Sant, Barcelona, Spain
| | - Marc Xipell
- Emergency Department, Hospital Clínic, Barcelona, Spain
| | - Alexis Inciarte
- Infectious Diseases Department, Hospital Clínic, Barcelona, Spain
| | - Gabriel Vallecillo
- Drug addiction Unit, Hospital del Mar, Parc de Salut Mar Consortium, Barcelona, Spain
| |
Collapse
|
18
|
Jackson L, Lee Y, Batey DS. Structural violence within communities and its impact on the well-being of people with HIV (PWH). AIDS Care 2023; 35:265-270. [PMID: 35727148 DOI: 10.1080/09540121.2022.2088679] [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] [Indexed: 10/18/2022]
Abstract
Structural violence (SV) is the concept that there are often invisible and intangible structures in place, whether political, economic, legal, cultural, religious, or social, that can inhibit individuals from reaching their full potential. There is a need to better understand the influence of SV on the well-being of people with HIV (PWH) in the Deep South. To address this gap in the literature, we interpreted data using a Structural Violence framework. In this community-based participatory research, in-depth interviews (n = 40) were conducted with PWH who previously established HIV medical care. In our study, we found that SV can have a widespread impact in communities, negatively impacting access to key tangible and emotional resources. SV themes included community crime and instability, financial insecurity, and disparate access to numerous resources known to influence health. Structures exacerbating unequal access to resources appear engrained within communities and often went unrecognized by participants as disadvantageous to achieving optimal HIV health. Greater effort is necessary to elucidate the influence and role of violent structures on access to key resources for and by PWH. A clearer understanding of SV's influence on HIV health can inform changes addressing these structural barriers to HIV health.
Collapse
Affiliation(s)
| | - Yookyong Lee
- Department of Social Work, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - D Scott Batey
- Department of Social Work, University of Alabama at Birmingham (UAB), Birmingham, USA
| |
Collapse
|
19
|
Identifying Longitudinal CD4:CD8 Ratio Trajectories Indicative of Chronic Renal Disease Risk among People Living with HIV: An Application of Growth Mixture Models. Viruses 2023; 15:v15020385. [PMID: 36851599 PMCID: PMC9963117 DOI: 10.3390/v15020385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/21/2023] [Accepted: 01/26/2023] [Indexed: 02/03/2023] Open
Abstract
The incidence of chronic kidney disease (CKD) is increasing among people living with HIV (PLWH). Routine monitoring of indicators such as CD4:CD8 ratio might improve the early detection of CKD. Our objective was to identify clinically relevant CD4:CD8 ratio trajectories indicative of CKD risk. Participants were ≥ 18 years old, initiated antiretroviral therapy between 2000 and 2016, and were followed for ≥6 months until 31 March 2017 or last contact date. Outcome was incidence of CKD. Growth mixture models (GMMs) and decay models were used to compare CD4:CD8 ratio trajectories. Following GMM, 4547 (93.5%) participants were classified in Class 1 with 5.4% developing CKD, and 316 (6.5%) participants were classified in Class 2 with 20.9% developing CKD. The final model suggested that participants in Class 2 had 8.72 times the incidence rate of developing CKD than those in Class 1. Exponential decay models indicated a significant CD4:CD8 ratio decline among Class 2 participants who developed CKD. Among those who developed CKD in Class 2, starting at 5.5 years of follow-up, the slope of their ratio trajectory curve changed significantly, and the rate of decline increased dramatically. Routine monitored CD4:CD8 ratios can be an effective strategy to identify early CKD risk among PLWH.
Collapse
|
20
|
Chen CY, Donga P, Campbell AK, Taiwo B. Economic Burden of HIV in a Commercially Insured Population in the United States. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2023; 10:10-19. [PMID: 36721765 PMCID: PMC9865714 DOI: 10.36469/001c.56928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/28/2022] [Indexed: 06/18/2023]
Abstract
Background: With advances in antiretroviral therapy (ART), people with HIV infection are living longer. Pre-exposure prophylaxis (PrEP) to reduce HIV infection risk continues to be underutilized in high-risk individuals. Recent data on economic burden for patients with newly diagnosed HIV-1 or initiated with PrEP are limited. Objectives: To assess characteristics, healthcare resource utilization (HRU), and costs among adults and adolescents either with newly diagnosed HIV-1 or initiated with PrEP. Methods: This retrospective observational study utilized data from the IBM MarketScan® Commercial Claims and Encounters database. Adults with newly diagnosed HIV-1 or those initiated with PrEP were included (index date was the first HIV diagnosis or PrEP prescription, respectively, between January 1, 2016, and April 30, 2021). Corresponding cohorts of adolescents were considered exploratory. Descriptive analyses were conducted to assess baseline demographics and clinical characteristics, and all-cause and HIV-related HRU and costs per patient per month (PPPM) during follow-up. Results: Data from 18 154 adults and 220 adolescents with newly diagnosed HIV and 34 123 adults and 175 adolescents initiated with PrEP were included. Approximately 70% of adolescents and 9% of adults receiving PrEP were female. Baseline depression/anxiety was present in 16.1% and 24.6% of adults and 14.5% and 45.1% of adolescents in the HIV and PrEP cohorts, respectively. Substance abuse in the HIV and PrEP cohorts, respectively, was reported in 10.1% and 7.0% of adults, and 2.7% and 17.7% of adolescents. During follow-up, among adults with newly diagnosed HIV, mean (SD) total all-cause and HIV-related PPPM costs were $2657 ($5954) and $1497 ($4463), respectively; pharmacy costs represented 47% of all-cause costs and 67% of HIV-related costs, but only 37% of patients had an HIV-related prescription. All-cause costs PPPM for adults with PrEP were $1761 ($1938), with pharmacy costs accounting for 71%. Conclusions: Despite advances in ART, patients with newly diagnosed HIV and at-risk patients receiving PrEP continue to incur HRU costs. The chronic nature of HIV warrants further exploration of factors contributing to disease burden and opportunities to improve prevention strategies.
Collapse
Affiliation(s)
- Cindy Y Chen
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | - Prina Donga
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | | | - Babafemi Taiwo
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
21
|
Maggiolo F, Rizzardini G, Molina JM, Pulido F, De Wit S, Vandekerckhove L, Berenguer J, D'Antoni ML, Blair C, Chuck SK, Piontkowsky D, Martin H, Haubrich R, McNicholl IR, Gallant J. Bictegravir/emtricitabine/tenofovir alafenamide in older individuals with HIV: Results of a 96-week, phase 3b, open-label, switch trial in virologically suppressed people ≥65 years of age. HIV Med 2023; 24:27-36. [PMID: 35527425 PMCID: PMC10083930 DOI: 10.1111/hiv.13319] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/11/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is an effective treatment for HIV-1 infection; however, clinical trial data in older people living with HIV (PLWH) are lacking. The primary 24-week and secondary 48-week analyses of study GS-US-380-4449 (NCT03405935), which assessed the efficacy and safety of switching to B/F/TAF in older PLWH, have been published. Here we report the results of the final 96-week analyses from the study. METHODS In this 96-week, phase 3b, open-label, single-arm trial, virologically suppressed PLWH aged ≥65 years switched from elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide or a tenofovir disoproxil fumarate-based regimen to B/F/TAF. Viral suppression, resistance, immune response, safety, tolerability and adherence were evaluated through week 96. RESULTS Of 90 participants screened, 86 were enrolled and switched to B/F/TAF. No participants had HIV-1 RNA ≥50 copies/ml (by FDA Snapshot algorithm) at weeks 72 or 96; virologic suppression rates were 94.2% (81/86; 95% CI 87.0-98.1) and 74.4% (64/86; 95% CI 63.9-83.2), respectively. No treatment-emergent resistance was observed, and CD4 counts remained stable. There were no study drug-related serious adverse events. Three participants experienced drug-related treatment-emergent adverse events that led to premature drug discontinuation. There were no clinically relevant changes from baseline to week 96 in fasting lipid parameters, and the median change in body weight at week 96 was 0.0 kg (IQR -2.3, 2.0). Median self-reported adherence was 100% (IQR 100-100%). CONCLUSIONS Switching to B/F/TAF is an effective long-term option for virologically suppressed adults ≥65 years of age, with favourable safety and tolerability profiles in this population.
Collapse
Affiliation(s)
- Franco Maggiolo
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giuliano Rizzardini
- Division of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy.,School of Clinical Medicine, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Jean-Michel Molina
- Department of Infectious Diseases, Saint Louis Hospital, University Paris Diderot, Paris, France
| | - Federico Pulido
- Unidad VIH, Hospital Universitario 12 de Octubre, imas12, UCM, Madrid, Spain
| | - Stephane De Wit
- St Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Juan Berenguer
- Infectious Diseases, Hospital General Universitario Gregorio Marañón (IiSGM), Madrid, Spain
| | | | | | | | | | - Hal Martin
- Gilead Sciences, Foster City, California, USA
| | | | | | | |
Collapse
|
22
|
Frey E, Johnston CD, Siegler EL. Treatment Regimens and Care Models for Older Patients Living with HIV: Are We Doing Enough? HIV AIDS (Auckl) 2023; 15:191-208. [PMID: 37153650 PMCID: PMC10155713 DOI: 10.2147/hiv.s311613] [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: 03/10/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023] Open
Abstract
With improved access to antiretroviral therapy throughout the world, people are aging with HIV, and a large portion of the global population of people with HIV (PWH) is now age 50 or older. Older PWH experience more comorbidities, aging-related syndromes, mental health challenges, and difficulties accessing fundamental needs than the population of older adults without HIV. As a result, ensuring that older PWH are receiving comprehensive healthcare can often be overwhelming for both PWH and the providers. Although there is a growing literature addressing the needs of this population, gaps remain in care delivery and research. In this paper, we suggest seven key components to any healthcare program designed to address the needs of older people with HIV: management of HIV, comorbidity screening and treatment, primary care coordination and planning, attention to aging related-syndromes, optimization of functional status, support of behavioral health, and improved access to basic needs and services. We review many of the difficulties and controversies related to the implementation of these components, which include the absence of screening guidelines for this population and the challenges of care integration, and we suggest key next steps.
Collapse
Affiliation(s)
- Emily Frey
- Department of Medicine, Weill Cornell/New York Presbyterian Hospital, New York, NY, USA
- Correspondence: Emily Frey, Department of Medicine, Weill Cornell Medicine, 505 East 70th Street, New York, NY, 10021, USA, Tel +1 212 746 4749, Fax +1 212 746 4609, Email
| | - Carrie D Johnston
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Eugenia L Siegler
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
23
|
García-Lloret P, Borrego-Izquierdo Y, Manzano-García M, Cantillana-Suárez MG, Gutiérrez-Pizarraya A, Morillo-Verdugo R. Potentially inappropriate medications according to Marc, STOPP and PRISCUS criteria in a cohort of elderly HIV+ patients. The COMMPI project. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2023; 36:52-58. [PMID: 36415149 PMCID: PMC9910679 DOI: 10.37201/req/070.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective is to determine the prevalence of potentially inappropriate drugs according to the Marc, STOPP, and PRISCUS lists in elderly HIV patients. METHODS It was an observational, retrospective, and multicenter study. People living with HIV 65 years or older who underwent chronic concomitant treatment were included. Descriptive and multivariate analyzes were performed to study the association between polypharmacy and potentially inappropriate medication compliance. RESULTS A total of 55 patients were included, 81.8% men and a median age of 69 years (IQR: 67-73). The median number of comorbidities was 3 (IQR: 2-5) and the most frequent pattern of multimorbidity was cardiometabolic (62.9%). The predominant antiretroviral treatment was triple therapy (65.5%). Polypharmacy was present in 70.9% of the patients and 25.5% had major polypharmacy. The most frequent polypharmacy pattern was cardiovascular (69.2%). The percentage of potentially inappropriate medications according to the Marc, STOPP and PRISCUS lists was 65.5%, 30.9% and 14.5%, respectively (p<0.001). Adjusted for age and sex, polypharmacy was not independently associated with potentially inappropriate medication compliance in any of the lists. CONCLUSIONS Polypharmacy and potentially inappropriate medications have a high prevalence. There is great variability in the percentage according to the list applied. Age, sex, and presence of polypharmacy are not predisposing factors to the presence of potentially inappropriate medications.
Collapse
Affiliation(s)
| | - Yolanda Borrego-Izquierdo
- Pharmacy Department, Gerencia de Atención Primaria. Cantabria (Spain),Correspondence: Yolanda Borrego Izquierdo Pharmacy Department, Gerencia de Atención Primaria. Cantabria (Spain). E-mail:
| | | | | | | | | |
Collapse
|
24
|
Low incidence of advanced neurological burden but high incidence of age-related conditions that are dementia risk factors in aging people living with HIV: a data-linkage 10-year follow-up study. J Neurovirol 2022; 29:141-155. [PMID: 36508059 DOI: 10.1007/s13365-022-01104-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/15/2022] [Accepted: 10/27/2022] [Indexed: 12/14/2022]
Abstract
Abstract
Although increasing research is focusing on age-related comorbidities (ARC) among people living with HIV (PLHIV), no studies have concomitantly assessed non-HIV age-related neurological disorders (e.g., Alzheimer’s dementia). A total of 254 PLHIV and 69 HIV-negative controls completed baseline medical history and cognitive testing. ARC data were collected from medical records over the subsequent 9-10 years and included all types of strokes, all types of dementia, mild cognitive impairment, Parkinson's disease, motor neuron disease (grouped into a non-HIV age-related neurological category), cardiovascular disease, chronic kidney disease, chronic liver disease, chronic lung disease, non-AIDS cancers, osteoporosis, and diabetes. Kaplan–Meier curves assessed differences in the incident rates (per 1000 person year) of groups of ARC as defined above and combined ARC (i.e., development of any of the ARC) among younger (baseline age < 50) and older (baseline age ≥ 50) PLHIV and younger and older controls. Cox-proportional hazard models assessed the individual and interaction effects of HIV status and chronological age, in addition to a range of demographic and clinical variables including historical and baseline HIV brain involvement on the risk of developing combined ARC. Older PLHIV had a higher incidence of cardiovascular disease, osteoporosis, and combined ARC compared to other groups (p < 0.05). Incident rate of non-HIV age-related neurological disorders was 2.3 [0.93, 4.79] per 1000 person year. While this incident rate was higher in older PLHIV (5.37 [1.97, 11.92]) than older HIV-negative participants (3.58 [0.18-17.67]), this was not significant. In multivariate analyses, HIV status and chronological age, but not their interaction, and smoking were associated with higher risk of combined ARC (p < 0.05). In analyses focusing on PLHIV, older age and taking abacavir/efavirenz/atazanavir/darunavir containing antiretroviral treatments at the time of diagnosis were associated with greater ARC (p < 0.05). Non-HIV age-related neurological disorders are uncommon in older PLHIV, where the majority were < 70 years of age at the end of follow-up. However, the greater burden of ARC among older PLHIV, most of which are established dementia risk factors, warrants the establishment of commensurate prevention strategies and greater attention to neurocognitive screening.
Collapse
|
25
|
Levitt DE, Simon L, Lin HY, Siggins RW, Ferguson TF, Molina PE, Welsh DA. Alcohol use, physical activity, and muscle strength moderate the relationship between body composition and frailty risk among people living with HIV. Alcohol Clin Exp Res 2022; 46:2041-2053. [PMID: 36124866 PMCID: PMC10801810 DOI: 10.1111/acer.14941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/19/2022] [Accepted: 09/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Antiretroviral therapy has improved life expectancy among people living with HIV (PLWH). Despite increased longevity, PLWH are at increased risk of age-related comorbidities, including frailty. We examined the relationship between body composition and frailty among PLWH, and moderation of this relationship by substance use, physical activity (PA), and physical function. METHODS Participants (n = 341; 71% male, 48 ± 10 years, body mass index (BMI) = 27.3 ± 7.0 kg/m2 ) enrolled in the New Orleans Alcohol Use in HIV (NOAH) study underwent measures of body composition, muscle strength, and gait speed. Whole blood phosphatidylethanol (PEth) was measured, and substance use and PA were self-reported. Frailty risk measures included the 58-Item Deficit Index (DI58) and the Veterans Aging Cohort Study (VACS) Index 1.0, where higher scores indicate greater frailty risk. RESULTS Multivariable linear regression adjusted for age, sex, and race showed that higher fat-free mass index (FFMI), body fat (%), waist-to-hip ratio, and body mass index (BMI) ≥ 25.0 kg/m2 vs. < 25.0 kg/m2 were significantly (p < 0.05) associated with decreased frailty risk measured by the VACS Index, whereas adjusted analyses showed no association between body composition variables and the DI58 score. Recent alcohol use, muscle strength, and PA, but not lifetime alcohol use or gait speed, significantly moderated associations between body composition variables and frailty risk with medium-to-large effect sizes. Subgroup analyses revealed a negative relationship between DI58 and FFMI among people with PEth > 8 ng/ml and negative relationships of VACS Index with FFMI and WHR in people with lower muscle strength. Overweight or obese BMI categories were positively associated with DI58 in people with lower muscle strength or higher PA level but negatively associated in those with higher muscle strength. CONCLUSIONS Our findings indicate that body composition has significant modulatory effects on frailty risk in PLWH, where obesity increases the risk of frailty and greater muscle mass may be protective, even in individuals who use alcohol. These results highlight the importance of considering body composition, physical activity, and physical function in assessing frailty risk in PLWH, particularly among individuals who use alcohol. Moreover, they support the implementation of physical activity interventions to ameliorate the risk of frailty in aging PLWH.
Collapse
Affiliation(s)
- Danielle E. Levitt
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Liz Simon
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Hui-Yi Lin
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Robert W. Siggins
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Tekeda F. Ferguson
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Patricia E. Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - David A. Welsh
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Internal Medicine, Section of Pulmonary/Critical Care, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| |
Collapse
|
26
|
Drwiega EN, Badowski ME, Michienzi S. Antiretroviral drug-drug interactions: A comparison of online drug interaction databases. J Clin Pharm Ther 2022; 47:1720-1724. [PMID: 36059105 PMCID: PMC9826109 DOI: 10.1111/jcpt.13750] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 01/11/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Antiretrovirals have a high drug interaction potential, which can lead to increased toxicity and/or decreased efficacy. Multiple databases are available to assess drug-drug interactions. The aim of our study was to compare interaction identification for commonly used ARVs and concomitant medications between six different online drug-drug interaction databases. COMMENT This was a cross-sectional review using each of the following six databases: LexiComp®, Clinical Pharmacology®, Micromedex®, Epocrates®, University of Liverpool, and University of Toronto. Sixteen antiretroviral drugs and 100 of the DrugStats Database "Top 200 of 2019" list of medications were included. Each of the six databases identified a different number of actual or potential interactions. The number of interactions ranged from 211 to 283. WHAT IS NEW AND CONCLUSIONS A variety of databases exist with inconsistent identification of actual or potential drug-drug interactions amongst them. It may be beneficial to cross-reference multiple databases prior to making decisions regarding patient care.
Collapse
Affiliation(s)
- Emily N. Drwiega
- College of PharmacyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | | | - Sarah Michienzi
- College of PharmacyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| |
Collapse
|
27
|
Denyer R, Zemskova J, Benator DA. HIV treatment with dolutegravir and doravirine: rationale for selection and clinical outcomes in a highly treatment experienced population. Int J STD AIDS 2022; 33:1073-1077. [DOI: 10.1177/09564624221116533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dolutegravir and doravirine are individually safe and effective antiretroviral therapy (ART) components, but their combined use has not been studied in clinical trials and is not recommended in HIV treatment guidelines. We noted persons with HIV (PWH) receiving dolutegravir with doravirine at our Washington, DC, infectious disease clinic and undertook a service evaluation to understand why providers selected this ART, whether HIV virologic suppression was achieved and identify adverse effects of concomitant use. Case registry and prescriptions data identified 21 PWH receiving concomitant dolutegravir and doravirine with mean follow-up 576.1 days (range 413–751); frequent reasons for switching were multiple ART resistance (57.1%), proton pump inhibitor usage (28.6%) and renal failure (28.6%), with 52.4% switched from protease inhibitor or cobicistat-boosted regimens. Dolutegravir with doravirine alone was prescribed for 60%, and additional ART in 40%. During 12 months follow-up mean CD4 was 585.9 (baseline 570.7) with undetectable viral load in 77.8% (baseline 66.7%). No discontinuations for drug-related adverse events or virologic failure occurred. Dolutegravir with doravirine was well tolerated in small numbers of highly treatment experienced PWH at our clinic, achieving virologic suppression in most. Establishing the efficacy and safety of dolutegravir with doravirine for HIV treatment in randomized trials remains important.
Collapse
Affiliation(s)
- Rachel Denyer
- Infectious Diseases Section, DC Veterans Affairs Medical Center, Washington, DC, USA
- Division of Infectious Diseases, The George Washington University, Washington, DC, USA
| | - Julie Zemskova
- Infectious Diseases Section, DC Veterans Affairs Medical Center, Washington, DC, USA
- Division of Infectious Diseases, The George Washington University, Washington, DC, USA
| | - Debra A Benator
- Infectious Diseases Section, DC Veterans Affairs Medical Center, Washington, DC, USA
- Division of Infectious Diseases, The George Washington University, Washington, DC, USA
| |
Collapse
|
28
|
Paudel M, Prajapati G, Buysman EK, Goswami S, Mao J, McNiff K, Kumar P. Comorbidity and comedication burden among people living with HIV in the United States. Curr Med Res Opin 2022; 38:1443-1450. [PMID: 35757905 DOI: 10.1080/03007995.2022.2088714] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the burden of comorbid conditions and comedications among people living with HIV (PLWH) vs. people living without HIV (PLWoH). METHODS This was a case-control study conducted among insured patients using administrative claims data. Adult PLWH were identified by antiretroviral therapy (ART) claims or HIV/AIDS diagnosis codes from 1 January 2018 to 31 December 2018 (index date was set by the earliest claim). Continuous enrollment was required for ≥12 months pre-index (baseline) and ≥30 days post-index (follow-up). Patients were required to have ≥1 HIV diagnosis during baseline or follow-up. Those with only HIV prophylaxis were excluded. PLWoH were matched 2:1 to PLWH on demographic characteristics. Study outcomes were compared using z-tests with robust standard errors in an ordinary least squares regression or Rao-Scott tests. RESULTS The study included 20,256 PLWH and 40,512 matched PLWoH, mean age 52 years. PLWH vs. PLWoH had higher mean (SD) Charlson comorbidity index scores (0.93 [1.59] vs. 0.61 [1.28]; p < .001) and a greater proportion had ≥1 comorbidity (69.1% vs. 54.5%, p < .001). The most prevalent comorbidities included hypertension (33.9% vs. 32.2%; p < .001), hyperlipidemia (29.4% vs. 24.6%; p < .001), chronic kidney disease (13.6% vs. 9.4%, p < .001), depression (13.1% vs. 7.3%, p < .001) and substance abuse (12.8% vs. 7.1%, p < .001). Mean (SD) non-ART prescription fills were higher among PLWH vs. PLWoH (11.9 [10.1] vs. 9.2 [9.4]; p < .001). CONCLUSIONS Multimorbidity and polypharmacy were more prevalent among PLWH vs. matched PLWoH. Findings support the need to consider comorbidities and comedications when choosing ART and to minimize drug-drug interactions and adverse events to improve patient outcomes.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Princy Kumar
- Georgetown University Medical Center, Washington, DC, USA
| |
Collapse
|
29
|
Bade B, Gwin M, Triplette M, Wiener RS, Crothers K. Comorbidity and life expectancy in shared decision making for lung cancer screening. Semin Oncol 2022; 49:S0093-7754(22)00057-4. [PMID: 35940959 DOI: 10.1053/j.seminoncol.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/02/2022] [Accepted: 07/03/2022] [Indexed: 11/11/2022]
Abstract
Shared decision making (SDM) is an important part of lung cancer screening (LCS) that includes discussing the risks and benefits of screening, potential outcomes, patient eligibility and willingness to participate, tobacco cessation, and tailoring a strategy to an individual patient. More than other cancer screening tests, eligibility for LCS is nuanced, incorporating the patient's age as well as tobacco use history and overall health status. Since comorbidities and multimorbidity (ie, 2 or more comorbidities) impact the risks and benefits of LCS, these topics are a fundamental part of decision-making. However, there is currently little evidence available to guide clinicians in addressing comorbidities and an individual's "appropriateness" for LCS during SDM visits. Therefore, this literature review investigates the impact of comorbidities and multimorbidity among patients undergoing LCS. Based on available evidence and guideline recommendations, we identify comorbidities that should be considered during SDM conversations and review best practices for navigating SDM conversations in the context of LCS. Three conditions are highlighted since they concomitantly portend higher risk of developing lung cancer, potentially increase risk of screening-related evaluation and treatment complications and can be associated with limited life expectancy: chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, and human immunodeficiency virus infection.
Collapse
Affiliation(s)
- Brett Bade
- Veterans Affairs (VA) Connecticut Healthcare System, Section of Pulmonary, Critical Care, and Sleep Medicine, West Haven, CT, United States of America (USA); Yale University School of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA.
| | - Mary Gwin
- University of Washington School of Medicine, Seattle, WA, USA
| | - Matthew Triplette
- University of Washington School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA, USA; Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, WA, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research and Medical Service, VA Boston Healthcare System, Boston, MA, USA; The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Kristina Crothers
- University of Washington School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA, USA; VA Puget Sound Health Care System, Section of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA, USA
| |
Collapse
|
30
|
Rubin LH, Neijna AG, Shi Q, Hoover DR, Tamraz B, Anastos K, Edmonds A, Fischl MA, Gustafson D, Maki PM, Merenstein D, Sheth AN, Springer G, Vance D, Weber KM, Sharma A. Degree of Polypharmacy and Cognitive Function in Older Women with HIV. AIDS Res Hum Retroviruses 2022; 38:571-579. [PMID: 35357949 PMCID: PMC9297323 DOI: 10.1089/aid.2021.0231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The number of people with HIV (PWH) experiencing age-associated comorbidities including those treated with medications and cognitive impairment is increasing. We examined associations between polypharmacy and cognition in older women with HIV (WWH) given their vulnerability to this comorbidity. Cross-sectional analysis capitalizing on Women's Interagency HIV Study data collected between 2014 and 2017. WWH meeting the following criteria were analyzed: age ≥50 years; availability of self-reported non-antiretroviral therapy (ART) medications data; and neuropsychological data. The number of non-ART medications used regularly in the prior 6 months was summed. Polypharmacy was categorized as none/low (0-4), moderate (5-9), or severe (≥10). Multivariable linear regression analyses examined polypharmacy-cognition (T-score) associations in the total sample and among virally suppressed (VS; < 20 copies/mL)-WWH after covariate adjustment for enrollment site, income, depressive symptoms, substance use (smoking, heavy alcohol, marijuana, crack, cocaine, and/or heroin), the Veterans Aging Cohort Study index (indicators of HIV disease and organ system function, hepatitis C virus serostatus), ART use, nadir CD4 count, and specific ART drugs (efavirenz, integrase inhibitors). We included 637 women (median age = 55 years; 72% Black). Ninety-four percent reported ART use in the past 6 months and 75% had HIV RNA <20 copies/mL. Comorbidity prevalence was high (61% hypertension; 26% diabetes). Moderate and severe polypharmacy in WWH were 34% and 24%. In WWH, severe polypharmacy was associated with poorer executive function (p = .007) and processing speed (p = .01). The same pattern of findings remained among VS-WWH. Moderate polypharmacy was not associated with cognition. Moderate and severe polypharmacy were common and associated with poorer executive function and processing speed in WWH. Severe polypharmacy may be a major contributor to the persistence of domain-specific cognitive complications in older WWH above and beyond the conditions that these medications are used to treat.
Collapse
Affiliation(s)
- Leah H. Rubin
- Department of Neurology and Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Address correspondence to: Leah H. Rubin, Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Meyer 6-113, Baltimore, MD 21287-7613, USA
| | - Ava G. Neijna
- Department of Neurology and Baltimore, Maryland, USA
| | - Qiuhu Shi
- New York Medical College, Valhalla, New York, USA
| | | | - Bani Tamraz
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, California, USA
| | | | - Andrew Edmonds
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Deborah Gustafson
- Department of Neurology, SUNY-Downstate Medical Center, Brooklyn, New York, USA
| | - Pauline M. Maki
- Department of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | | | - Gayle Springer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David Vance
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Kathleen M. Weber
- Cook County Health & Hospital System/Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Anjali Sharma
- Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
31
|
Mefford MT, Silverberg MJ, Leong TK, Hechter RC, Towner WJ, Go AS, Horberg M, Hu H, Harrison TN, Sung SH, Reynolds K. Multimorbidity Burden and Incident Heart Failure Among People With and Without HIV: The HIV-HEART Study. Mayo Clin Proc Innov Qual Outcomes 2022; 6:218-227. [PMID: 35539894 PMCID: PMC9079699 DOI: 10.1016/j.mayocpiqo.2022.03.004] [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] [Indexed: 11/30/2022] Open
Abstract
Objective To examine the association between multimorbidity burden and incident heart failure (HF) among people with HIV (PWH) and people without HIV (PWoH). Patients and Methods The HIV-HEART study is a retrospective cohort study that included adult PWH and PWoH aged 21 years or older at Kaiser Permanente between 2000 and 2016. Multimorbidity burden was defined by the baseline prevalence of 22 chronic conditions and was categorized as 0-1, 2-3, and 4 or more comorbidities on the basis of distribution of the overall population. People with HIV and PWoH were followed for a first HF event, all-cause death, or up to the end of follow-up on December 31, 2016. Using Cox proportional hazard regression, hazard ratios and 95% CIs were calculated to examine the association between multimorbidity burden and incident HF among PWH and PWoH, separately. Results The prevalences of 0-1, 2-3, and 4 or more comorbidities were 83.3%, 13.0%, and 3.7% in PWH (n=38,868), and 82.2%, 14.3%, and 3.5% in PWoH (n=386,586), respectively. After multivariable adjustment, compared with people with 0-1 comorbidities, the hazard ratios of incident HF associated with 2-3 and 4 or more comorbidities were 1.33 (95% CI, 1.04-1.71) and 2.41 (95% CI, 1.78-3.25) in PWH and 2.10 (95% CI, 1.92-2.29) and 4.09 (95% CI, 3.64-4.61) in PWoH, respectively. Conclusion Multimorbidity was associated with a higher risk of incident HF among PWH and PWoH, with more prominent associations in PWoH and certain patient subgroups. The identification of specific multimorbidity patterns that contribute to higher HF risk in PWH may lead to future preventative strategies.
Collapse
Affiliation(s)
- Matthew T Mefford
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Departments of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Thomas K Leong
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Department of Epidemiology, University of California Los Angeles, Los Angeles, CA
| | - William J Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.,Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Department of Infectious Disease, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Departments of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.,Department of Medicine, University of California, San Francisco, CA.,Department of Medicine, Stanford University, Palo Alto, CA
| | - Michael Horberg
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | - Haihong Hu
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | - Teresa N Harrison
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| |
Collapse
|
32
|
Olivieri-Mui B, Wilson I, Shi S, Montano M, McCarthy EP, Oh G, Kim DH. Geriatric Conditions Associated with Nonadherence to Antiretroviral Therapy Among Older People with HIV: The Importance of Frailty. AIDS Patient Care STDS 2022; 36:226-235. [PMID: 35687816 PMCID: PMC9242718 DOI: 10.1089/apc.2022.0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Poor compliance with medications is a growing concern in geriatric care and is increasingly more relevant among people living with HIV (PLWH) as they age. Our goal was to understand geriatric conditions associated with antiretroviral therapy (ART) nonadherence in a Medicare population of older PLWH. We analyzed Medicare data from PLWH aged 50 years or older who were continuously enrolled in fee-for-service Medicare from January 1, 2014 to June 30, 2015. Prevalent geriatric conditions (dementia, depression, falls, hip fracture, sensory deficits, osteoporosis, orthostatic hypotension, urinary incontinence, frailty) were identified in January 1, 2014-December 31, 2014. ART nonadherence was defined as <80% proportion of days covered (PDC) by at least two ART medications in January 1, 2015-June 30, 2015. We examined geriatric condition association with nonadherence using lowest Akaike Information Criterion multi-variate logistic models, controlling for age, sex, race, census region, substance use, Medicaid eligibility, and polypharmacy. Of 8778 PLWH, 23% (n = 2042) had <80% PDC. The average age was 60 years (standard deviation ±8), and >70% were males. In adjusted models, age was not associated with nonadherence, frailty status was the only geriatric condition associated with nonadherence [robust: reference, prefrail odds ratio (OR): 0.97, confidence interval (95% CI) 0.86-1.10, frail OR: 1.34 95% CI 1.11-1.61], and odds of nonadherence were lower for polypharmacy [OR: 0.48 (0.43-0.54)]. Our findings suggest that patient-centered care plans aimed at improving ART adherence among older PLWH would benefit from long-term surveillance; a deeper understanding of the role of frailty and polypharmacy, even at chronologically younger ages in PLWH.
Collapse
Affiliation(s)
- Brianne Olivieri-Mui
- The Roux Inst and Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA.,The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA.,Address correspondence to: Brianne Olivieri-Mui, MPH, PhD, The Roux Inst and Department of Health Sciences, Northeastern University, 360 Huntington Avenue, 316a Robinson Hall, Boston, MA 02115, USA
| | - Ira Wilson
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Sandra Shi
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Monty Montano
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ellen P. McCarthy
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Gahee Oh
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Dae Hyun Kim
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
33
|
Emanuel KM, Runner K, Brodnik ZD, Morsey BM, Lamberty BG, Johnson HS, Acharya A, Byrareddy SN, España RA, Fox HS, Gaskill PJ. Deprenyl reduces inflammation during acute SIV infection. iScience 2022; 25:104207. [PMID: 35494221 PMCID: PMC9046124 DOI: 10.1016/j.isci.2022.104207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/28/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022] Open
Abstract
In the era of antiretroviral therapy, inflammation is a central factor in numerous HIV-associated comorbidities, such as cardiovascular disease, cognitive impairment, and neuropsychiatric disorders. This highlights the value of developing therapeutics that both reduce HIV-associated inflammation and treat associated comorbidities. Previous research on monoamine oxidase inhibitors (MAOIs) suggests this class of drugs has anti-inflammatory properties in addition to neuropsychiatric effects. Therefore, we examined the impact of deprenyl, an MAOI, on SIV-associated inflammation during acute SIV infection using the rhesus macaque model of HIV infection. Our results show deprenyl decreased both peripheral and CNS inflammation but had no effect on viral load in either the periphery or CNS. These data show that the MAOI deprenyl may have broad anti-inflammatory effects when given during the acute stage of SIV infection, suggesting more research into the anti-inflammatory effects of this drug could result in a beneficial adjuvant for antiretroviral therapy.
Collapse
Affiliation(s)
- K M Emanuel
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - K Runner
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA 19102, USA
| | - Z D Brodnik
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
- Center on Compulsive Behaviors, NIH Intramural Research Program, Baltimore, MD 21224, USA
- Integrative Neuroscience Research Branch, Neuronal Networks Section, Baltimore, MD 21224, USA
| | - B M Morsey
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - B G Lamberty
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - H S Johnson
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA 19102, USA
| | - A Acharya
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - S N Byrareddy
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - R A España
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - H S Fox
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - P J Gaskill
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA 19102, USA
| |
Collapse
|
34
|
Nanditha NGA, Dong X, McLinden T, Sereda P, Kopec J, Hogg RS, Montaner JSG, Lima VD. The impact of lookback windows on the prevalence and incidence of chronic diseases among people living with HIV: an exploration in administrative health data in Canada. BMC Med Res Methodol 2022; 22:1. [PMID: 34991473 PMCID: PMC8734246 DOI: 10.1186/s12874-021-01448-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/21/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We described the impact of different lengths of lookback window (LW), a retrospective time period to observe diagnoses in administrative data, on the prevalence and incidence of eight chronic diseases. METHODS Our study populations included people living with HIV (N = 5151) and 1:5 age-sex-matched HIV-negative individuals (N = 25,755) in British Columbia, Canada, with complete follow-up between 1996 and 2012. We measured period prevalence and incidence of diseases in 2012 using LWs ranging from 1 to 16 years. Cases were deemed prevalent if identified in 2012 or within a defined LW, and incident if newly identified in 2012 with no previous cases detected within a defined LW. Chronic disease cases were ascertained using published case-finding algorithms applied to population-based provincial administrative health datasets. RESULTS Overall, using cases identified by the full 16-year LW as the reference, LWs ≥8 years and ≥ 4 years reduced the proportion of misclassified prevalent and incidence cases of most diseases to < 20%, respectively. The impact of LWs varied across diseases and populations. CONCLUSIONS This study underscored the importance of carefully choosing LWs and demonstrated data-driven approaches that may inform these choices. To improve comparability of prevalence and incidence estimates across different settings, we recommend transparent reporting of the rationale and limitations of chosen LWs.
Collapse
Affiliation(s)
- Ni Gusti Ayu Nanditha
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Xinzhe Dong
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Taylor McLinden
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jacek Kopec
- Arthritis Research Canada, Richmond, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
35
|
Chen YW, Anderson D, Pericone CD, Donga P. Real-World Assessment of Weight Change in African American Females and Hispanics with HIV-1 After Initiating Integrase Strand-Transfer Inhibitors or Protease Inhibitors. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2022; 9:1-10. [PMID: 35083364 PMCID: PMC8723886 DOI: 10.36469/001c.30184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
Background: Studies have shown an increase in weight among people living with HIV (PLWH) who initiated integrase strand transfer inhibitors (INSTI). However, weight gain with INSTI-based regimens vs other regimens in females or racial/ethnic minorities is poorly understood. Objective: This study assessed differences in weight gain among treatment-naïve, female, African Americans and Hispanics after initiating INSTI-based vs protease inhibitor (PI)-based regimens. Methods: This retrospective, observational cohort study included data from the Optum® deidentified Electronic Health Record Database. Female African Americans or Hispanics initiating INSTI- or PI-based regimens between January 1, 2015, and December 31, 2018 (first prescription was index date), with ≥12-month baseline and follow-up periods, ≥1 weight measure during each period, and no prior antiretroviral (ARV) use were included. Inverse probability of treatment weighting was used to reduce selection bias and improve cohort comparability. Multivariable models were used to compare absolute weight/body mass index (BMI) changes and proportion of patients with weight/BMI increases from pre- to post-index (last measure between the 4th and 12th months post-index). Results: Weighted cohorts included 3407 African American females (INSTI, 1704; PI, 1703) and 3711 Hispanics (INSTI, 1865; PI, 1846) PLWH. Mean time to follow-up weight measure was ~9.5 months. Among female African Americans, INSTI initiators had a 1.5 kg greater mean weight gain (2.1 kg vs 0.6 kg; P = 0.033), and a higher proportion with ≥5% weight gain (32% vs 29%; odds ratio [OR]=1.2; 95% CI [1.0-1.4]) than PI initiators. Among Hispanics, INSTI and PI initiators had similar mean increases in weight (2.1 and 1.8 kg, respectively), but INSTI initiators had a higher proportion with ≥5% weight gain (31% vs 27%; OR=1.2; 95% CI [1.1-1.4]). Female African American INSTI initiators were more likely to shift from normal or overweight to a worse BMI classification. Hispanic INSTI initiators were less likely to shift from normal BMI to overweight but more likely to shift from normal or overweight to obese. Conclusion: In a real-world setting, INSTI-based regimens were associated with greater weight gain for treatment-naïve female African Americans, compared with PI-based regimens. Differences between regimens were less consistent for Hispanics. These results may inform ARV choice for PLWH who are at risk for ARV-related weight gain.
Collapse
Affiliation(s)
- Yen-Wen Chen
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | | | - Prina Donga
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| |
Collapse
|
36
|
Smith L, Letendre S, Erlandson KM, Ma Q, Ellis RJ, Farhadian SF. Polypharmacy in older adults with HIV infection: Effects on the brain. J Am Geriatr Soc 2021; 70:924-927. [PMID: 34855982 PMCID: PMC8904273 DOI: 10.1111/jgs.17569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/07/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Lauren Smith
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Scott Letendre
- Department of Infectious Diseases, University of California San Diego School of Medicine, San Diego, California, USA
| | - Kristine M Erlandson
- Department of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Qing Ma
- School of Pharmacy & Pharmaceutical Sciences, University of Buffalo, Buffalo, New York, USA
| | - Ronald J Ellis
- Departments of Neurosciences and Psychiatry, University of California San Diego School of Medicine, San Diego, California, USA
| | - Shelli F Farhadian
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
37
|
De Sá Pinheiro A, Souza Lima S, Oliveira Naiff Ferreira GR, Rodrigues Feijão A, Rosendo da Silva RA, Gir E, Reis RK, Vieira Pereira FM, Hisako Takase Gonçalves L, Isse Polaro SH, Pereira Cruz Ramos AM, Pinheiro Botelho E. HIV epidemic in a province of the Brazilian Amazon region: Temporal trend analysis. J Public Health Res 2021; 11. [PMID: 34850619 PMCID: PMC9363914 DOI: 10.4081/jphr.2021.2513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/10/2021] [Indexed: 11/22/2022] Open
Abstract
Background Although considerable progress has been made over the last decades, human
immunodeficiency virus (HIV) incidence and acquired immunodeficiency
syndrome (AIDS) mortality rates have remarkably increased in the Brazilian
Amazon region. Here, we employed temporal analysis to determine the impact
of public policies on the HIV epidemic in the state of Pará, Brazil, which
has the second highest HIV incidence rate in the Amazon region. Design and methods This is an ecological study conducted in the state of Pará, employing
secondary data of HIV/AIDS cases notified to the Information System for
Notifiable Diseases, 2007– 2018. The following epidemiological variables
were collected: year of notification, municipality of residence, age, sex,
education, exposure category, and HIV/AIDS diagnostic criteria. The study
population was composed of 21,504 HIV/AIDS cases. The HIV/AIDS incidence
rates were analyzed employing the temporal trend analysis (TTA) followed by
the chi-square test and residue analysis to determine the association
between the epidemiological variables and time series periods. Results A total of 50% of the notifications were composed of AIDS cases. TTA
identified two periods in HIV/AIDS incidence, with stabilization of cases in
the first period (G1, 2007–2012) and an upward trend in the second period
(G2, 2012–2018). The most prevalent epidemiological characteristics in G2
(versus G1) were as follows: young people, brown skin
color, higher schooling, and homosexuals. Conclusions Public policy to control HIV infection in the Brazilian Amazon region has
been partially effective. HIV screening tests and treatment should be made
widely available to eradicate HIV infection in the Amazon region by
2030.
Collapse
Affiliation(s)
| | - Sandra Souza Lima
- Biology of Infectious and Parasitic Agents Graduate Program, Federal University of Pará, Belém.
| | | | | | | | - Elucir Gir
- Graduate Program in Fundamental Nursing, University of Sao Paulo, Ribeirão Preto.
| | - Renata Karina Reis
- Graduate Program in Fundamental Nursing, University of Sao Paulo, Ribeirão Preto.
| | | | | | | | | | | |
Collapse
|
38
|
Sok P, Seeman MV, Nisenbaum R, Watson J, Rourke SB. Four-Year Trajectories of Health-Related Quality of Life in People Living with HIV: Impact of Unmet Basic Needs across Age Groups in Positive Spaces, Healthy Places. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212256. [PMID: 34832010 PMCID: PMC8622128 DOI: 10.3390/ijerph182212256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022]
Abstract
Despite significant advances in antiretroviral therapy, unmet basic needs can negatively impact health-related quality of life (HRQoL) in people living with HIV, especially as they age. We aimed to examine the effect of unmet basic needs across age groups on changes in HRQoL over a 4-year period in persons with HIV. Physical and mental HRQoL scores from the Positive Spaces, Healthy Spaces cohort interviewed in 2006 (n = 538), 2007 (n = 506), and 2009 (n = 406) were examined across three age groups according to their unmet needs for food, clothing, and housing. Individual growth curve model analyses were used to investigate changes over time, adjusting for demographics, employment, living conditions, social supports, HIV status, and health behavior risks. Low scores on physical and mental HRQoL were positively associated with higher number of unmet basic needs (β = −6.40, standard error (SE) = 0.87, p < 0.001 and β = −7.39, SE = 1.00, p < 0.001, respectively). There was a slight improvement in physical and mental HRQoL over 4 years in this HIV cohort, but the burden of unmet basic needs took its toll on those over 50 years of age. Regularly assessing unmet basic needs is recommended given the impact these can have on HRQOL for people living with HIV. Recognition of unmet needs is vital, as is the development of timely interventions.
Collapse
Affiliation(s)
- Phan Sok
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (P.S.); (M.V.S.)
| | - Mary V. Seeman
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (P.S.); (M.V.S.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; (R.N.); (J.W.)
- Applied Health Research Centre, St. Michael’s Hospital, Toronto, ON M5G 1B1, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - James Watson
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; (R.N.); (J.W.)
| | - Sean B. Rourke
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (P.S.); (M.V.S.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada; (R.N.); (J.W.)
- Correspondence: ; Tel.: +1-(416)-878-2779
| | | |
Collapse
|
39
|
Justice AC, Gordon KS, Romero J, Edelman EJ, Garcia BJ, Jones P, Khoo S, Lo Re V, Rentsch CT, Tate JP, Tseng A, Womack J, Jacobson D. Polypharmacy-associated risk of hospitalisation among people ageing with and without HIV: an observational study. THE LANCET. HEALTHY LONGEVITY 2021; 2:e639-e650. [PMID: 34870254 PMCID: PMC8639138 DOI: 10.1016/s2666-7568(21)00206-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Polypharmacy, defined as use of five or more medications concurrently, is associated with adverse health outcomes and people ageing with HIV might be at greater risk than similar uninfected individuals. We aimed to determine whether known pairwise drug interactions (KPDIs) were associated with risk of admission to hospital (hereafter referred to as hospitalisation) and medication count among people ageing with and without HIV after accounting for physiological frailty. Methods In this observational study, we collected individual-level data for participants of the Veterans Aging Cohort Study (VACS) with HIV on antiretroviral therapy (ART) and with supressed HIV-1 RNA and people without HIV who were receiving at least one prescription medication, based on active medications in the 2009 fiscal year (ie, Oct 1, 2008, to Sept 30, 2009). We identified KPDIs among these patients by linking prescription fill and refill data with data from DrugBank (version 5.0.11). We collected data on all-cause mortality and hospitalisations between Oct 1, 2009, and March 31, 2019. We compared KPDI counts using random selection and actual patterns of use across medication counts from two to 12. We created a weighted KPDI Index on the basis of the average association of each KPDI with mortality among people ageing without HIV and used nested Cox models stratified by HIV status to estimate the association between medication count and hospitalisation, with incremental adjustments for demographics, physiological frailty, and KPDI Index. Findings We collected data for 9186 people ageing with HIV and 37 930 individuals without HIV. 45 913 (97·4%) of 47 116 patients were men and the sample was predominantly aged 50–64 years (30 413 [64·6%]). Compared with a random sample of medications, real-world pattern of medication counts and combinations were associated with five-to-six times more KPDIs (eg, for a combination of six medications, KPDI count was 1·09 in the random sample, 5·49 in the HIV-negative population, and 7·13 in the HIV-positive population). For each additional observed medication, people ageing with HIV had approximately 2·94 additional KPDIs and comparators had approximately 2·67 additional KPDIs. Adjustment for demographics, physiological frailty, and KPDI Index reduced the association between medication count and risk of hospitalisation for people ageing with HIV (hazard ratio 1·08 [95% CI 1·07–1·09] reduced to 1·06 [1·05–1·07]) and those without HIV (1·08 [1·07–1·08] reduced to 1·04 [1·03–1·05]). Interpretation For each additional medication, people ageing with HIV have more drug–drug interactions than those without HIV. Adjusting for known non-ART drug–drug interactions, each additional non-ART medication confers excess risk of hospitalisation for people ageing with HIV. Randomised trials will be needed to determine whether reducing these interactions improves outcomes. Funding National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Department of Veterans Affairs Health Services Research & Development, and Office of Research and Development.
Collapse
Affiliation(s)
- Amy C Justice
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Kirsha S Gordon
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Jonathon Romero
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - E Jennifer Edelman
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Benjamin J Garcia
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Piet Jones
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Saye Khoo
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Vincent Lo Re
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Christopher T Rentsch
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Janet P Tate
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Alice Tseng
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Julie Womack
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| | - Daniel Jacobson
- School of Medicine, Yale University, New Haven, CT, USA (Prof A C Justice MD, K S Gordon PhD, E J Edelman MD, J P Tate ScD); VA Connecticut Healthcare System, West Haven, CT, USA (Prof A C Justice, K S Gordon, J P Tate, C T Rentsch PhD, J Womack PhD); Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA (J Romero BSc, P Jones MSc); Biosciences Division, Oak Ridge National Laboratory, Oak Ridge, TN, USA (B J Garcia PhD, D Jacobson PhD); Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK (Prof S Khoo MD); Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA (V Lo Re III MD); Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK (C T Rentsch); University Health Network and Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (A Tseng PharmD); Faculty of Yale University School of Nursing, West Haven, CT, USA (J Womack)
| |
Collapse
|
40
|
Psychosocial Mechanisms of Self-rated Successful Aging with HIV: A Structural Equation Model. AIDS Behav 2021; 25:2875-2885. [PMID: 34115265 DOI: 10.1007/s10461-021-03340-7] [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] [Accepted: 06/05/2021] [Indexed: 02/06/2023]
Abstract
This study tested a conceptual psychosocial model of self-rated successful aging (SRSA) with HIV. Our sample (n = 356) included older women living with HIV (OWLH): average age 56.5 years, 73% Black. SRSA was assessed using a research-based 10-point scale (higher scores = better outcomes). We conducted adjusted structural equation modeling. The global model included two latent variables-protective attributes (composite of positive psychosocial factors: resilience, personal mastery, optimism, spirituality) and psychological distress (composite of negative psychosocial factors: anxiety, depression, loneliness, internalized HIV-related stigma). The model showed good fit (χ2(58) = 76, p = 0.06; RMSEA = 0.03; CFI = 0.99). Increased protective attributes were associated with improved SRSA both directly and mediated by improved coping with stress. While psychological distress did not have a direct effect on SRSA, it was indirectly associated with worsened SRSA via diminished protective attributes and via decreased coping with stress. Findings suggest the need for interventions enhancing positive and mitigating negative psychosocial factors in OWLH.
Collapse
|
41
|
Taramasso L, De Vito A, Ricci ED, Orofino G, Squillace N, Menzaghi B, Molteni C, Gulminetti R, De Socio GV, Pellicanò GF, Sarchi E, Celesia BM, Calza L, Rusconi S, Valsecchi L, Martinelli CV, Cascio A, Maggi P, Vichi F, Angioni G, Guadagnino G, Cenderello G, Dentone C, Bandera A, Falasca K, Bonfanti P, Di Biagio A, Madeddu G, Bonfanti P, Di Biagio A, Ricci E, Sarchi E, Chichino G, Bolla C, Bellacosa C, Angarano G, Saracino A, Calza L, Menzaghi B, Farinazzo M, Angioni G, Bruno G, Celesia BM, Falasca K, Mastroianni A, Guadagnino G, Vichi F, Salomoni E, Martinelli C, Di Biagio A, Dentone C, Taramasso L, Bassetti M, Cenderello G, Molteni C, Piconi S, Pellicanò GF, Nunnari G, Valsecchi L, Cordier L, Parisini S, Rizzardini G, Rusconi S, Conti F, Bandera A, Gori A, Motta D, Puoti M, Bonfanti P, Squillace N, Migliorino GM, Maggi P, Martini S, Cascio A, Trizzino M, Gulminetti R, Pagnucco L, De Socio GV, Nofri M, Francisci D, Cibelli D, Parruti G, Madeddu G, Mameli MS, Orofino G, Guastavigna M. Durability of Dolutegravir-Based Regimens: A 5-Year Prospective Observational Study. AIDS Patient Care STDS 2021; 35:342-353. [PMID: 34524918 DOI: 10.1089/apc.2021.0089] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This study evaluates the frequency and causes of dolutegravir (DTG) discontinuation along 5 years of follow-up, in both antiretroviral treatment (ART)-naive and experienced people living with HIV (PLWH). This is a prospective multi-center cohort study enrolling PLWH on DTG from July 2014 until November 2020. DTG-durability was investigated using the Kaplan-Meier survival curve. The Cox proportional-hazards model was used for estimating the hazard ratio (HR) of DTG discontinuation for any cause, and for adverse events (AEs). Nine hundred sixty-three PLWH were included, 25.3% were women and 28.0% were ART-naive. Discontinuations for any causes were 10.1 [95% confidence interval (95% CI) 8.9-11.5] per 100 person-years, similar in most regimens, with the apparent exception of tenofovir alafenamide/emtricitabine+DTG (p < 0.0001). In the multivariable Cox regression model, non-Caucasian ethnicity, age ≥50 years, and lower estimated glomerular filtration rate (eGFR) were associated with a higher probability of DTG interruption. The incidence rate of virological failure was 0.4 (95% CI 0.2-0.7) per 100 person-years, while the estimated discontinuation rate for AEs was 4.0 (3.2-4.9) per 100 person-years. Thirty-four DTG interruptions were due to grade ≥3 events (10 central nervous system, 6 hypersensitivity, 3 renal, 3 myalgia/asthenia, 3 abdominal pain, 2 gastrointestinal, and 7 other events). People with lower body mass index, age ≥50 years, and lower eGFR were at higher risk of AEs, while dual combinations were protective (HR 0.41 compared with abacavir/lamivudine/DTG, 95% CI 0.22-0.77). In this prospective observational study, we found high DTG durability and a low rate of virological failures. Dual therapies seemed protective toward AEs and might be considered, when feasible, a suitable option to minimize drug interactions and improve tolerability.
Collapse
Affiliation(s)
- Lucia Taramasso
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Andrea De Vito
- Unit of Infectious and Tropical Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Giancarlo Orofino
- Unit of Infectious Diseases, “Divisione A”, Amedeo di Savoia Hospital, Torino, Italy
| | - Nicola Squillace
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Chiara Molteni
- Infectious Disease Unit, Ospedale A. Manzoni, Lecco, Italy
| | - Roberto Gulminetti
- Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giuseppe Vittorio De Socio
- Clinic of Infectious Diseases, Department of Medicine 2, Azienda Ospedaliera di Perugia, Santa Maria Hospital, Perugia, Italy
| | - Giovanni Francesco Pellicanò
- Unit of Infectious Diseases, Department of Human Pathology of the Adult and the Developmental Age ‘G. Barresi’, University of Messina, Messina, Italy
| | - Eleonora Sarchi
- Infectious Diseases Unit, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | - Leonardo Calza
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, “Alma Mater Studiorum” University of Bologna, Bologna, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università degli Studi di Milano, Milan, Italy
| | - Laura Valsecchi
- Infectious Disease Unit (I Divisione), ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Paolo Maggi
- Department of Infectious Disease, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Vichi
- Infectious Diseases Department, SOC 1, USLCENTROFIRENZE, Santa Maria Annunziata Hospital, Florence, Italy
| | | | - Giuliana Guadagnino
- Department of Infectious and Tropical Diseases, St. Annunziata Hospital, Cosenza, Italy
| | | | - Chiara Dentone
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Alessandra Bandera
- Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda, University of Milan, Ospedale Maggiore Policlinico, Milan, Italy
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University ‘G. d'Annunzio’ Chieti-Pescara, Chieti, Italy
| | - Paolo Bonfanti
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| | - Giordano Madeddu
- Unit of Infectious and Tropical Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Lee Y, Walton R, Jackson L, Batey DS. Community-Level Factors and HIV Health Among Older People Living With HIV (PLWH) in Alabama, United States: A Qualitative Analysis. J Assoc Nurses AIDS Care 2021; 32:589-598. [PMID: 33009174 DOI: 10.1097/jnc.0000000000000214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT As the number of older people living with HIV (PLWH) is increasing, there is an urgent need for research on community-level factors to better understand the health care needs of this population. In-depth interview transcripts of 20 older PLWH who participated in a community-based participatory research study conducted in Alabama, in the United States, were analyzed through a phenomenological research approach. Results suggest that crime, lack of resources, and social isolation experienced at the community levels were found to be associated with the wellbeing of older PLWH. Moreover, community characteristics may confound older PLWH's comorbid conditions and resultant polypharmacy. An increased understanding of the impact of contextual factors on HIV health can inform more holistic individual- and community-level interventions aimed at addressing barriers to retention or re-engagement in HIV medical care and viral suppression among older PLWH.
Collapse
Affiliation(s)
- Yookyong Lee
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rick Walton
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lindsey Jackson
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D Scott Batey
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
43
|
Siegler E, Moxley J, Mauer E, Glesby M. Cross-sectional study of correlates and prevalence of functional and high-risk multimorbidity in an academic HIV practice in New York City. BMJ Open 2021; 11:e047199. [PMID: 34380723 PMCID: PMC8359525 DOI: 10.1136/bmjopen-2020-047199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES People with HIV have high levels of multimorbidity, but studies often focus on high-risk comorbidities such as hypertension or coronary artery disease. We examined both high-risk and functional comorbidities in an ethnically diverse clinic population to compare the prevalence of comorbidities and different patterns of multimorbidity. DESIGN Retrospective cross-sectional study. SETTING University-based primary care HIV clinic with two locations in New York City. PARTICIPANTS Patients who had been seen by a physician at least once between 1 June 2016 and 31 May 2017. PRIMARY AND SECONDARY OUTCOME MEASURES Data regarding demographics, diagnoses and lab values were downloaded in a one-time data import from the electronic medical record. Comorbidities were classified as high-risk (with major impact on mortality) or functional (with major impact on function), and multimorbidity was determined for both classes in the total sample of 2751. Factors associated with high-risk and functional multimorbidity were determined first through bivariate analysis and then through multivariable median regression in 2013 patients with complete data. RESULTS Median age was 52 years (IQR 43-59). Cisgendered women comprised 24.6% of the sample, and 31.7% were African-American. Both functional and high-risk comorbidities were common and risk increased with age. Among those 75 and older, median number of both functional and high-risk comorbidities was 3 (IQR 2-4). High-risk comorbidities were associated with age (p<0.001), more years with an HIV diagnosis (p<0.001) and being an African-American (p<0.001). Associated with a higher number of functional comorbidities were age (p<0.001), being a cisgender female (p<0.001), being Hispanic (p=0.01) and more years with an HIV diagnosis (p<0.001). CONCLUSIONS Comorbidities with functional impact increase with age in parallel to those with a more direct impact on mortality and should be assessed and monitored, especially as the population with HIV ages.
Collapse
Affiliation(s)
- Eugenia Siegler
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jerad Moxley
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Elizabeth Mauer
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
- Tempus Labs, Inc, New York, New York, USA
| | - Marshall Glesby
- Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
44
|
Yu X, Westra JR, Giordano TP, Berenson AB, Baillargeon JG, Kuo YF. Assessing comorbidities and survival in HIV-infected and uninfected matched Medicare enrollees. AIDS 2021; 35:1667-1675. [PMID: 34049353 PMCID: PMC8286326 DOI: 10.1097/qad.0000000000002963] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE People with HIV infection experience excessive mortality compared with their noninfected counterparts. It is unclear whether the impact of HIV infection on mortality varies by comorbidities or whether sex difference exists in this relationship. This study assessed the effect of newly diagnosed HIV infection on overall mortality among Medicare beneficiaries for both disabled and older adults (≥65 years old) based on their original entitlement. METHODS We constructed a retrospective matched cohort using a 5% nationally representative sample of Medicare beneficiaries between 1996 and 2015. People with incident HIV diagnoses were individually matched to up to three controls based on demographics. Cox proportional hazards models adjusted for baseline demographics and comorbidities were used to assess the effect of HIV status on survival among four disabled groups by sex strata. Within each stratum, interactions between comorbidity variables and HIV status were examined. RESULTS People with HIV, especially older women, had a higher prevalence of baseline comorbidities than controls. HIV--mortality association varied according to sex in older adults (P = 0.004). Comorbidity--HIV interactions were more pronounced in disabled groups (P < 0.0001). People with HIV with more chronic conditions had a less pronounced increase in the risk of death than those with fewer conditions, compared with uninfected controls. CONCLUSION Medicare enrollees with newly diagnosed HIV had more prevalent baseline comorbidities and were at higher risk of death than people without HIV. HIV infection has a more pronounced effect among those with fewer comorbidities. Sex differences in HIV--mortality association exist among older Medicare enrollees.
Collapse
Affiliation(s)
- Xiaoying Yu
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Center for Interdisciplinary Research in Women’s Health, The University of Texas Medical Branch at Galveston, TX, USA
| | - Jordan R. Westra
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Thomas P. Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Abbey B. Berenson
- Center for Interdisciplinary Research in Women’s Health, The University of Texas Medical Branch at Galveston, TX, USA
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, TX, USA
| | - Jacques G. Baillargeon
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Center for Interdisciplinary Research in Women’s Health, The University of Texas Medical Branch at Galveston, TX, USA
| |
Collapse
|
45
|
Livio F, Deutschmann E, Moffa G, Rrustemi F, Stader F, Elzi L, Braun DL, Calmy A, Hachfeld A, Cavassini M, Tarr PE, Wissel K, Battegay M, Marzolini C. Analysis of inappropriate prescribing in elderly patients of the Swiss HIV Cohort Study reveals gender inequity. J Antimicrob Chemother 2021; 76:758-764. [PMID: 33279997 DOI: 10.1093/jac/dkaa505] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The extent of inappropriate prescribing observed in geriatric medicine has not been thoroughly evaluated in people ageing with HIV. We determined the prevalence of and risk factors for inappropriate prescribing in individuals aged ≥75 years enrolled in the Swiss HIV Cohort Study. METHODS Retrospective review of medical records was performed to gain more insights into non-HIV comorbidities. Inappropriate prescribing was screened using the Beers criteria, the STOPP/START criteria and the Liverpool drug-drug interactions (DDIs) database. RESULTS For 175 included individuals, the median age was 78 years (IQR 76-81) and 71% were male. The median number of non-HIV comorbidities was 7 (IQR 5-10). The prevalence of polypharmacy and inappropriate prescribing was 66% and 67%, respectively. Overall, 40% of prescribing issues could have deleterious consequences. Prescribing issues occurred mainly with non-HIV drugs and included: incorrect dosage (26%); lack of indication (21%); prescription omission (drug not prescribed although indicated) (17%); drug not appropriate in elderly individuals (18%) and deleterious DDIs (17%). In the multivariable logistic regression, risk factors for prescribing issues were polypharmacy (OR: 2.5; 95% CI: 1.3-4.7), renal impairment (OR: 2.7; 95% CI: 1.4-5.1), treatment with CNS-active drugs (OR: 2.1; 95% CI: 1.1-3.8) and female sex (OR: 8.3; 95% CI: 2.4-28.1). CONCLUSIONS Polypharmacy and inappropriate prescribing are highly prevalent in elderly people living with HIV. Women are at higher risk than men, partly explained by sex differences in the occurrence of non-HIV comorbidities and medical care. Medication reconciliation and periodic review of prescriptions by experienced physicians could help reduce polypharmacy and inappropriate prescribing in this vulnerable, growing population.
Collapse
Affiliation(s)
- Françoise Livio
- Service of Clinical Pharmacology, University Hospital Lausanne, Lausanne, Switzerland
| | - Elisabeth Deutschmann
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Giusi Moffa
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | | | - Felix Stader
- University of Basel, Basel, Switzerland.,Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Luigia Elzi
- Division of Infectious Diseases, Regional Hospital Bellinzona, Bellinzona, Switzerland
| | - Dominique L Braun
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland
| | - Anna Hachfeld
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland.,University of Bern, Bern, Switzerland
| | - Matthias Cavassini
- Service of Infectious Diseases, University Hospital Lausanne, Lausanne, Switzerland
| | - Philip E Tarr
- University Department of Medicine, Kantonsspital Baselland, University of Basel, Basel, Switzerland
| | - Kerstin Wissel
- Division of Infectious Diseases and Hospital Epidemiology, Canton Hospital St. Gallen, St. Gallen, Switzerland
| | - Manuel Battegay
- University of Basel, Basel, Switzerland.,Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Catia Marzolini
- University of Basel, Basel, Switzerland.,Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.,Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | | |
Collapse
|
46
|
The association between antimicrobial resistance and HIV infection: a systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:846-853. [PMID: 33813126 DOI: 10.1016/j.cmi.2021.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES People living with HIV (PLWH) are at increased risk of infections with resistant organisms due to more frequent healthcare utilization. Our objective was to investigate the association between HIV and antimicrobial resistance (AMR). METHODS We searched MEDLINE, EMBASE, Web of Science, LILACS and African Journals Online. Studies were eligible if they reported on AMR for colonization or infection with bacterial pathogens (excluding mycobacteria and bacteria causing sexually transmitted infections) and were stratified by HIV status, species and antimicrobials tested. Pooled odds ratios were used to evaluate the association between HIV and resistance. RESULTS In total, 92 studies published between 1995 and 2020 were identified. The studies included the following organisms: Staphylococcusaureus (n = 47), Streptococcus pneumoniae (n = 28), Escherichia coli (n = 6) and other Gram-negative bacteria. PLWH had a 2.12 (95%CI 1.36-3.30) higher odds for colonization and 1.90 (95%CI 1.45-2.48) higher odds for infection with methicillin-resistant S. aureus, a 2.28 (95%CI 1.75-2.97) higher odds of infection with S. pneumoniae with decreased penicillin susceptibility, and a 1.59 (95%CI 0.83-3.05) higher odds of resistance to third-generation cephalosporins in E. coli and Klebsiella pneumoniae. CONCLUSION This review shows an increased risk of AMR in PLWH across a range of bacterial pathogens and multiple drug classes. The lack of laboratory capacity for identifying AMR, and limited access to alternative treatment options in countries with the highest burden of HIV, highlight the need for more research on AMR in PLWH. Overall, the quality of studies was moderate or low, which may impact the findings of this review.
Collapse
|
47
|
Olaru ID, Ferrand RA, Chisenga M, Yeung S, Macrae B, Chonzi P, Stabler RA, Hopkins H, Mabey D, Masunda KPE, Kranzer K. Prevalence of ESBL-producing Escherichia coli in adults with and without HIV presenting with urinary tract infections to primary care clinics in Zimbabwe. JAC Antimicrob Resist 2021; 3:dlab082. [PMID: 34223141 PMCID: PMC8242135 DOI: 10.1093/jacamr/dlab082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND People living with HIV may be at increased risk for infections with resistant organisms. Infections with ESBL-producing organisms are of particular concern because they limit treatment options for severe Gram-negative infections in low-resource settings. OBJECTIVES To investigate the association between HIV status and urinary tract infections (UTIs) with ESBL-producing Escherichia coli. PATIENTS AND METHODS Cross-sectional study enrolling adults presenting with UTI symptoms to primary care clinics in Harare, Zimbabwe. Demographic and clinical data were collected during interviews and a urine sample was collected for culture from each participant. Antimicrobial susceptibility testing was performed according to EUCAST recommendations. RESULTS Of the 1164 who were enrolled into the study, 783 (64%) were female and 387 (33%) were HIV infected. The median age was 35.8 years. Urine cultures were positive in 338 (29.0%) participants, and the majority of bacterial isolates were E. coli (n = 254, 75.2%). The presence of ESBL was confirmed in 49/254 (19.3%) E. coli. Participants with HIV had a 2.13 (95% CI 1.05-4.32) higher odds of infection with ESBL-producing E. coli than individuals without HIV. Also, the prevalence of resistance to most antimicrobials was higher among participants with HIV. CONCLUSIONS This study found an association between HIV and ESBL-producing E. coli in patients presenting with symptoms suggestive of UTI to primary care in Harare. HIV status should be considered when prescribing empirical antimicrobial treatment.
Collapse
Affiliation(s)
- Ioana D Olaru
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Biomedical Research and Training Institute, 10 Seagrave Road, Harare, Zimbabwe
| | - Rashida A Ferrand
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Biomedical Research and Training Institute, 10 Seagrave Road, Harare, Zimbabwe
| | - Mutsawashe Chisenga
- Biomedical Research and Training Institute, 10 Seagrave Road, Harare, Zimbabwe
| | - Shunmay Yeung
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- St Mary’s Imperial College Hospital, Praed Street, Paddington, London W2 1NY, UK
| | - Bruce Macrae
- Clinical Microbiology, University College London Hospitals NHS Foundation Trust, 235 Euston Road, Bloomsbury, London NW1 2BU, UK
| | - Prosper Chonzi
- Department of Health, Harare City Council, Rowan Martin Building, 1 Pennefather Avenue, Harare, Zimbabwe
| | - Richard A Stabler
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Heidi Hopkins
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - David Mabey
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Kudzai P E Masunda
- Department of Health, Harare City Council, Rowan Martin Building, 1 Pennefather Avenue, Harare, Zimbabwe
| | - Katharina Kranzer
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Biomedical Research and Training Institute, 10 Seagrave Road, Harare, Zimbabwe
- Division of Infectious and Tropical Medicine, Medical Centre of the University of Munich, Leopoldstrasse, 80802, Munich, Germany
| |
Collapse
|
48
|
Causey ST, Towe SL, Hartsock J, Xu Y, Meade CS. Perceived Healthcare Access among Persons with and without HIV Who Use Illicit Stimulants: The Role of Cumulative Risk. Subst Use Misuse 2021; 56:1387-1396. [PMID: 34034631 PMCID: PMC8370044 DOI: 10.1080/10826084.2021.1928211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Persons who use stimulant drugs have greater morbidity and mortality relative to non-users. HIV infection has the potential to contribute to even great disparity in health outcomes among persons who use stimulants. These health disparities likely result in part due to poorer access to healthcare. Our study used a cumulative risk model to examine the impact of multiple risk factors on healthcare access in a sample of persons with and without HIV who use stimulants. Method: Our sample included 453 persons who reported recent use of illicit stimulants (102 HIV+, 351 HIV-). Participants completed clinical interviews, questionnaires, and a rapid oral HIV test. We constructed an 8-item cumulative risk index that included factors related to socioeconomic status, homelessness, legal history, and substance use. Results: Participants with HIV (PHW) were older than participants without HIV and more likely to have health insurance. Participants with and without HIV reported similar prior treatment utilization, but PWH reported better healthcare access and lower cumulative risk scores. Regression analyses showed cumulative risk was a significant predictor of healthcare access (β = -0.20, p < 0.001) even after controlling for age, HIV status, and health insurance status. We did not observe an interaction of HIV status by cumulative risk. Conclusions: Access to care among persons who use stimulants, both with and without HIV, is negatively impacted by the accumulation of risk factors from a number of different domains. Understanding the cumulative effects of these factors is critical for developing interventions to facilitate access to care, thus reducing health disparities and improving health outcomes.
Collapse
Affiliation(s)
- Shakiera T Causey
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sheri L Towe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jeremiah Hartsock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Yunan Xu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christina S Meade
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
49
|
Siegler EL, Moxley JH, Glesby MJ. Aging-Related Concerns of People Living with HIV Referred for Geriatric Consultation. HIV AIDS (Auckl) 2021; 13:467-474. [PMID: 33958897 PMCID: PMC8096415 DOI: 10.2147/hiv.s306532] [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: 02/14/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE People with HIV (PWH) are living longer lives and likely experiencing accentuated aging. Comprehensive geriatric assessment (CGA) has been proposed as a way to identify and help meet each individual patient's needs. PATIENTS AND METHODS We performed a retrospective review of the results of CGA in an HIV clinic in New York City. CGA included assessment of basic and instrumental activities of daily living, screens for depression, anxiety, frailty, cognition, and quality of life, along with general discussion of concerns and goals. We compared the group of PWH referred for CGA to those of comparable age who were not referred to determine the factors that were associated with referral. We carried out a descriptive analysis of those undergoing CGA, along with regression to determine factors associated with poorer PHQ-2 depression scores and higher VACS score. RESULTS A total of 105 patients underwent full CGA during the study period. Mean age of referred patients was 66.5 years, ranging from 50 to 84 years (SD 7.99). More than 92% were virally suppressed. Compared with their non-referred counterparts over 50, referred patients were older and had more functional comorbidities like cerebrovascular disease, neuropathy, and urinary incontinence. More than half complained of fatigue, and 2/3 noted poor memory. Almost 60% were frail or prefrail. Ninety patients were asked about their goals, and the most commonly cited were related to health or finances; fifteen patients were unable to articulate any goals. Having fewer goals and noting weight loss or fatigue were predictive of higher scores on the PHQ-2 depression screen. CONCLUSION Although most older PWH undergoing CGA can manage their ADL, many have concerns and deficits beyond their comorbidities. CGA offers an important window into the psychosocial concerns and needs of older PWH.
Collapse
Affiliation(s)
- Eugenia L Siegler
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Jerad H Moxley
- Division of Geriatrics and Palliative Care, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Marshall J Glesby
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, 10065, USA
| |
Collapse
|
50
|
Frain J. Considering the Impact of Aging When Caring For and Treating Adults With HIV. J Gerontol Nurs 2021; 46:31-40. [PMID: 32219455 DOI: 10.3928/00989134-20200304-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/11/2019] [Indexed: 11/20/2022]
Abstract
The current study investigates how age impacts factors associated with successfully managing HIV. One hundred thirty adults with HIV were recruited for the study. Participants were divided into two groups, those age ≥50 and those age <50. Cognitive impairment and depressive symptoms were seen at higher rates in older adults, and the severity of depressive symptoms was also higher in older adults. Depressive symptoms impacted cognitive function to a higher degree in older adults compared to younger adults (r = -0.293, p = 0.018 vs. r = -0.109, p = 0.387). Polypharmacy was a greater concern in older adults, with 88% having polypharmacy compared with 60% of younger adults. Similarly, the prevalence of comorbidities was more than double in older adults compared to younger adults. Factors associated with aging complicate management of HIV. Gaining insight into the challenges of caring for this population will furnish nurses with information necessary to provide the best possible care for this growing population. [Journal of Gerontological Nursing, 46(4), 31-40.].
Collapse
|