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Aouizerat BE, Garcia JN, Domingues CV, Xu K, Quach BC, Page GP, Konkle-Parker D, Bolivar HH, Lahiri CD, Golub ET, Cohen MH, Kassaye SG, DeHovitz J, Kuniholm MH, Archin NM, Tien PC, Hancock DB, Johnson EO. Frequent Cocaine Use is Associated With Larger HIV Latent Reservoir Size. J Acquir Immune Defic Syndr 2024; 97:156-164. [PMID: 39250649 DOI: 10.1097/qai.0000000000003472] [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: 07/31/2022] [Indexed: 09/11/2024]
Abstract
BACKGROUND Cocaine-one of the most frequently abused illicit drugs among persons living with HIV [people living with HIV (PLWH)]-slows the decline of viral production after antiretroviral therapy and is associated with higher HIV viral load, more rapid HIV progression, and increased mortality. SETTING We examined the impact of cocaine use on the CD4+ T-cell HIV latent reservoir (HLR) in virally suppressed PLWH participating in a national, longitudinal cohort study of the natural and treated history of HIV in the United States. METHODS CD4+ T-cell genomic DNA from 434 women of diverse ancestry (ie, 75% Black, 14% Hispanic, 12% White) who self-reported cocaine use (ie, 160 cocaine users, 59 prior users, 215 non-users) was analyzed using the Intact Proviral HIV DNA Assay, measuring intact provirus per 106 CD4+ T cells. FINDINGS HIV latent reservoir size differed by cocaine use (ie, median [interquartile range]: 72 [14-193] for never users, 165 [63-387] for prior users, 184 [28-502] for current users), which was statistically significantly larger in both prior (P = 0.023) and current (P = 0.001) cocaine users compared with never users. CONCLUSIONS Cocaine use may contribute to a larger replication competent HLR in CD4+ T cells among virologically suppressed women living with HIV. Our findings are important because women are underrepresented in HIV reservoir studies and in studies of the impact of cocaine use on outcomes among PLWH.
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Affiliation(s)
- Bradley E Aouizerat
- Department of Oral and Maxillofacial Surgery, New York University
- Translational Research Center, New York University
| | - Josephine N Garcia
- Department of Oral and Maxillofacial Surgery, New York University
- Translational Research Center, New York University
| | - Carlos V Domingues
- Department of Oral and Maxillofacial Surgery, New York University
- Translational Research Center, New York University
| | - Ke Xu
- Department of Psychiatry, School of Medicine, Yale University
- VA Connecticut Health Care
| | - Bryan C Quach
- Genomics and Translational Research Center, Analytics Practice Area, RTI International
| | - Grier P Page
- Genomics and Translational Research Center, Analytics Practice Area, RTI International
- Fellow Program, RTI International
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS
| | - Hector H Bolivar
- Division of Infectious Disease, University of Miami-ACRU, Miami, FL
| | - Cecile D Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Elizabeth T Golub
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital, Cook County Health System, Chicago, IL
| | - Seble G Kassaye
- Department of Medicine, Division of Infectious Diseases, Georgetown University, Washington, DC
| | - Jack DeHovitz
- Department of Medicine, Division of Infectious Diseases, Downstate Health Sciences University, Brooklyn, NY
| | - Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY
| | - Nancie M Archin
- UNC HIV Cure Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, CA; and
- Department of Veterans Affairs Medical Center, San Francisco, CA
| | - Dana B Hancock
- Genomics and Translational Research Center, Analytics Practice Area, RTI International
| | - Eric Otto Johnson
- Genomics and Translational Research Center, Analytics Practice Area, RTI International
- Fellow Program, RTI International
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2
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Lin H, Chen Y, Abror-Lacks G, Price M, Morris A, Sun J, Palella F, Chew KW, Brown TT, Rinaldo CR, Peddada SD. Sexual behavior is linked to changes in gut microbiome and systemic inflammation that lead to HIV-1 infection in men who have sex with men. Commun Biol 2024; 7:1145. [PMID: 39277660 PMCID: PMC11401892 DOI: 10.1038/s42003-024-06816-z] [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: 05/22/2024] [Accepted: 08/30/2024] [Indexed: 09/17/2024] Open
Abstract
Pathogenic changes in gut microbial composition precede the onset of HIV-1 infection in men who have sex with men (MSM). This process is associated with increased levels of systemic inflammatory biomarkers and risk for AIDS development. Using mediation analysis framework, in this report we link the effects of unprotected receptive intercourse among MSM prior to primary HIV-1 infection to higher levels of proinflammatory cytokines sCD14 and sCD163 in plasma and a significant decrease in the abundance of A. muciniphila, B. caccae, B. fragilis, B. uniformis, Bacteroides spp., Butyricimonas spp., and Odoribacter spp., and a potential increase in the abundance of Dehalobacterium spp. and Methanobrevibacter spp. in stools of MSM with the highest number of sexual partners. These differences in microbiota, together with a reduction in the pairwise correlations among commensal and short-chain fatty acid-producing bacteria with a number of sexual partners, support an increase in gut dysbiosis with the number of sexual partners. These results demonstrate the interconnectedness of sexual behavior, immune response, and microbiota composition, notably among MSM participating in high-risk sexual behaviors.
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Affiliation(s)
- Huang Lin
- Biostatistics and Computational Biology, National Institute of Environmental Health Sciences (NIH), Research Triangle Park, NC, USA
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, USA
| | - Yue Chen
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Grace Abror-Lacks
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Meaghan Price
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alison Morris
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jing Sun
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank Palella
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kara W Chew
- School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Todd T Brown
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Charles R Rinaldo
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Shyamal D Peddada
- Biostatistics and Computational Biology, National Institute of Environmental Health Sciences (NIH), Research Triangle Park, NC, USA.
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3
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Breslow AS, Lopez M, Warren B, Levin J, Sharma A, Watnick D, Sims G, Cavic E, Bassey O, Fisher MR, Bauman LJ. Lessons Learned from a Community-led, Pilot Teletherapy Group for Older Women Living with Depression and HIV. AIDS Behav 2024:10.1007/s10461-024-04468-y. [PMID: 39222185 DOI: 10.1007/s10461-024-04468-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
Older women with HIV face challenges to their quality of life, including neurocognitive decline, early-onset menopause, and chronic health issues. Chief among these concerns is depression, the most common psychiatric comorbidity among people living with HIV, with rates twice as high among women as men. However, tailored interventions among older women living with HIV and depression are lacking. Following the ADAPT-ITT framework to adapt existing interventions for cultural relevance among groups of people living with HIV, the study team revised an evidence-based intervention, the 'Stress Management and Relaxation Training/Expressive Supportive Therapy Women's Project (SMART/EST),' for online implementation. Working with two community stakeholders, the study team conducted focus groups, theater testing, and manual adaptation. This resulted in the development of e-SMART/EST, an online teletherapy group co-facilitated by a Licensed Psychologist and a credentialed Peer Counselor. The adapted, eight-session weekly intervention was tested with an exploratory pilot sample of eight older women (55 years and older) with HIV and depression. Participants rated the acceptability, feasibility, and appropriateness of the intervention, as well as symptoms of depression and HIV-related quality of life before and after the group. The e-SMART/EST Women's Project demonstrated high acceptability, feasibility, and appropriateness. Engagement was high, as women attended an average of 6.8 sessions. In qualitative interviews, participants reported peer co-facilitation, culturally relevant themes (e.g., HIV-related minority stress, critical consciousness, grief, and sex and pleasure), mindfulness techniques, and cohesion with other women as main favorable elements of the intervention. Barriers to online implementation included technological issues, distractions due to remote participation, and hindered emotional attunement compared with in-person group therapy. Findings support further research to test similar interventions in full-scale trials with older women living with depression and HIV.
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Affiliation(s)
- Aaron S Breslow
- PRIME Center for Health Equity, Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Psychiatry & Behavioral Sciences, Montefiore Medical Center, Bronx, NY, USA.
- Einstein-Rockefeller-CUNY Center for AIDS Research, Albert Einstein College of Medicine, Bronx, NY, USA.
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Van Etten 4A-47, Bronx, NY, 10461, USA.
| | - Michelle Lopez
- PRIME Center for Health Equity, Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
- Einstein-Rockefeller-CUNY Center for AIDS Research, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Barbara Warren
- LGBT Programs and Policies, Office for Diversity and Inclusion, Mount Sinai Health System, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jules Levin
- PRIME Center for Health Equity, Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
- Einstein-Rockefeller-CUNY Center for AIDS Research, Albert Einstein College of Medicine, Bronx, NY, USA
- National AIDS Treatment Advocacy Project, New York, NY, USA
| | - Anjali Sharma
- Einstein-Rockefeller-CUNY Center for AIDS Research, Albert Einstein College of Medicine, Bronx, NY, USA
- Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dana Watnick
- Einstein-Rockefeller-CUNY Center for AIDS Research, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ginette Sims
- PRIME Center for Health Equity, Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth Cavic
- PRIME Center for Health Equity, Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Obioesio Bassey
- PRIME Center for Health Equity, Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Psychiatry & Behavioral Sciences, Montefiore Medical Center, Bronx, NY, USA
| | - Marla R Fisher
- PRIME Center for Health Equity, Psychiatry Research Institute at Montefiore Einstein, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
- Mount Sinai Morningside/West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurie J Bauman
- Department of Psychiatry & Behavioral Sciences, Montefiore Medical Center, Bronx, NY, USA
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Konkle-Parker D, Cleveland JD, Long D, Nair V, Fischl M, Wingood G, Edmonds A. Population Density and Health Outcomes in Women with HIV in the Southern United States: A Retrospective Longitudinal Analysis. J Womens Health (Larchmt) 2024; 33:1111-1119. [PMID: 38864119 DOI: 10.1089/jwh.2023.0698] [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] [Indexed: 06/13/2024] Open
Abstract
Purpose: Published studies have revealed challenges for people with human immunodeficiency virus (HIV) living in rural areas compared to those in urban areas, such as poor access to HIV care, insufficient transportation, and isolation. The purpose of this study was to examine associations between population density and multiple psychosocial and clinical outcomes in the largest cohort of women with HIV (WWH) in the United States. Methods: Women's Interagency HIV Study (WIHS) participants from Southern sites (n = 561) in 2013-2018 were categorized and compared by population density quartiles. The most urban quartile was compared with the most rural quartile in several psychosocial and clinical variables, including HIV viral load suppression, HIV medication adherence, HIV care attendance, depression, internalized HIV stigma, and perceived discrimination in healthcare settings. Results: Although women in the lowest density quartile were unexpectedly more highly resourced, women in that quartile had greater odds of not attending an HIV care visit in the last six months (odds ratio [OR] = 0.64, 95% confidence interval [CI] [0.43-0.95]), yet higher odds for having fully suppressed HIV when compared to women in the highest density quartile (OR = 1.64, 95% CI [1.13-2.38]). Highly urban WWH had greater likelihood of unsuppressed HIV, even after controlling for income, employment, and health insurance, despite reporting greater HIV care adherence and similar medication adherence. Discussion: Further investigation into the reasons for these disparities by population density is needed, and particular clinical attention should be focused on individuals from high population density areas to help maximize their health outcomes.
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Affiliation(s)
- D Konkle-Parker
- Schools of Medicine, Nursing, Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - J D Cleveland
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - V Nair
- School of Population Health, Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - M Fischl
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miami, FL, USA
| | - G Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - A Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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5
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Raju S, Siddharthan T, McCormack MC, Patel SR, Kunisaki KM, D’Souza G, Cho JHJ, Stosor V, Morris A, Margolick JB, Brown TT, Punjabi NM. Influence of Impaired Diffusing Capacity and Sleep-disordered Breathing on Nocturnal Hypoxemia and Health Outcomes in Men with and without Human Immunodeficiency Virus. Ann Am Thorac Soc 2024; 21:1085-1093. [PMID: 38498872 PMCID: PMC11284323 DOI: 10.1513/annalsats.202309-757oc] [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: 09/01/2023] [Accepted: 03/18/2024] [Indexed: 03/20/2024] Open
Abstract
Rationale: Nocturnal hypoxemia is common in sleep-disordered breathing (SDB) and is associated with increased morbidity and mortality. Although impaired diffusing capacity of the lung for carbon monoxide (DlCO) is associated with daytime hypoxemia, its influence on SDB-related nocturnal hypoxemia is not known. Objectives: To characterize the effects of DlCO impairment on SDB-related nocturnal hypoxemia and associated health outcomes. Methods: Data from a multicenter cohort of men with and without human immunodeficiency virus (HIV) infection, with concomitant measures of DlCO and home-based polysomnography (n = 544), were analyzed. Multivariable quantile regression models characterized associations between DlCO and several measures of SDB-related hypoxemia (e.g., total sleep time with oxygen saturation as measured by pulse oximetry [SpO2] < 90% [T90]). Structural equation models were used to assess associations of impaired DlCO and SDB-related hypoxemia measures with prevalent hypertension and type 2 diabetes. Results: DlCO impairment (<80% predicted) was associated with sleep-related hypoxemia. Participants with severe SDB (apnea-hypopnea index ⩾ 30 events/h) and impaired DlCO had higher T90 (median difference, 15.0% [95% confidence interval (CI), 10.3% to 19.7%]) and average SDB-related desaturation (median difference, 1.0 [95% CI, 0.5 to 1.5]) and lower nadir SpO2 (median difference, -8.2% [95% CI, -11.4% to -4.9%]) and average SpO2 during sleep (median difference, -1.1% [95% CI, -2.1% to -0.01%]) than those with severe SDB and preserved DlCO. Higher T90 was associated with higher adjusted odds of prevalent hypertension (odds ratio, 1.39 [95% CI, 1.14 to 1.70]) and type 2 diabetes (odds ratio, 1.25 [95% CI, 1.07 to 1.46]). Conclusions: DlCO impairment in severe SDB was associated with sleep-related hypoxemia, prevalent hypertension, and type 2 diabetes. Assessment of SDB should be considered in those with impaired DlCO to guide testing and risk stratification strategies.
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Affiliation(s)
- Sarath Raju
- Division of Pulmonary and Critical Care Medicine and
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care Medicine and
- Division of Pulmonary and Critical Care Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Sanjay R. Patel
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ken M. Kunisaki
- Section of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
- Divison of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Gypsyamber D’Souza
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Joshua Hyong-Jin Cho
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California; and
| | - Valentina Stosor
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alison Morris
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, and Metabolism, School of Medicine, and
| | - Naresh M. Punjabi
- Division of Pulmonary and Critical Care Medicine and
- Division of Pulmonary and Critical Care Medicine, Miller School of Medicine, University of Miami, Miami, Florida
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6
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Celeste-Villalvir A, Palar K, Then-Paulino A, Wallace DD, Jimenez-Paulino G, Fulcar MA, Acevedo R, Derose KP. Perceived Impacts of Urban Gardens and Peer Nutritional Counseling for People Living With HIV in the Dominican Republic. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:478-488. [PMID: 38613552 PMCID: PMC11227956 DOI: 10.1016/j.jneb.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE Explore participants' perceptions of urban gardens and peer nutritional counseling intervention for people with HIV and food insecurity on antiretroviral therapy in the Dominican Republic. METHODS Semistructured endline interviews (n = 21) with intervention participants about their perceptions of diet, health, and quality of life. A codebook was applied to verbatim transcripts, and coded data were analyzed using matrices to identify themes. RESULTS Participants were mostly Dominican (86%; 14% Haitian); 57% were men; the mean age was 45 years. The most salient experiences described by intervention participants were improved dietary quality and diversity, improved food security, and saving money. Participants also emphasized improved social interactions, mental health, and emotional well-being. CONCLUSIONS AND IMPLICATIONS Urban gardens and peer nutritional counseling may improve participants' diet and psychosocial well-being. Nutrition programs with marginalized populations may need to improve access to healthy foods and build camaraderie and linkages to programs addressing structural factors.
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Affiliation(s)
| | - Kartika Palar
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Deshira D Wallace
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gipsy Jimenez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Maria Altagracia Fulcar
- World Food Programme, Country Office for the Dominican Republic, Santo Domingo, Dominican Republic
| | - Ramon Acevedo
- Consejo Nacional para el VIH y Sida, Santo Domingo, Dominican Republic
| | - Kathryn P Derose
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA; Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA.
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7
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Brennan-Ing M, Haberlen S, Ware D, Meanley S, Palella FJ, Bolan R, Cook JA, Okafor CN, Friedman MR, Plankey MW. Does Resilience Mediate the Relationship Between Negative Self-Image and Psychological Distress in Middle-Aged and Older Gay and Bisexual Men? Res Aging 2024:1640275241261414. [PMID: 38886913 DOI: 10.1177/01640275241261414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Aging gay and bisexual men may have negative self-images due to body image dissatisfaction and internalized ageism, resulting in psychological distress. Gay and bisexual men with HIV may be at greater risk for distress because of research linking HIV to accelerated aging. We examined associations between self-image and psychological distress, and potential mediating effects (resilience, fitness engagement), and whether these relationships were moderated by HIV serostatus. We tested our hypotheses with structural equation modeling using data from gay and bisexual men with HIV (n = 525, Mage = 57.6) and without HIV (n = 501, Mage = 62.2). We observed significant positive associations between self-image and distress and significant mediation effects (resilience, fitness engagement) that were moderated by HIV serostatus (resilience was only significant for men with HIV). We conclude that resilience interventions may be beneficial in alleviating distress from negative self-image among aging gay and bisexual men with HIV.
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Affiliation(s)
- Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, the City University of New York, New York, NY, USA
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Deanna Ware
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Frank J Palella
- Feinberg School of Medicine, Northwestern Medicine, Northwestern University, Chicago, IL, USA
| | - Robert Bolan
- Department of Family Medicine, University of Southern California, Los Angeles, CA, USA
| | - Judith A Cook
- Center on Mental Health Services Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Chukwuemeka N Okafor
- Division of Infectious Diseases, Department of Medicine, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - M Reuel Friedman
- School of Public Health, Rutgers the State University of New Jersey, New Brunswick, NJ, USA
| | - Michael W Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
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8
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Shahid A, Jones BR, Duncan MC, MacLennan S, Dapp MJ, Kuniholm MH, Aouizerat B, Archin NM, Gange S, Ofotokun I, Fischl MA, Kassaye S, Goldstein H, Anastos K, Joy JB, Brumme ZL. A simple phylogenetic approach to analyze hypermutated HIV proviruses reveals insights into their dynamics and persistence during antiretroviral therapy. RESEARCH SQUARE 2024:rs.3.rs-4549934. [PMID: 38947061 PMCID: PMC11213167 DOI: 10.21203/rs.3.rs-4549934/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Hypermutated proviruses, which arise in a single HIV replication cycle when host antiviral APOBEC3 proteins introduce extensive G-to-A mutations throughout the viral genome, persist in all people living with HIV receiving antiretroviral therapy (ART). But, the within-host evolutionary origins of hypermutated sequences are incompletely understood because phylogenetic inference algorithms, which assume that mutations gradually accumulate over generations, incorrectly reconstruct their ancestor-descendant relationships. Using > 1400 longitudinal single-genome-amplified HIV env-gp120 sequences isolated from six women over a median 18 years of follow-up - including plasma HIV RNA sequences collected over a median 9 years between seroconversion and ART initiation, and > 500 proviruses isolated over a median 9 years on ART - we evaluated three approaches for removing hypermutation from nucleotide alignments. Our goals were to 1) reconstruct accurate phylogenies that can be used for molecular dating and 2) phylogenetically infer the integration dates of hypermutated proviruses persisting during ART. Two of the tested approaches (stripping all positions containing putative APOBEC3 mutations from the alignment, or replacing individual putative APOBEC3 mutations in hypermutated sequences with the ambiguous base R) consistently normalized tree topologies, eliminated erroneous clustering of hypermutated proviruses, and brought env-intact and hypermutated proviruses into comparable ranges with respect to multiple tree-based metrics. Importantly, these corrected trees produced integration date estimates for env-intact proviruses that were highly concordant with those from benchmark trees that excluded hypermutated sequences, indicating that the corrected trees can be used for molecular dating. Use of these trees to infer the integration dates of hypermutated proviruses persisting during ART revealed that these spanned a wide age range, with the oldest ones dating to shortly after infection. This indicates that hypermutated proviruses, like other provirus types, begin to be seeded into the proviral pool immediately following infection, and can persist for decades. In two of the six participants, hypermutated proviruses differed from env-intact ones in terms of their age distributions, suggesting that different provirus types decay at heterogeneous rates in some hosts. These simple approaches to reconstruct hypermutated provirus' evolutionary histories, allow insights into their in vivo origins and longevity, towards a more comprehensive understanding of HIV persistence during ART.
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Affiliation(s)
- Aniqa Shahid
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Bradley R Jones
- Department of Mathematics, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Maggie C Duncan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Signe MacLennan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Michael J Dapp
- Department of Microbiology, University of Washington, School of Medicine, Seattle, Washington, USA
| | - Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, USA
| | | | - Nancie M Archin
- UNC HIV Cure Center, Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Stephen Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Margaret A Fischl
- Division of Infectious Diseases, Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA
| | - Seble Kassaye
- Division of Infectious Diseases and Tropical Medicine, Georgetown University, Washington, DC, USA
| | - Harris Goldstein
- Departments of Microbiology and Immunology and Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jeffrey B Joy
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zabrina L Brumme
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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9
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Anderko RR, DePuyt AE, Bronson R, Bullotta AC, Aga E, Bosch RJ, Jones RB, Eron JJ, Mellors JW, Gandhi RT, McMahon DK, Macatangay BJ, Rinaldo CR, Mailliard RB. Persistence of a Skewed Repertoire of NK Cells in People with HIV-1 on Long-Term Antiretroviral Therapy. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2024; 212:1564-1578. [PMID: 38551350 PMCID: PMC11073922 DOI: 10.4049/jimmunol.2300672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024]
Abstract
HIV-1 infection greatly alters the NK cell phenotypic and functional repertoire. This is highlighted by the expansion of a rare population of FcRγ- NK cells exhibiting characteristics of traditional immunologic memory in people with HIV (PWH). Although current antiretroviral therapy (ART) effectively controls HIV-1 viremia and disease progression, its impact on HIV-1-associated NK cell abnormalities remains unclear. To address this, we performed a longitudinal analysis detailing conventional and memory-like NK cell characteristics in n = 60 PWH during the first 4 y of ART. Throughout this regimen, a skewed repertoire of cytokine unresponsive FcRγ- memory-like NK cells persisted and accompanied an overall increase in NK surface expression of CD57 and KLRG1, suggestive of progression toward immune senescence. These traits were linked to elevated serum inflammatory biomarkers and increasing Ab titers to human CMV, with human CMV viremia detected in approximately one-third of PWH at years 1-4 of ART. Interestingly, 40% of PWH displayed atypical NK cell subsets, representing intermediate stages of NK-poiesis based on single-cell multiomic trajectory analysis. Our findings indicate that NK cell irregularities persist in PWH despite long-term ART, underscoring the need to better understand the causative mechanisms that prevent full restoration of immune health in PWH.
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Affiliation(s)
- Renee R. Anderko
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Allison E. DePuyt
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Rhianna Bronson
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Arlene C. Bullotta
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evgenia Aga
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ronald J. Bosch
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - R. Brad Jones
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Joseph J. Eron
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John W. Mellors
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rajesh T. Gandhi
- Infectious Disease Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Deborah K. McMahon
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bernard J. Macatangay
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Charles R. Rinaldo
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Robbie B. Mailliard
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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10
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Curnow AC, Huang L, Fischl MA, Floris-Moore M, Morris A, Nouraie M, Reddy DB, Seaberg EC, Sheth AN, Tien PC, Wang RJ. Hepatitis C Virus Clearance and Diffusing Capacity for Carbon Monoxide in Women With and Without Human Immunodeficiency Virus. Open Forum Infect Dis 2024; 11:ofae251. [PMID: 38770208 PMCID: PMC11103618 DOI: 10.1093/ofid/ofae251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
Hepatitis C virus (HCV) infection is associated with extrahepatic effects, including reduced diffusing capacity of the lungs. It is unknown whether clearance of HCV infection is associated with improved diffusing capacity. In this sample of women with and without human immunodeficiency virus, there was no association between HCV clearance and diffusing capacity.
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Affiliation(s)
- Andrew C Curnow
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Laurence Huang
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Margaret A Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michelle Floris-Moore
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Alison Morris
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mehdi Nouraie
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Divya B Reddy
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Eric C Seaberg
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anandi N Sheth
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Richard J Wang
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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11
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Murphy K, Shi Q, Hoover DR, Adimora AA, Alcaide ML, Brockmann S, Daubert E, Duggal P, Merenstein D, Dionne JA, Sheth AN, Keller MJ, Herold BC, Anastos K, Aouizerat B. Genetic predictors for bacterial vaginosis in women living with and at risk for HIV infection. Am J Reprod Immunol 2024; 91:e13845. [PMID: 38720636 PMCID: PMC11410097 DOI: 10.1111/aji.13845] [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: 08/31/2023] [Revised: 03/24/2024] [Accepted: 04/03/2024] [Indexed: 08/29/2024] Open
Abstract
PROBLEM Bacterial vaginosis (BV) disproportionally impacts Black and Hispanic women, placing them at risk for HIV, sexually transmitted infections and preterm birth. It is unknown whether there are differences by genetic ancestry in BV risk or whether polymorphisms associated with BV risk differ by ancestry. METHODS Women's Interagency HIV Study (WIHS) participants with longitudinal Nugent scores were dichotomized as having (n = 319, Nugent 7-10) or not having BV (n = 367, Nugent 0-3). Genetic ancestry was defined by clustering of principal components from ancestry informative markers and further stratified by BV status. 627 single nucleotide polymorphisms (SNPs) across 41 genes important in mucosal defense were identified in the WIHS GWAS. A logistic regression analysis was adjusted for nongenetic predictors of BV and self-reported race/ethnicity to assess associations between genetic ancestry and genotype. RESULTS Self-reported race and genetic ancestry were associated with BV risk after adjustment for behavioral factors. Polymorphisms in mucosal defense genes including syndecans, cytokines and toll-like receptors (TLRs) were associated with BV in all ancestral groups. CONCLUSIONS The common association of syndecan, cytokine and TLR genes and the importance of immune function and inflammatory pathways in BV, suggests these should be targeted for further research on BV pathogenesis and therapeutics.
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Affiliation(s)
- Kerry Murphy
- Departments of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Quihu Shi
- School of Health Sciences and Practice, New York Medical College, Valhalla, New York, USA
| | - Donald R Hoover
- Department of Statistics and Institute for Health, Health Care Policy and Aging Research Rutgers the State University of New Jersey, Piscataway, New Jersey, USA
| | - Adaora A Adimora
- Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Maria L Alcaide
- Department of Medicine, Obstetrics & Gynecology and Public Health, University of Miami Miller School of Medicine, Miami, USA
| | - Susan Brockmann
- Health Sciences Center, State University of New York, Brooklyn, New York, USA
| | - Elizabeth Daubert
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Priya Duggal
- Department of Epidemiology and International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jodie A Dionne
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anandi N Sheth
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marla J Keller
- Departments of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Betsy C Herold
- Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
- Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathryn Anastos
- Departments of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, USA
- Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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12
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Friedman MR, Badri S, Bowleg L, Haberlen SA, Jones DL, Kempf MC, Konkle-Parker D, Kwait J, Martinson J, Mimiaga MJ, Plankey MW, Stosor V, Tsai AC, Turan JM, Ware D, Wu K. Intersectional stigma and the non-communicable disease syndemic in the context of HIV: protocol for a multisite, observational study in the USA. BMJ Open 2024; 14:e075368. [PMID: 38670612 PMCID: PMC11057270 DOI: 10.1136/bmjopen-2023-075368] [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] [Received: 05/05/2023] [Accepted: 06/22/2023] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The increasing burden of non-communicable diseases, such as hypertension, diabetes and dyslipidaemia, presents key challenges to achieving optimal HIV care outcomes among ageing people living with HIV. These diseases are often comorbid and are exacerbated by psychosocial and structural inequities. This interaction among multiple health conditions and social factors is referred to as a syndemic. In the USA, there are substantial disparities by social position (ie, racial, ethnic and socioeconomic status) in the prevalence and/or control of non-communicable diseases and HIV. Intersecting stigmas, such as racism, classism and homophobia, may drive these health disparities by contributing to healthcare avoidance and by contributing to a psychosocial syndemic (stress, depression, violence victimisation and substance use), reducing success along the HIV and non-communicable disease continua of care. Our hypothesis is that marginalised populations experience disparities in non-communicable disease incidence, prevalence and control, mediated by intersectional stigma and the psychosocial syndemic. METHODS AND ANALYSIS Collecting data over a 4 year period, we will recruit sexual minority men (planned n=1800) enrolled in the MACS/WIHS Combined Cohort Study, a long-standing mixed-serostatus observational cohort in the USA, to investigate the following specific aims: (1) assess relationships between social position, intersectional stigma and the psychosocial syndemic among middle-aged and ageing sexual minority men, (2) assess relationships between social position and non-communicable disease incidence and prevalence and (3) assess relationships between social position and HIV and non-communicable disease continua of care outcomes, mediated by intersectional stigma and the psychosocial syndemic. Analyses will be conducted using generalised structural equation models using a cross-lagged panel model design. ETHICS AND DISSEMINATION This protocol is approved as a single-IRB study (Advarra Institutional Review Board: Protocol 00068335). We will disseminate results via peer-reviewed academic journals, scientific conferences, a dedicated website, site community advisory boards and forums hosted at participating sites.
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Grants
- U01 HL146245 NHLBI NIH HHS
- U01 HL146208 NHLBI NIH HHS
- UL1 TR001409 NCATS NIH HHS
- KL2 TR001432 NCATS NIH HHS
- U01 HL146192 NHLBI NIH HHS
- U01 HL146242 NHLBI NIH HHS
- TL1 TR001431 NCATS NIH HHS
- U01 HL146193 NHLBI NIH HHS
- R01 HL160326 NHLBI NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U01 HL146241 NHLBI NIH HHS
- P30 AI027767 NIAID NIH HHS
- P30 AI050409 NIAID NIH HHS
- U01 HL146333 NHLBI NIH HHS
- U01 HL146205 NHLBI NIH HHS
- P30 MH116867 NIMH NIH HHS
- P30 AI073961 NIAID NIH HHS
- U01 HL146201 NHLBI NIH HHS
- U01 HL146204 NHLBI NIH HHS
- U01 HL146202 NHLBI NIH HHS
- UL1 TR001881 NCATS NIH HHS
- UL1 TR000004 NCATS NIH HHS
- U01 HL146240 NHLBI NIH HHS
- U01 HL146203 NHLBI NIH HHS
- UL1 TR003098 NCATS NIH HHS
- P30 AI050410 NIAID NIH HHS
- Data Analysis and Coordination Center
- National Heart, Lung, and Blood Institute (NHLBI)
- National Institutes of Health, National Heart, Lung, and Blood Institute
- National Institutes of Health (NIH)
- UCLA
- CTSA
- ICTR
- National Institutes of Health, Office of AIDS Research (OAR)
- UCSF
- the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD)
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Affiliation(s)
- M Reuel Friedman
- Department of Urban-Global Public Health, Rutgers University, Newark, New Jersey, USA
| | - Sheila Badri
- Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Lisa Bowleg
- Department of Psychology, The George Washington University, Washington, District of Columbia, USA
| | - Sabina A Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jenn Kwait
- Whitman-Walker Institute, Washington, District of Columbia, USA
| | - Jeremy Martinson
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew J Mimiaga
- Center for LGBTQ+ Advocacy, Research & Health and Department of Epidemiology, University of California-Los Angeles, Los Angeles, California, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Valentina Stosor
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- School of Medicine and Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Janet M Turan
- Schools of Nursing, Public Health, and Medicine, University of Albama, Birmingham, Alabama, USA
| | - Deanna Ware
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Katherine Wu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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13
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Luo K, Peters BA, Moon JY, Xue X, Wang Z, Usyk M, Hanna DB, Landay AL, Schneider MF, Gustafson D, Weber KM, French A, Sharma A, Anastos K, Wang T, Brown T, Clish CB, Kaplan RC, Knight R, Burk RD, Qi Q. Metabolic and inflammatory perturbation of diabetes associated gut dysbiosis in people living with and without HIV infection. Genome Med 2024; 16:59. [PMID: 38643166 PMCID: PMC11032597 DOI: 10.1186/s13073-024-01336-1] [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: 06/21/2023] [Accepted: 04/16/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Gut dysbiosis has been linked with both HIV infection and diabetes, but its interplay with metabolic and inflammatory responses in diabetes, particularly in the context of HIV infection, remains unclear. METHODS We first conducted a cross-sectional association analysis to characterize the gut microbial, circulating metabolite, and immune/inflammatory protein features associated with diabetes in up to 493 women (~ 146 with prevalent diabetes with 69.9% HIV +) of the Women's Interagency HIV Study. Prospective analyses were then conducted to determine associations of identified metabolites with incident diabetes over 12 years of follow-up in 694 participants (391 women from WIHS and 303 men from the Multicenter AIDS Cohort Study; 166 incident cases were recorded) with and without HIV infection. Mediation analyses were conducted to explore whether gut bacteria-diabetes associations are explained by altered metabolites and proteins. RESULTS Seven gut bacterial genera were identified to be associated with diabetes (FDR-q < 0.1), with positive associations for Shigella, Escherichia, Megasphaera, and Lactobacillus, and inverse associations for Adlercreutzia, Ruminococcus, and Intestinibacter. Importantly, the associations of most species, especially Adlercreutzia and Ruminococcus, were largely independent of antidiabetic medications use. Meanwhile, 18 proteins and 76 metabolites, including 3 microbially derived metabolites (trimethylamine N-oxide, phenylacetylglutamine (PAGln), imidazolepropionic acid (IMP)), 50 lipids (e.g., diradylglycerols (DGs) and triradylglycerols (TGs)) and 23 non-lipid metabolites, were associated with diabetes (FDR-q < 0.1), with the majority showing positive associations and more than half of them (59/76) associated with incident diabetes. In mediation analyses, several proteins, especially interleukin-18 receptor 1 and osteoprotegerin, IMP and PAGln partially mediate the observed bacterial genera-diabetes associations, particularly for those of Adlercreutzia and Escherichia. Many diabetes-associated metabolites and proteins were altered in HIV, but no effect modification on their associations with diabetes was observed by HIV. CONCLUSION Among individuals with and without HIV, multiple gut bacterial genera, blood metabolites, and proinflammatory proteins were associated with diabetes. The observed mediated effects by metabolites and proteins in genera-diabetes associations highlighted the potential involvement of inflammatory and metabolic perturbations in the link between gut dysbiosis and diabetes in the context of HIV infection.
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Affiliation(s)
- Kai Luo
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Zheng Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mykhaylo Usyk
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Michael F Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York-Downstate Medical Center, Brooklyn, NY, USA
| | | | - Audrey French
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tao Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Todd Brown
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rob Knight
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA, USA
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, USA
| | - Robert D Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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14
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Abelman RA, Schneider MF, Cox C, Messerlian G, Cohen M, Gustafson D, Plankey M, Sharma A, Price J, Grunfeld C, Tien PC. Association of Androgen Hormones, Sex Hormone-Binding Globulin, and the Menopausal Transition With Incident Diabetes Mellitus in Women With and Without HIV. J Acquir Immune Defic Syndr 2024; 95:486-493. [PMID: 38180885 PMCID: PMC10947917 DOI: 10.1097/qai.0000000000003380] [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: 08/24/2023] [Accepted: 12/01/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND HIV is associated with alterations in androgen hormone levels and sex hormone-binding globulin (SHBG) in women. Higher SHBG has been associated with a lower risk of diabetes in the general population, but the contribution of HIV, androgen hormones, SHBG, and menopausal phase to diabetes is unclear. METHODS From April 2003 through February 2020, 896 women with HIV (WWH) and 343 women without HIV (WWOH) from the Women's Interagency HIV Study with morning total testosterone, dehydroepiandrosterone sulfate (DHEAS), and SHBG levels were followed to assess for incident diabetes. Parametric regression models were used with age as the time scale and relative times (RT) as the measure of association of hormone level and menopausal phase with incident diabetes. Analyses incorporated time-dependent androgen hormone, SHBG levels, and menopausal phase and were adjusted for race/ethnicity, enrollment year, smoking status, BMI, hepatitis C virus status, and HIV-related factors. RESULTS In total, 128 (14%) WWH and 47 (14%) WWOH developed diabetes. In WWH, a doubling of SHBG and DHEAS were associated with a 7% (RT = 1.07 [95% CI: 0.82 to 1.40] and 15% (RT = 1.15 [95% CI: 0.95 to 1.39]) longer time to diabetes, respectively; in WWOH, a doubling of SHBG and DHEAS were associated with 84% (RT = 1.84 [95% CI: 0.89 to 3.82]) and 41% (RT= 1.41 [95% CI: 0.82 to 2.44]) longer times to diabetes. Total testosterone was not associated. In WWH, later menopausal phase was associated with shorter times to diabetes. CONCLUSIONS Despite alterations in androgen hormone and SHBG levels in HIV, regardless of HIV status, higher SHBG and DHEAS were associated with nonstatistically significant slower progression to diabetes. The menopausal transition may be a better hormonal indicator of diabetes risk in WWH.
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Affiliation(s)
- Rebecca A Abelman
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Michael F Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Geralyn Messerlian
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI
| | - Mardge Cohen
- Department of Medicine, Stroger Hospital, Cook County Health, Chicago, IL
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY; and
| | - Jennifer Price
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Carl Grunfeld
- Department of Medicine, University of California San Francisco, San Francisco, CA
- Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA
| | - Phyllis C Tien
- Department of Medicine, University of California San Francisco, San Francisco, CA
- Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA
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15
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Tuttle DJ, Castanha PMS, Nasser A, Wilkins MS, Galarza TG, Alaoui-El-Azher M, Cuff DE, Chhibbar P, Das J, Li Y, Barratt-Boyes SM, Mailliard RB, Sluis-Cremer N, Rinaldo CR, Marques ETA. SARS-CoV-2 mRNA Vaccines Induce Greater Complement Activation and Decreased Viremia and Nef Antibodies in Men With HIV-1. J Infect Dis 2024; 229:1147-1157. [PMID: 38035792 PMCID: PMC11011180 DOI: 10.1093/infdis/jiad544] [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: 08/16/2023] [Revised: 11/16/2023] [Accepted: 11/28/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Immune dysregulation in people with human immunodeficiency virus-1 (PWH) persists despite potent antiretroviral therapy and, consequently, PWH tend to have lower immune responses to licensed vaccines. However, limited information is available about the impact of mRNA vaccines in PWH. This study details the immunologic responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccines in PWH and their impact on HIV-1. METHODS We quantified anti-S immunoglobulin G (IgG) binding and neutralization of 3 SARS-CoV-2 variants of concern and complement activation in blood from virally suppressed men with HIV-1 (MWH) and men without HIV-1 (MWOH), and the characteristics that may impact the vaccine immune responses. We also studied antibody levels against HIV-1 proteins and HIV-1 plasma RNA. RESULTS MWH had lower anti-S IgG binding and neutralizing antibodies against the 3 variants compared to MWOH. MWH also produced anti-S1 antibodies with a 10-fold greater ability to activate complement and exhibited higher C3a blood levels than MWOH. MWH had decreased residual HIV-1 plasma viremia and anti-Nef IgG approximately 100 days after immunization. CONCLUSIONS MWH respond to SARS-CoV-2 mRNA vaccines with lower antibody titers and with greater activation of complement, while exhibiting a decrease in HIV-1 viremia and anti-Nef antibodies. These results suggest an important role of complement activation mediating protection in MWH.
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Affiliation(s)
- Dylan J Tuttle
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Priscila M S Castanha
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Amro Nasser
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Maris S Wilkins
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Tamara García Galarza
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Mounia Alaoui-El-Azher
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Deirdre E Cuff
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Prabal Chhibbar
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jishnu Das
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yijia Li
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Simon M Barratt-Boyes
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Robbie B Mailliard
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nicolas Sluis-Cremer
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Charles R Rinaldo
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ernesto T A Marques
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Department of Virology and Experimental Therapeutics, Instituto Aggeu, Magalhães, Fundação Oswaldo Cruz, Recife, Pernambuco, Brazil
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Riley ED, Vittinghoff E, Ravi A, Coffin PO, Lynch KL, Wu AHB, Martinez C, Hsue PY. Brief Report: The Role of Substance Use in Structural Heart Disease Among Women Living With HIV. J Acquir Immune Defic Syndr 2024; 95:342-346. [PMID: 38133589 PMCID: PMC10922783 DOI: 10.1097/qai.0000000000003366] [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: 09/06/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND People living with HIV have increased risk of cardiovascular disease, but few studies focus on women with HIV (WWH) and few account for the use of multiple substances. SETTING We recruited WWH from San Francisco shelters, free meal programs, street encampments, and a safety net HIV clinic. METHODS Between 2016 and 2019, participants completed 6 monthly interviews, specimen collection, and a transthoracic echocardiogram. We assessed associations between 3 echocardiographic indices of cardiac hypertrophy (concentric hypertrophy, concentric remodeling, and eccentric hypertrophy) and study factors, including cardiovascular risk factors, substance use, and HIV-specific factors (CD4 + count, viral load, HIV medication). RESULTS Among 62 participants, the average age was 53 years and 70% were ethnic minority women. Just over 70% had elevated blood pressure. Toxicology-confirmed substance use included tobacco (63%), cannabis (52%), cocaine (51%), methamphetamine (29%), and alcohol (26%). Concentric hypertrophy was detected in 26% of participants. It was positively associated with cocaine use [adjusted relative risk (aRR) = 32.5, P < 0.01] and negatively associated with cannabis use (aRR = 0.07, P < 0.01). Concentric remodeling was detected in 40% of participants. It was positively associated with cocaine use (aRR = 11.2, P < 0.01) and negatively associated with cannabis use (aRR = 0.17, P = 0.02). Eccentric hypertrophy was not significantly associated with factors studied here. CONCLUSIONS Routine evaluation of stimulant use as a contributing factor to cardiovascular risk may improve risk assessment in WWH. Whether cannabis use mitigates the impact of cocaine use on structural heart disease among WWH merits further investigation.
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Affiliation(s)
- Elise D Riley
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, School of Medicine, San Francisco, CA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, School of Medicine, San Francisco, CA
| | - Akshay Ravi
- University of California, School of Medicine, Clinical Informatics, San Francisco, CA
| | - Phillip O Coffin
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, School of Medicine, San Francisco, CA
- San Francisco Department of Public Health, San Francisco, CA
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California, School of Medicine, San Francisco, CA
| | - Alan H B Wu
- Department of Laboratory Medicine, University of California, School of Medicine, San Francisco, CA
| | - Claudia Martinez
- Division of Cardiovascular Medicine, Department of Medicine, University of Miami, School of Medicine, Miami, FL; and
| | - Priscilla Y Hsue
- Division of Cardiology, Department of Medicine, University of California, School of Medicine, San Francisco, CA
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17
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Frongillo EA, Bethancourt HJ, Norcini Pala A, Maya S, Wu KC, Kizer JR, Tien PC, Kempf MC, Hanna DB, Appleton AA, Merenstein D, D'Souza G, Ofotokun I, Konkle-Parker D, Michos ED, Krier S, Stosor V, Turan B, Weiser SD. Complementing the United States Household Food Security Survey Module with Items Reflecting Social Unacceptability. J Nutr 2024; 154:1428-1439. [PMID: 38408732 PMCID: PMC11007734 DOI: 10.1016/j.tjnut.2024.02.023] [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: 11/13/2023] [Revised: 02/11/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Social unacceptability of food access is part of the lived experience of food insecurity but is not assessed as part of the United States Household Food Security Survey Module (HFSSM). OBJECTIVES The objectives were as follows: 1) to determine the psychometric properties of 2 additional items on social unacceptability in relation to the HFSSM items and 2) to test whether these 2 items provided added predictive accuracy to that of the HFSSM items for mental health outcomes. METHODS Cross-sectional data used were from the Intersection of Material-Need Insecurities and HIV and Cardiovascular Health substudy of the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study. Data on the 10-item HFSSM and 2 new items reflecting social unacceptability were collected between Fall 2020 and Fall 2021 from 1342 participants from 10 United States cities. The 2 social unacceptability items were examined psychometrically in relation to the HFSSM-10 items using models from item response theory. Linear and logistic regression was used to examine prediction of mental health measured by the 20-item Center for Epidemiologic Studies Depression scale and the 10-item Perceived Stress Scale. RESULTS The social unacceptability items were affirmed throughout the range of severity of food insecurity but with increasing frequency at higher severity of food insecurity. From item response theory models, the subconstructs reflected in the HFSSM-10 and the subconstruct of social unacceptability were distinct, not falling into one dimension. Regression models confirmed that social unacceptability was distinct from the subconstructs reflected in the HFSSM-10. The social unacceptability items as a separate scale explained more (∼1%) variation in mental health than when combined with the HFSSM-10 items in a single scale, and the social unacceptability subconstruct explained more (∼1%) variation in mental health not explained by the HFSSM-10. CONCLUSIONS Two social unacceptability items used as a separate scale along with the HFSSM-10 predicted mental health more accurately than did the HFSSM-10 alone.
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Affiliation(s)
- Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
| | - Hilary J Bethancourt
- Department of Medicine, University of California San Francisco, San Franciso, CA, United States
| | | | - Sigal Maya
- Department of Medicine, University of California San Francisco, San Franciso, CA, United States
| | - Katherine C Wu
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Jorge R Kizer
- Department of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States; Cardiology Section, San Francisco Veterans Affairs Health System, San Francisco, CA, United States
| | - Phyllis C Tien
- Department of Medicine, University of California San Francisco, San Franciso, CA, United States; Infectious Diseases Section, San Francisco Veterans Affairs Health System, San Francisco, CA, United States
| | - Mirjam-Colette Kempf
- Schools of Nursing and Medicine, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - David B Hanna
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Allison A Appleton
- Epidemiology & Biostatistics, University at Albany School of Public Health, Albany, NY, United States
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University, Washington, DC, United States
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Igho Ofotokun
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health, University of Mississippi Medical Center, Jackson, MS, United States
| | - Erin D Michos
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Sarah Krier
- Infectious Diseases & Microbiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Valentina Stosor
- School of Medicine, Northwestern University, Evanston, IL, United States
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey; Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sheri D Weiser
- Department of Medicine, University of California San Francisco, San Franciso, CA, United States
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18
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Appleton AA, Kuniholm MH, Vásquez E, Cohen MH, Donohue J, Floris-Moore M, Friedman MR, Hanna DB, Mimiaga MJ, Moran CA, Plankey MW, Teplin LA, Shitole SG, Ware D, Jones DL, Wise J. Life course history of physical and sexual abuse is associated with cardiovascular disease risk among women living with and without HIV. AIDS 2024; 38:739-750. [PMID: 38126350 PMCID: PMC10939824 DOI: 10.1097/qad.0000000000003822] [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] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Sexual and physical abuse predict cardiovascular disease (CVD) among women in the general population. Women living with HIV (WLWH) report more abuse and have higher CVD risk compared with other women, yet associations between abuse history and CVD have not been considered among WLWH. This study fills this gap, and describes possible pathways linking abuse to CVD risk among WLWH and women living without HIV (WLWOH). METHODS Using 25 years of data from the Women's Interagency HIV Study (WIHS; n = 2734; WLWH n = 1963; WLWOH n = 771), we used longitudinal generalized estimating equations (GEE) to test associations between sexual and physical abuse with CVD risk. Framingham (FRS-H) and the American College of Cardiology/American Heart Association-Pooled Cohort Equation (ACC/AHA-PCE) scores were examined. Analyses were stratified by HIV-serostatus. RESULTS Among WLWH, childhood sexual abuse was associated with higher CVD risk ( βFRS-H = 1.25, SE = 1.08, P = 0.005; βACC/AHA-PCE = 1.14, SE = 1.07, P = 0.04) compared with no abuse. Adulthood sexual abuse was associated with higher CVD risk for WLWH ( βFRS-H = 1.39, SE = 1.08, P < 0.0001) and WLWOH ( βFRS-H = 1.58, SE = 1.14, P = 0.0006). Childhood physical abuse was not associated with CVD risk for either group. Adulthood physical abuse was associated with CVD risk for WLWH ( βFRS-H = 1.44, SE = 1.07; P < 0.0001, βACC/AHA-PCE = 1.18, SE = 1.06, P = 0.002) and WLWOH ( βFRS-H = 1.68, SE = 1.12, P < 0.0001; βACC/AHA-PCE = 1.24, SE = 1.11, P = 0.03). Several pathway factors were significant, including depression, smoking, and hepatitis C infection. CONCLUSION Life course abuse may increase CVD risk among WLWH and women at high risk of acquiring HIV. Some comorbidities help explain the associations. Assessing abuse experiences in clinical encounters may help contextualize cardiovascular risk among this vulnerable population and inform intervention.
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Affiliation(s)
- Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY
| | - Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY
| | - Elizabeth Vásquez
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, IL
| | - Jessica Donohue
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michelle Floris-Moore
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - M Reuel Friedman
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, New Brunswick, NJ
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Matthew J Mimiaga
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA
| | - Caitlin A Moran
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sanyog G Shitole
- Cardiology Section, San Francisco Veterans Affairs Healthcare System
- Department of Medicine, University of California San Francisco, San Francisco, CA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Deanna Ware
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Jenni Wise
- Department of Family, Community, and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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19
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Pulliam L, Sun B, McCafferty E, Soper SA, Witek MA, Hu M, Ford JM, Song S, Kapogiannis D, Glesby MJ, Merenstein D, Tien PC, Freasier H, French A, McKay H, Diaz MM, Ofotokun I, Lake JE, Margolick JB, Kim EY, Levine SR, Fischl MA, Li W, Martinson J, Tang N. Microfluidic Isolation of Neuronal-Enriched Extracellular Vesicles Shows Distinct and Common Neurological Proteins in Long COVID, HIV Infection and Alzheimer's Disease. Int J Mol Sci 2024; 25:3830. [PMID: 38612641 PMCID: PMC11011771 DOI: 10.3390/ijms25073830] [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: 02/15/2024] [Revised: 03/16/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Long COVID (LongC) is associated with a myriad of symptoms including cognitive impairment. We reported at the beginning of the COVID-19 pandemic that neuronal-enriched or L1CAM+ extracellular vesicles (nEVs) from people with LongC contained proteins associated with Alzheimer's disease (AD). Since that time, a subset of people with prior COVID infection continue to report neurological problems more than three months after infection. Blood markers to better characterize LongC are elusive. To further identify neuronal proteins associated with LongC, we maximized the number of nEVs isolated from plasma by developing a hybrid EV Microfluidic Affinity Purification (EV-MAP) technique. We isolated nEVs from people with LongC and neurological complaints, AD, and HIV infection with mild cognitive impairment. Using the OLINK platform that assesses 384 neurological proteins, we identified 11 significant proteins increased in LongC and 2 decreased (BST1, GGT1). Fourteen proteins were increased in AD and forty proteins associated with HIV cognitive impairment were elevated with one decreased (IVD). One common protein (BST1) was decreased in LongC and increased in HIV. Six proteins (MIF, ENO1, MESD, NUDT5, TNFSF14 and FYB1) were expressed in both LongC and AD and no proteins were common to HIV and AD. This study begins to identify differences and similarities in the neuronal response to LongC versus AD and HIV infection.
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Affiliation(s)
- Lynn Pulliam
- Department of Laboratory Medicine, University of California, San Francisco, CA 94143, USA
- Department of Laboratory Medicine, San Francisco VA Health Care System, San Francisco, CA 94121, USA; (B.S.); (E.M.); (N.T.)
| | - Bing Sun
- Department of Laboratory Medicine, San Francisco VA Health Care System, San Francisco, CA 94121, USA; (B.S.); (E.M.); (N.T.)
| | - Erin McCafferty
- Department of Laboratory Medicine, San Francisco VA Health Care System, San Francisco, CA 94121, USA; (B.S.); (E.M.); (N.T.)
| | - Steven A. Soper
- Department of Chemistry, The University of Kansas, Lawrence, KS 66045, USA; (S.A.S.); (M.A.W.)
- Center of BioModular Multiscale Systems for Precision Medicine, The University of Kansas, Lawrence, KS 66045, USA
- Cancer Biology, The University of Kansas Medical Center, Kansas City, KS 66103, USA;
- Bioengineering Program, The University of Kansas, Lawrence, KS 66045, USA
| | - Malgorzata A. Witek
- Department of Chemistry, The University of Kansas, Lawrence, KS 66045, USA; (S.A.S.); (M.A.W.)
- Center of BioModular Multiscale Systems for Precision Medicine, The University of Kansas, Lawrence, KS 66045, USA
- Cancer Biology, The University of Kansas Medical Center, Kansas City, KS 66103, USA;
| | - Mengjia Hu
- Cancer Biology, The University of Kansas Medical Center, Kansas City, KS 66103, USA;
| | - Judith M. Ford
- Department of Mental Health, San Francisco VA Health Care System, San Francisco, CA 94121, USA; (J.M.F.); (S.S.)
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA 94143, USA
| | - Sarah Song
- Department of Mental Health, San Francisco VA Health Care System, San Francisco, CA 94121, USA; (J.M.F.); (S.S.)
| | - Dimitrios Kapogiannis
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 20892, USA;
| | - Marshall J. Glesby
- Department of Medicine, Weill Cornell Medical College, New York City, NY 10021, USA;
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University School of Medicine, Washington, DC 20007, USA;
| | - Phyllis C. Tien
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA; (P.C.T.); (H.F.)
- Department of Medicine, San Francisco VA Health Care System, San Francisco, CA 94121, USA
| | - Heather Freasier
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA; (P.C.T.); (H.F.)
| | - Audrey French
- Department of Medicine, Cook County Health, Chicago, IL 60612, USA;
| | - Heather McKay
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA;
| | - Igho Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Jordan E. Lake
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Eun-Young Kim
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Steven R. Levine
- Department of Neurology, State University of New York College of Medicine and Downstate Medical Sciences University, Brooklyn, NY 11203, USA;
| | | | - Wei Li
- Department of Clinical and Diagnostic Sciences, University of Alabama, Birmingham, AL 35294, USA;
| | - Jeremy Martinson
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15260, USA;
| | - Norina Tang
- Department of Laboratory Medicine, San Francisco VA Health Care System, San Francisco, CA 94121, USA; (B.S.); (E.M.); (N.T.)
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20
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Bravo CA, Moon JY, Davy K, Kaplan RC, Anastos K, Rodriguez CJ, Post WS, Gange SJ, Kassaye SG, Kingsley LA, Lazar JM, Mack WJ, Pyslar N, Tien PC, Witt MD, Palella FJ, Li Y, Yan M, Hodis HN, Hanna DB. Association of HIV and HCV Infection With Carotid Artery Plaque Echomorphology in the MACS/WIHS Combined Cohort Study. Stroke 2024; 55:651-659. [PMID: 38333992 PMCID: PMC10940210 DOI: 10.1161/strokeaha.123.043922] [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: 05/17/2023] [Accepted: 12/19/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND HIV and hepatitis C virus (HCV) are associated with increased risk of carotid artery atherosclerotic plaque and stroke. We examined associations of HIV- and HCV-related factors with echomorphologic features of carotid artery plaque. METHODS This cross-sectional study included participants from the MACS (Multicenter AIDS Cohort Study)/WIHS (Women's Interagency HIV Study) Combined Cohort Study who underwent high-resolution B-mode carotid artery ultrasound. Plaques were characterized from 6 areas of the right carotid artery. Poisson regression controlling for demographic and cardiometabolic risk factors determined adjusted prevalence ratios (aPRs) and 95% CIs for associations of HIV- and HCV-related factors with echomorphologic features. RESULTS Of 2655 participants (65% women, median age 44 [interquartile range, 37-50] years), 1845 (70%) were living with HIV, 600 (23%) were living with HCV, and 425 (16%) had carotid plaque. There were 191 plaques identified in 129 (11%) women with HIV, 51 plaques in 32 (7%) women without HIV, 248 plaques in 171 (28%) men with HIV, and 139 plaques in 93 (29%) men without HIV. Adjusted analyses showed that people with HIV and current CD4+ count <200 cells/µL had a significantly higher prevalence of predominantly echolucent plaque (aPR, 1.86 [95% CI, 1.08-3.21]) than those without HIV. HCV infection alone (aPR, 1.86 [95% CI, 1.08-3.19]) and HIV-HCV coinfection (aPR, 1.75 [95% CI, 1.10-2.78]) were each associated with higher prevalence of predominantly echogenic plaque. HIV-HCV coinfection was also associated with higher prevalence of smooth surface plaque (aPR, 2.75 [95% CI, 1.03-7.32]) compared with people without HIV and HCV. CONCLUSIONS HIV with poor immunologic control, as well as HCV infection, either alone or in the presence of HIV, were associated with different echomorphologic phenotypes of carotid artery plaque.
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Affiliation(s)
| | | | | | - Robert C. Kaplan
- Albert Einstein College of Medicine, Bronx, NY, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Wendy S. Post
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephen J. Gange
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Jason M. Lazar
- State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Wendy J. Mack
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Phyllis C. Tien
- University of California-San Francisco and Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Mallory D. Witt
- Lundquist Institute for Biomedical Research at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Frank J. Palella
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yanjie Li
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mingzhu Yan
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Howard N. Hodis
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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21
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Zhang X, Hu Y, Vandenhoudt RE, Yan C, Marconi VC, Cohen MH, Wang Z, Justice AC, Aouizerat BE, Xu K. Computationally inferred cell-type specific epigenome-wide DNA methylation analysis unveils distinct methylation patterns among immune cells for HIV infection in three cohorts. PLoS Pathog 2024; 20:e1012063. [PMID: 38466776 PMCID: PMC10957090 DOI: 10.1371/journal.ppat.1012063] [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: 10/11/2023] [Revised: 03/21/2024] [Accepted: 02/20/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Epigenome-wide association studies (EWAS) have identified CpG sites associated with HIV infection in blood cells in bulk, which offer limited knowledge of cell-type specific methylation patterns associated with HIV infection. In this study, we aim to identify differentially methylated CpG sites for HIV infection in immune cell types: CD4+ T-cells, CD8+ T-cells, B cells, Natural Killer (NK) cells, and monocytes. METHODS Applying a computational deconvolution method, we performed a cell-type based EWAS for HIV infection in three independent cohorts (Ntotal = 1,382). DNA methylation in blood or in peripheral blood mononuclear cells (PBMCs) was profiled by an array-based method and then deconvoluted by Tensor Composition Analysis (TCA). The TCA-computed CpG methylation in each cell type was first benchmarked by bisulfite DNA methylation capture sequencing in a subset of the samples. Cell-type EWAS of HIV infection was performed in each cohort separately and a meta-EWAS was conducted followed by gene set enrichment analysis. RESULTS The meta-analysis unveiled a total of 2,021 cell-type unique significant CpG sites for five inferred cell types. Among these inferred cell-type unique CpG sites, the concordance rate in the three cohorts ranged from 96% to 100% in each cell type. Cell-type level meta-EWAS unveiled distinct patterns of HIV-associated differential CpG methylation, where 74% of CpG sites were unique to individual cell types (false discovery rate, FDR <0.05). CD4+ T-cells had the largest number of unique HIV-associated CpG sites (N = 1,624) compared to any other cell type. Genes harboring significant CpG sites are involved in immunity and HIV pathogenesis (e.g. CD4+ T-cells: NLRC5, CX3CR1, B cells: IFI44L, NK cells: IL12R, monocytes: IRF7), and in oncogenesis (e.g. CD4+ T-cells: BCL family, PRDM16, monocytes: PRDM16, PDCD1LG2). HIV-associated CpG sites were enriched among genes involved in HIV pathogenesis and oncogenesis that were enriched among interferon-α and -γ, TNF-α, inflammatory response, and apoptotic pathways. CONCLUSION Our findings uncovered computationally inferred cell-type specific modifications in the host epigenome for people with HIV that contribute to the growing body of evidence regarding HIV pathogenesis.
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Affiliation(s)
- Xinyu Zhang
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Ying Hu
- Center for Biomedical Information and Information Technology, National Cancer Institute, Rockville, Maryland, United States of America
| | - Ral E. Vandenhoudt
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Chunhua Yan
- Center for Biomedical Information and Information Technology, National Cancer Institute, Rockville, Maryland, United States of America
| | - Vincent C. Marconi
- Division of Infectious Diseases, Emory University School of Medicine and Department of Global Health, Rollins School of Public Health, Emory University, Georgia, United States of America
- Atlanta Veterans Affairs Healthcare System, Decatur, Georgia, United States of America
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, United States of America
| | - Zuoheng Wang
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Amy C. Justice
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Bradley E. Aouizerat
- Translational Research Center, College of Dentistry, New York University, New York, New York, United States of America
- Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York, New York, United States of America
| | - Ke Xu
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
- Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut, United States of America
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22
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Shahid A, MacLennan S, Jones BR, Sudderuddin H, Dang Z, Cobarrubias K, Duncan MC, Kinloch NN, Dapp MJ, Archin NM, Fischl MA, Ofotokun I, Adimora A, Gange S, Aouizerat B, Kuniholm MH, Kassaye S, Mullins JI, Goldstein H, Joy JB, Anastos K, Brumme ZL. The replication-competent HIV reservoir is a genetically restricted, younger subset of the overall pool of HIV proviruses persisting during therapy, which is highly genetically stable over time. J Virol 2024; 98:e0165523. [PMID: 38214547 PMCID: PMC10878278 DOI: 10.1128/jvi.01655-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/07/2023] [Indexed: 01/13/2024] Open
Abstract
Within-host HIV populations continually diversify during untreated infection, and this diversity persists within infected cell reservoirs during antiretroviral therapy (ART). Achieving a better understanding of on-ART proviral evolutionary dynamics, and a better appreciation of how the overall persisting pool of (largely genetically defective) proviruses differs from the much smaller replication-competent HIV reservoir, is critical to HIV cure efforts. We reconstructed within-host HIV evolutionary histories in blood from seven participants of the Women's Interagency HIV Study who experienced HIV seroconversion, and used these data to characterize the diversity, lineage origins, and ages of proviral env-gp120 sequences sampled longitudinally up to 12 years on ART. We also studied HIV sequences emerging from the reservoir in two participants. We observed that proviral clonality generally increased over time on ART, with clones frequently persisting long term. While on-ART proviral integration dates generally spanned the duration of untreated infection, HIV emerging in plasma was exclusively younger (i.e., dated to the years immediately pre-ART). The genetic and age distributions of distinct proviral sequences remained stable during ART in all but one participant, in whom there was evidence that younger proviruses had been preferentially eliminated after 12 years on ART. Analysis of the gag region in three participants corroborated our env-gp120-based observations, indicating that our observations are not influenced by the HIV region studied. Our results underscore the remarkable genetic stability of the distinct proviral sequences that persist in blood during ART. Our results also suggest that the replication-competent HIV reservoir is a genetically restricted, younger subset of this overall proviral pool.IMPORTANCECharacterizing the genetically diverse HIV sequences that persist in the reservoir despite antiretroviral therapy (ART) is critical to cure efforts. Our observations confirm that proviruses persisting in blood on ART, which are largely genetically defective, broadly reflect the extent of within-host HIV evolution pre-ART. Moreover, on-ART clonal expansion is not appreciably accompanied by the loss of distinct proviral lineages. In fact, on-ART proviral genetic composition remained stable in all but one participant, in whom, after 12 years on ART, proviruses dating to around near ART initiation had been preferentially eliminated. We also identified recombinant proviruses between parental sequence fragments of different ages. Though rare, such sequences suggest that reservoir cells can be superinfected with HIV from another infection era. Overall, our finding that the replication-competent reservoir in blood is a genetically restricted, younger subset of all persisting proviruses suggests that HIV cure strategies will need to eliminate a reservoir that differs in key respects from the overall proviral pool.
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Affiliation(s)
- Aniqa Shahid
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Signe MacLennan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Bradley R. Jones
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Bioinformatics Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hanwei Sudderuddin
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Zhong Dang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kyle Cobarrubias
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Maggie C. Duncan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Natalie N. Kinloch
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Michael J. Dapp
- Department of Microbiology, University of Washington, School of Medicine, Seattle, Washington, USA
| | - Nancie M. Archin
- UNC HIV Cure Center, Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Margaret A. Fischl
- Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adaora Adimora
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Mark H. Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, New York, USA
| | - Seble Kassaye
- Division of Infectious Diseases and Tropical Medicine, Georgetown University, Washington, DC, USA
| | - James I. Mullins
- Department of Microbiology, University of Washington, School of Medicine, Seattle, Washington, USA
- Department of Global Health, University of Washington, School of Medicine, Seattle, Washington, USA
- Department of Medicine, University of Washington, School of Medicine, Seattle, Washington, USA
| | - Harris Goldstein
- Departments of Microbiology and Immunology and Pediatrics, Albert Einstein College of Medicine, Bronx, New York, New York, USA
| | - Jeffrey B. Joy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Bioinformatics Program, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - Zabrina L. Brumme
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - the MACS/WIHS combined cohort study (MWCSS)OfotokunIghovwerha1ShethAnandi1WingoodGina1BrownTodd2MargolickJoseph2AnastosKathryn3HannaDavid3SharmaAnjali3GustafsonDeborah4WilsonTracey4D’SouzaGypsyamber5GangeStephen5TopperElizabeth5CohenMardge6FrenchAudrey6WolinskySteven7PalellaFrank7StosorValentina7AouizeratBradley8PriceJennifer8TienPhyllis8DetelsRoger9MimiagaMatthew9KassayeSeble10MerensteinDaniel10AlcaideMaria11FischlMargaret11JonesDeborah11MartinsonJeremy12RinaldoCharles12KempfMirjam-Colette13Dionne-OdomJodie13Konkle-ParkerDeborah13BrockJames B.13AdimoraAdaora14Floris-MooreMichelle14Emory University, Atlanta, Georgia, USAJohns Hopkins University, Baltimore, Maryland, USAAlbert Einstein College of Medicine, Bronx, New York, USASuny Downstate Medical Center, Brooklyn, New York, USAJohns Hopkins University, Baltimore, Maryland, USAHektoen Institute for Medical Research, Chicago, Illinois, USANorthwestern University at Chicago, Chicago, Illinois, USAUniversity of California San Francisco, San Francisco, California, USAUniversity of California Los Angeles, Los Angeles, California, USAGeorgetown University, Washington, DC, USAUniversity of Miami School of Medicine, Coral Gables, Florida, USAUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USAUniversity of Alabama Birmingham, Birmingham, Alabama, USAUniversity of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Bioinformatics Program, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Microbiology, University of Washington, School of Medicine, Seattle, Washington, USA
- UNC HIV Cure Center, Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- College of Dentistry, New York University, New York, New York, USA
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, New York, USA
- Division of Infectious Diseases and Tropical Medicine, Georgetown University, Washington, DC, USA
- Department of Global Health, University of Washington, School of Medicine, Seattle, Washington, USA
- Department of Medicine, University of Washington, School of Medicine, Seattle, Washington, USA
- Departments of Microbiology and Immunology and Pediatrics, Albert Einstein College of Medicine, Bronx, New York, New York, USA
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
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23
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Reeves DB, Rigau DN, Romero A, Zhang H, Simonetti FR, Varriale J, Hoh R, Zhang L, Smith KN, Montaner LJ, Rubin LH, Gange SJ, Roan NR, Tien PC, Margolick JB, Peluso MJ, Deeks SG, Schiffer JT, Siliciano JD, Siliciano RF, Antar AAR. Mild HIV-specific selective forces overlaying natural CD4+ T cell dynamics explain the clonality and decay dynamics of HIV reservoir cells. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.13.24302704. [PMID: 38405967 PMCID: PMC10888981 DOI: 10.1101/2024.02.13.24302704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
The latent reservoir of HIV persists for decades in people living with HIV (PWH) on antiretroviral therapy (ART). To determine if persistence arises from the natural dynamics of memory CD4+ T cells harboring HIV, we compared the clonal dynamics of HIV proviruses to that of memory CD4+ T cell receptors (TCRβ) from the same PWH and from HIV-seronegative people. We show that clonal dominance of HIV proviruses and antigen-specific CD4+ T cells are similar but that the field's understanding of the persistence of the less clonally dominant reservoir is significantly limited by undersampling. We demonstrate that increasing reservoir clonality over time and differential decay of intact and defective proviruses cannot be explained by mCD4+ T cell kinetics alone. Finally, we develop a stochastic model of TCRβ and proviruses that recapitulates experimental observations and suggests that HIV-specific negative selection mediates approximately 6% of intact and 2% of defective proviral clearance. Thus, HIV persistence is mostly, but not entirely, driven by natural mCD4+ T cell kinetics.
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24
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Luo K, Wang Z, Peters BA, Hanna DB, Wang T, Sollecito CC, Grassi E, Wiek F, St Peter L, Usyk M, Post WS, Landay AL, Hodis HN, Weber KM, French A, Golub ET, Lazar J, Gustafson D, Sharma A, Anastos K, Clish CB, Knight R, Kaplan RC, Burk RD, Qi Q. Tryptophan metabolism, gut microbiota, and carotid artery plaque in women with and without HIV infection. AIDS 2024; 38:223-233. [PMID: 37199567 PMCID: PMC10640661 DOI: 10.1097/qad.0000000000003596] [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] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The perturbation of tryptophan (TRP) metabolism has been linked with HIV infection and cardiovascular disease (CVD), but the interrelationship among TRP metabolites, gut microbiota, and atherosclerosis remain unclear in the context of HIV infection. METHODS We included 361 women (241 HIV+, 120 HIV-) with carotid artery plaque assessments from the Women's Interagency HIV Study, measured 10 plasma TRP metabolites and profiled fecal gut microbiome. TRP metabolite-related gut bacteria were selected through the Analysis of Compositions of Microbiomes with Bias Correction method. Associations of TRP metabolites and related microbial features with plaque were examined using multivariable logistic regression. RESULTS Although plasma kynurenic acid (KYNA) [odds ratio (OR) = 1.93, 95% confidence interval (CI): 1.12-3.32 per one SD increase; P = 0.02) and KYNA/TRP [OR = 1.83 (95% CI 1.08-3.09), P = 0.02] were positively associated with plaque, indole-3-propionate (IPA) [OR = 0.62 (95% CI 0.40-0.98), P = 0.03] and IPA/KYNA [OR = 0.51 (95% CI 0.33-0.80), P < 0.01] were inversely associated with plaque. Five gut bacterial genera and many affiliated species were positively associated with IPA (FDR-q < 0.25), including Roseburia spp ., Eubacterium spp., Lachnospira spp., and Coprobacter spp.; but no bacterial genera were found to be associated with KYNA. Furthermore, an IPA-associated-bacteria score was inversely associated with plaque [OR = 0.47 (95% CI 0.28-0.79), P < 0.01]. But no significant effect modification by HIV serostatus was observed in these associations. CONCLUSION In a cohort of women living with and without HIV infection, plasma IPA levels and related gut bacteria were inversely associated with carotid artery plaque, suggesting a potential beneficial role of IPA and its gut bacterial producers in atherosclerosis and CVD.
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Affiliation(s)
- Kai Luo
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Zheng Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tao Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Christopher C Sollecito
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Evan Grassi
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Fanua Wiek
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Lauren St Peter
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mykhaylo Usyk
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Howard N Hodis
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Audrey French
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jason Lazar
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York-Downstate Medical Center, Brooklyn, New York, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Rob Knight
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
- Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA, USA
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Robert D Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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25
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Lin H, Chen Y, Abror G, Price M, Morris A, Sun J, Palella F, Chew KW, Brown TT, Rinaldo CR, Peddada SD. The effect of sexual behavior on HIV-1 seroconversion is mediated by the gut microbiome and proinflammatory cytokines. RESEARCH SQUARE 2024:rs.3.rs-3868545. [PMID: 38343862 PMCID: PMC10854284 DOI: 10.21203/rs.3.rs-3868545/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
The association between HIV-1 seroconversion and gut dysbiosis is well documented, and its association with sexual activity is also widely recognized. However, it is not known whether the gut dysbiosis mediates the effects of high-risk sexual behavior on HIV-1 seroconversion. In this report we focused on men who engaged in high-risk sexual behavior where they had receptive anal intercourse with multiple men. We demonstrate that proinflammatory cytokines, sCD14 and sCD163, and gut microbiota mediate the effects of this high-risk sexual behavior on subsequent HIV seroconversion. We discovered changes in the gut microbial ecology, prior to seroconversion, both in terms of the composition as well as inter-relationships among the commensal species. Furthermore, these changes correlate with future HIV seroconversion. Specifically, as the number of sexual partners increased, we discovered in a "dose-response" manner, a decrease in the abundance of commensal and short-chain fatty acid-producing species, A. muciniphila, B. caccae, B. fragilis, B. uniformis, Bacteroides spp., Butyricimonas spp., and Odoribacter spp, and an increase in proinflammatory species Dehalobacterium spp. and Methanobrevibacter spp. These changes were also observed among subsequent HIV seroconverters. Interestingly, we also discovered a reduction in correlations among these commensal and short-chain fatty acid producing bacteria in a "dose-response" manner with the number of sexual partners. Our mediation analysis not only provides a conceptual model for the disease process but also provides clues for future clinical interventions that will manipulate the gut microbiota to treat high-risk subjects to prevent HIV seroconversion.
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Affiliation(s)
- Huang Lin
- Co-first authors
- Biostatistics and Computational Biology, National Institute of Environmental Health Sciences (NIH), Research Triangle Park, NC USA
| | - Yue Chen
- Co-first authors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Grace Abror
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Meaghan Price
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Alison Morris
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Jing Sun
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Frank Palella
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Kara W Chew
- School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Todd T Brown
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Charles R Rinaldo
- Co-senior authors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Shyamal D Peddada
- Co-senior authors
- Biostatistics and Computational Biology, National Institute of Environmental Health Sciences (NIH), Research Triangle Park, NC USA
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26
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Peters BA, Hanna DB, Wang Y, Weber KM, Topper E, Appleton AA, Sharma A, Hodis HN, Santoro N, Guillemette C, Caron P, Knight R, Burk RD, Kaplan RC, Qi Q. Sex Hormones, the Stool Microbiome, and Subclinical Atherosclerosis in Women With and Without HIV. J Clin Endocrinol Metab 2024; 109:483-497. [PMID: 37643897 PMCID: PMC11032255 DOI: 10.1210/clinem/dgad510] [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] [Received: 05/18/2023] [Revised: 07/07/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
CONTEXT Cardioprotective roles of endogenous estrogens may be particularly important in women with HIV, who have reduced estrogen exposure and elevated cardiovascular disease risk. The gut microbiome metabolically interacts with sex hormones, but little is known regarding possible impact on cardiovascular risk. OBJECTIVE To analyze potential interplay of sex hormones and gut microbiome in cardiovascular risk. METHODS Among 197 postmenopausal women in the Women's Interagency HIV Study, we measured 15 sex hormones in serum and assessed the gut microbiome in stool. Presence of carotid artery plaque was determined (B-mode ultrasound) in a subset (n = 134). We examined associations of (i) sex hormones and stool microbiome, (ii) sex hormones and plaque, and (iii) sex hormone-related stool microbiota and plaque, adjusting for potential confounders. RESULTS Participant median age was 58 years and the majority were living with HIV (81%). Sex hormones (estrogens, androgens, and adrenal precursors) were associated with stool microbiome diversity and specific species, similarly in women with and without HIV. Estrogens were associated with higher diversity, higher abundance of species from Alistipes, Collinsella, Erysipelotrichia, and Clostridia, and higher abundance of microbial β-glucuronidase and aryl-sulfatase orthologs, which are involved in hormone metabolism. Several hormones were associated with lower odds of carotid artery plaque, including dihydrotestosterone, 3α-diol-17G, estradiol, and estrone. Exploratory mediation analysis suggested that estrone-related species, particularly from Collinsella, may mediate the protective association of estrone with plaque. CONCLUSION Serum sex hormones are significant predictors of stool microbiome diversity and composition. The gut microbiome may play a role in estrogen-related cardiovascular protection.
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Affiliation(s)
- Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Yi Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Kathleen M Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, IL 60608, USA
| | - Elizabeth Topper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, NY 12144, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Howard N Hodis
- Departments of Medicine and Population and Public Health Sciences, Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Chantal Guillemette
- Centre Hospitalier Universitaire (CHU) de Québec—Université Laval Research Center, Cancer research center (CRC) and Faculty of Pharmacy, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Patrick Caron
- Centre Hospitalier Universitaire (CHU) de Québec—Université Laval Research Center, Cancer research center (CRC) and Faculty of Pharmacy, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Rob Knight
- Departments of Pediatrics, Computer Science and Engineering, Bioengineering, and Center for Microbiome Innovation, University of California San Diego, La Jolla, CA 92093, USA
| | - Robert D Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Departments of Microbiology and Immunology and Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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27
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Tierney HR, Ma Y, Bacchetti P, Adimora AA, Chandran A, Kempf MC, Collins LF, DeHovitz J, DiClemente RJ, French AL, Jones DL, Sharma A, Spence AB, Hahn JA, Price JC, Tien PC. Pivoting from in-person to phone survey assessment of alcohol and substance use: effects on representativeness in a United States prospective cohort of women living with and without HIV. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:54-63. [PMID: 37956200 PMCID: PMC10939835 DOI: 10.1080/00952990.2023.2267745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 09/28/2023] [Indexed: 11/15/2023]
Abstract
Background: Many clinical and population-based research studies pivoted from in-person assessments to phone-based surveys due to the COVID-19 pandemic. The impact of these transitions on survey response remains understudied, especially for people living with HIV. Given that there are gender-specific trends in alcohol and substance use, it is particularly important to capture these data for women.Objective: Identify factors associated with responding to an alcohol and substance use phone survey administered during the COVID-19 pandemic in the Women's Interagency HIV Study, a multicenter US prospective cohort of women living with and without HIV.Methods: We used multivariable logistic regression to assess for associations of pre-pandemic (April-September 2019) sociodemographic factors, HIV status, housing status, depressive symptoms, alcohol use, and substance use with response to an early-pandemic (August-September 2020) phone survey.Results: Of 1,847 women who attended an in-person visit in 2019, 78% responded to a phone survey during the pandemic. The odds of responding were lower for women of Hispanic ethnicity (aOR 0.47 95% CI 0.33-0.66, ref=Black/African American) and those who reported substance use (aOR 0.63 95% CI 0.41-0.98). By contrast, the odds were higher for White women (aOR 1.64 95% CI 1.02-2.70, ref=Black/African American) and those with stable housing (aOR 1.74 95% CI 1.24-2.43).Conclusions: Pivoting from an in-person to phone-administered alcohol and substance use survey may lead to underrepresentation of key subpopulations of women who are often neglected in substance use and HIV research. As remote survey methods become more common, investigators need to ensure that the study population is representative of the target population.
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Affiliation(s)
- Hannah R. Tierney
- School of Medicine, University of California, San Francisco, CA, USA
| | - Yifei Ma
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Adaora A. Adimora
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Aruna Chandran
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Medicine and Public Health Birmingham, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lauren F. Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Jack DeHovitz
- Department of Medicine, State University of New York-Downstate Medical Center, Brooklyn, NY, USA
| | - Ralph J. DiClemente
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York, NY, USA
| | - Audrey L. French
- Department of Medicine, Division of Infectious Diseases, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | - Amanda B. Spence
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - Judith A. Hahn
- Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer C. Price
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Phyllis C. Tien
- Department of Medicine, Department of Veteran Affairs Medical Center, University of California San Francisco, San Francisco, CA, USA
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Salway T, Kinitz DJ, Kia H, Ashley F, Giustini D, Tiwana A, Archibald R, Mallakzadeh A, Dromer E, Ferlatte O, Goodyear T, Abramovich A. A systematic review of the prevalence of lifetime experience with 'conversion' practices among sexual and gender minority populations. PLoS One 2023; 18:e0291768. [PMID: 37792717 PMCID: PMC10550144 DOI: 10.1371/journal.pone.0291768] [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: 01/23/2023] [Accepted: 08/25/2023] [Indexed: 10/06/2023] Open
Abstract
RATIONALE Conversion practices (CPs) refer to organized attempts to deter people from adopting or expressing non-heterosexual identities or gender identities that differ from their gender/sex assigned at birth. Numerous jurisdictions have contemplated or enacted legislative CP bans in recent years. Syntheses of CP prevalence are needed to inform further public health policy and action. OBJECTIVES To conduct a systematic review describing CP prevalence estimates internationally and exploring heterogeneity across country and socially relevant subgroups. METHODS We performed literature searches in eight databases (Medline, Embase, PsycInfo, Social Work Abstracts, CINAHL, Web of Science, LGBTQ+ Source, and Proquest Dissertations) and included studies from all jurisdictions, globally, conducted after 2000 with a sampling frame of sexual and gender minority (SGM) people, as well as studies of practitioners seeing SGM patients. We used the Hoy et al. risk of bias tool for prevalence studies and summarized distribution of estimates using median and range. RESULTS We identified fourteen articles that reported prevalence estimates among SGM populations, and two articles that reported prevalence estimates from studies of mental health practitioners. Prevalence estimates among SGM samples ranged 2%-34% (median: 8.5). Prevalence estimates were greater in studies conducted in the US (median: 13%), compared to Canada (median: 7%), and greater among transgender (median: 12%), compared to cisgender (median: 4%) subsamples. Prevalence estimates were greatest among people assigned male at birth, whether transgender (median: 10%) or cisgender (median: 8%), as compared to people assigned female at birth (medians: 5% among transgender participants, 3% among cisgender participants). Further differences were observed by race (medians: 8% among Indigenous and other racial minorities, 5% among white groups) but not by sexual orientation. CONCLUSIONS CPs remain prevalent, despite denouncements from professional bodies. Social inequities in CP prevalence signal the need for targeted efforts to protect transgender, Indigenous and racial minority, and assigned-male-at-birth subgroups.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - David J. Kinitz
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hannah Kia
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada
| | - Florence Ashley
- Faculty of Law & Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Dean Giustini
- Biomedical Branch Library, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amrit Tiwana
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Reilla Archibald
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Amirali Mallakzadeh
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Elisabeth Dromer
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Olivier Ferlatte
- École de santé publique, Université de Montréal, Montréal, Quebec, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Quebec, Canada
| | - Trevor Goodyear
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Palar K, Sheira LA, Frongillo EA, Kushel M, Wilson TE, Conroy AA, Adedimeji A, Merenstein D, Cohen MH, Wentz EL, Adimora AA, Ofotokun I, Metsch LR, Turan JM, Tien PC, Weiser SD. Longitudinal Relationship Between Food Insecurity, Engagement in Care, and ART Adherence Among US Women Living with HIV. AIDS Behav 2023; 27:3345-3355. [PMID: 37067613 PMCID: PMC10783960 DOI: 10.1007/s10461-023-04053-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/18/2023]
Abstract
Food insecurity disproportionately affects people with HIV and women in the United States (US). More evidence is needed to understand the interplay between levels of food insecurity and levels of antiretroviral therapy (ART) adherence over time, as well as how food insecurity relates to engagement in HIV care. We used random effects models with longitudinal data from the US Women's Interagency HIV Study to estimate the (1) adjusted associations of current and 6-month lagged food security with ART adherence categories (n = 1646), and (2) adjusted associations of food security with engagement-in-care (n = 1733). Very low food security was associated with a higher relative risk of ART non-adherence at prior and current visits compared with food security, and this association increased across non-adherence categories. Very low food security was associated with lower odds of receiving HIV care and higher odds of a missed visit. Food insecurity among US women with HIV is associated with poorer engagement in care and degree of ART non-adherence over time.
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Affiliation(s)
- Kartika Palar
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
| | - Lila A Sheira
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Margot Kushel
- Division of General Internal Medicine at San Francisco General Hospital, UCSF, San Francisco, CA, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Health Sciences University, School of Public Health, Brooklyn, NY, USA
| | - Amy A Conroy
- Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital, Chicago, IL, USA
| | - Eryka L Wentz
- Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University, Atlanta, GA, USA
- Grady Healthcare System, Atlanta, GA, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, CA, USA
- Medical Service, Department of Veteran Affairs Medical Center, San Francisco, USA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA
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Martínez LE, Magpantay LI, Guo Y, Hegde P, Detels R, Hussain SK, Epeldegui M. Extracellular vesicles as biomarkers for AIDS-associated non-Hodgkin lymphoma risk. Front Immunol 2023; 14:1259007. [PMID: 37809067 PMCID: PMC10556683 DOI: 10.3389/fimmu.2023.1259007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Extracellular vesicles are membrane-bound structures secreted into the extracellular milieu by cells and can carry bioactive molecules. There is emerging evidence suggesting that EVs play a role in the diagnosis, treatment, and prognosis of certain cancers. In this study, we investigate the association of EVs bearing PD-L1 and molecules important in B-cell activation and differentiation with AIDS-NHL risk. Methods EVs were isolated from archived serum collected prior to the diagnosis of AIDS-NHL in cases (N = 51) and matched HIV+ controls (N = 52) who were men enrolled in the Los Angeles site of the MACS/WIHS Combined Cohort Study (MWCCS). Serum specimens of AIDS-NHL cases were collected at a mean time of 1.25 years (range of 2 to 36 months) prior to an AIDS-NHL diagnosis. The expression of PD-L1 and other molecules on EVs (CD40, CD40L, TNF-RII, IL-6Rα, B7-H3, ICAM-1, and FasL) were quantified by Luminex multiplex assay. Results and discussion We observed significantly higher levels of EVs bearing PD-L1, CD40, TNF-RII and/or IL-6Rα in AIDS-NHL cases compared with controls. Using multivariate conditional logistic regression models adjusted for age and CD4+ T-cell count, we found that EVs bearing PD-L1 (OR = 1.93; 95% CI: 1.10 - 3.38), CD40 (OR = 1.97, 95% CI: 1.09 - 3.58), TNF-RII (OR = 5.06; 95% CI: 1.99 - 12.85) and/or IL-6Rα (OR = 4.67; 95% CI: 1.40 - 15.53) were significantly and positively associated with AIDS-NHL risk. In addition, EVs bearing these molecules were significantly and positively associated with non-CNS lymphoma: PD-L1 (OR = 1.94; 95% CI: 1.01 - 3.72); CD40 (OR = 2.66; 95% CI: 1.12 - 6.35); TNF-RII (OR = 9.64; 95% CI: 2.52 - 36.86); IL-6Rα (OR = 8.34; 95% CI: 1.73 - 40.15). These findings suggest that EVs bearing PD-L1, CD40, TNF-RII and/or IL-6Rα could serve as biomarkers for the early detection of NHL in PLWH.
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Affiliation(s)
- Laura E. Martínez
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Larry I. Magpantay
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Yu Guo
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Priya Hegde
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Roger Detels
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shehnaz K. Hussain
- Department of Public Health Sciences, School of Medicine and Comprehensive Cancer Center, University of California, Davis, Davis, CA, United States
| | - Marta Epeldegui
- UCLA AIDS Institute and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, United States
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Perez NB, D'Eramo Melkus G, Yu G, Brown-Friday J, Anastos K, Aouizerat B. Study Protocol Using Cohort Data and Latent Variable Modeling to Guide Sampling Women With Type 2 Diabetes and Depressive Symptoms. Nurs Res 2023; 72:409-415. [PMID: 37625185 PMCID: PMC10534023 DOI: 10.1097/nnr.0000000000000669] [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] [Indexed: 05/17/2023]
Abstract
BACKGROUND Depression affects one in three women with Type 2 diabetes, and this concurrence significantly increases the risks of diabetes complications, disability, and early mortality. Depression is underrecognized because of wide variation in presentation and the lack of diagnostic biomarkers. Converging evidence suggests inflammation is a shared biological pathway in diabetes and depression. Overlapping epigenetic associations and social determinants of diabetes and depression implicate inflammatory pathways as a common thread. OBJECTIVES This article describes the protocol and methods for a pilot study aimed to examine associations between depressive symptoms, inflammation, and social determinants of health among women with Type 2 diabetes. METHODS This is an observational correlational study that leverages existing longitudinal data from the Women's Interagency HIV Study (WIHS), a multicenter cohort of HIV seropositive (66%) and HIV seronegative (33%) women, to inform purposive sampling of members from latent subgroups emergent from a prior retrospective cohort-wide analysis. Local active cohort participants from the Bronx study site are then selected for the study. The WIHS recently merged with the Multicenter Aids Cohort Study (MACS) to form the MACS/WIHS Combined Cohort Study. Latent subgroups represent distinct symptom trajectories resultant from a growth mixture model analysis of biannually collected depressive symptom data. Participants complete surveys (symptom and social determinants) and provide blood samples to analyze plasma levels and DNA methylation of genes that encode for inflammatory markers (CRP, IL-6, TNF-α). Correlation and regression analysis will be used to estimate the effect sizes between depressive symptoms and inflammatory markers, clinical indices (body mass index, hemoglobin A1C, comorbidities), and social determinants of health. RESULTS The study began in January 2022, and completed data collection is estimated by early 2023. We hypothesize that depressive symptom severity will associate with higher levels of inflammation, clinical indices (e.g., higher hemoglobin A1C), and exposure to specific social determinants of health (e.g., lower income, nutritional insecurity). DISCUSSION Study findings will provide the basis for future studies aimed at improving outcomes for women with Type 2 diabetes by informing the development and testing of precision health strategies to address and prevent depression in populations most at risk.
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Bekker LG, Beyrer C, Mgodi N, Lewin SR, Delany-Moretlwe S, Taiwo B, Masters MC, Lazarus JV. HIV infection. Nat Rev Dis Primers 2023; 9:42. [PMID: 37591865 DOI: 10.1038/s41572-023-00452-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
The AIDS epidemic has been a global public health issue for more than 40 years and has resulted in ~40 million deaths. AIDS is caused by the retrovirus, HIV-1, which is transmitted via body fluids and secretions. After infection, the virus invades host cells by attaching to CD4 receptors and thereafter one of two major chemokine coreceptors, CCR5 or CXCR4, destroying the host cell, most often a T lymphocyte, as it replicates. If unchecked this can lead to an immune-deficient state and demise over a period of ~2-10 years. The discovery and global roll-out of rapid diagnostics and effective antiretroviral therapy led to a large reduction in mortality and morbidity and to an expanding group of individuals requiring lifelong viral suppressive therapy. Viral suppression eliminates sexual transmission of the virus and greatly improves health outcomes. HIV infection, although still stigmatized, is now a chronic and manageable condition. Ultimate epidemic control will require prevention and treatment to be made available, affordable and accessible for all. Furthermore, the focus should be heavily oriented towards long-term well-being, care for multimorbidity and good quality of life. Intense research efforts continue for therapeutic and/or preventive vaccines, novel immunotherapies and a cure.
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Affiliation(s)
- Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, RSA, Cape Town, South Africa.
| | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Nyaradzo Mgodi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Sharon R Lewin
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | | | - Babafemi Taiwo
- Division of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Mary Clare Masters
- Division of Infectious Diseases, Northwestern University, Chicago, IL, USA
| | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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Shahid A, MacLennan S, Jones BR, Sudderuddin H, Dang Z, Cobamibias K, Duncan MC, Kinloch NN, Dapp MJ, Archin NM, Fischl MA, Ofotokun I, Adimora A, Gange S, Aouizerat B, Kuniholm MH, Kassaye S, Mullins JI, Goldstein H, Joy JB, Anastos K, Brumme ZL. The replication-competent HIV reservoir is a genetically restricted, younger subset of the overall pool of HIV proviruses persisting during therapy, which is highly genetically stable over time. RESEARCH SQUARE 2023:rs.3.rs-3259040. [PMID: 37645749 PMCID: PMC10462229 DOI: 10.21203/rs.3.rs-3259040/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Within-host HIV populations continually diversify during untreated infection, and members of these diverse forms persist within infected cell reservoirs, even during antiretroviral therapy (ART). Characterizing the diverse viral sequences that persist during ART is critical to HIV cure efforts, but our knowledge of on-ART proviral evolutionary dynamics remains incomplete, as does our understanding of the differences between the overall pool of persisting proviral DNA (which is largely genetically defective) and the subset of intact HIV sequences capable of reactivating. Here, we reconstructed within-host HIV evolutionary histories in blood from seven participants of the Women's Interagency HIV Study (WIHS) who experienced HIV seroconversion. We measured diversity, lineage origins and ages of proviral sequences (env-gp120) sampled up to four times, up to 12 years on ART. We used the same techniques to study HIV sequences emerging from the reservoir in two participants. Proviral clonality generally increased over time on ART, with clones frequently persisting across multiple time points. The integration dates of proviruses persisting on ART generally spanned the duration of untreated infection (though were often skewed towards years immediately pre-ART), while in contrast, reservoir-origin viremia emerging in plasma was exclusively "younger" (i.e., dated to the years immediately pre-ART). The genetic and age distributions of distinct proviral sequences remained highly stable during ART in all but one participant in whom, after 12 years, there was evidence that "younger" proviruses had been preferentially eliminated. Analysis of within-host recombinant proviral sequences also suggested that HIV reservoirs can be superinfected with virus reactivated from an older era, yielding infectious viral progeny with mosaic genomes of sequences with different ages. Overall, results underscore the remarkable genetic stability of distinct proviral sequences that persist on ART, yet suggest that replication-competent HIV reservoir represents a genetically-restricted and overall "younger" subset of the overall persisting proviral pool in blood.
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Affiliation(s)
- Aniqa Shahid
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Signe MacLennan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Bradley R Jones
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Hanwei Sudderuddin
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Zhong Dang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Kyle Cobamibias
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Maggie C Duncan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Natalie N Kinloch
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Michael J Dapp
- Department of Microbiology, University of Washington, School of Medicine, Seattle, WA, USA
| | - Nande M Archin
- UNC HIV Cure Center, Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, NC, USA
| | - Margaret A Fischl
- Department of Medicine, University of Miami School of Medicine, Miami, FL, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Adaora Adimora
- Departments of Medicine and Epidemiology, University of North Carolina School of Medicine, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Stephen Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, NY, USA
| | - Seble Kassaye
- Division of Infectious Diseases and Tropical Medicine, Georgetown University, Washington, DC, USA
| | - James I Mullins
- Department of Microbiology, University of Washington, School of Medicine, Seattle, WA, USA
| | - Harris Goldstein
- Departments of Microbiology and Immunology and Pediatrics, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Jeffrey B Joy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | - Zabrina L Brumme
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Collins LF, Palella FJ, Mehta CC, Holloway J, Stosor V, Lake JE, Brown TT, Topper EF, Naggie S, Anastos K, Taylor TN, Kassaye S, French AL, Adimora AA, Fischl MA, Kempf MC, Koletar SL, Tien PC, Ofotokun I, Sheth AN. Aging-Related Comorbidity Burden Among Women and Men With or At-Risk for HIV in the US, 2008-2019. JAMA Netw Open 2023; 6:e2327584. [PMID: 37548977 PMCID: PMC10407688 DOI: 10.1001/jamanetworkopen.2023.27584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Importance Despite aging-related comorbidities representing a growing threat to quality-of-life and mortality among persons with HIV (PWH), clinical guidance for comorbidity screening and prevention is lacking. Understanding comorbidity distribution and severity by sex and gender is essential to informing guidelines for promoting healthy aging in adults with HIV. Objective To assess the association of human immunodeficiency virus on the burden of aging-related comorbidities among US adults in the modern treatment era. Design, Setting, and Participants This cross-sectional analysis included data from US multisite observational cohort studies of women (Women's Interagency HIV Study) and men (Multicenter AIDS Cohort Study) with HIV and sociodemographically comparable HIV-seronegative individuals. Participants were prospectively followed from 2008 for men and 2009 for women (when more than 80% of participants with HIV reported antiretroviral therapy use) through last observation up until March 2019, at which point outcomes were assessed. Data were analyzed from July 2020 to April 2021. Exposures HIV, age, sex. Main Outcomes and Measures Comorbidity burden (the number of total comorbidities out of 10 assessed) per participant; secondary outcomes included individual comorbidity prevalence. Linear regression assessed the association of HIV status, age, and sex with comorbidity burden. Results A total of 5929 individuals were included (median [IQR] age, 54 [46-61] years; 3238 women [55%]; 2787 Black [47%], 1153 Hispanic or other [19%], 1989 White [34%]). Overall, unadjusted mean comorbidity burden was higher among women vs men (3.4 [2.1] vs 3.2 [1.8]; P = .02). Comorbidity prevalence differed by sex for hypertension (2188 of 3238 women [68%] vs 2026 of 2691 men [75%]), psychiatric illness (1771 women [55%] vs 1565 men [58%]), dyslipidemia (1312 women [41%] vs 1728 men [64%]), liver (1093 women [34%] vs 1032 men [38%]), bone disease (1364 women [42%] vs 512 men [19%]), lung disease (1245 women [38%] vs 259 men [10%]), diabetes (763 women [24%] vs 470 men [17%]), cardiovascular (493 women [15%] vs 407 men [15%]), kidney (444 women [14%] vs 404 men [15%]) disease, and cancer (219 women [7%] vs 321 men [12%]). In an unadjusted model, the estimated mean difference in comorbidity burden among women vs men was significantly greater in every age strata among PWH: age under 40 years, 0.33 (95% CI, 0.03-0.63); ages 40 to 49 years, 0.37 (95% CI, 0.12-0.61); ages 50 to 59 years, 0.38 (95% CI, 0.20-0.56); ages 60 to 69 years, 0.66 (95% CI, 0.42-0.90); ages 70 years and older, 0.62 (95% CI, 0.07-1.17). However, the difference between sexes varied by age strata among persons without HIV: age under 40 years, 0.52 (95% CI, 0.13 to 0.92); ages 40 to 49 years, -0.07 (95% CI, -0.45 to 0.31); ages 50 to 59 years, 0.88 (95% CI, 0.62 to 1.14); ages 60 to 69 years, 1.39 (95% CI, 1.06 to 1.72); ages 70 years and older, 0.33 (95% CI, -0.53 to 1.19) (P for interaction = .001). In the covariate-adjusted model, findings were slightly attenuated but retained statistical significance. Conclusions and Relevance In this cross-sectional study, the overall burden of aging-related comorbidities was higher in women vs men, particularly among PWH, and the distribution of comorbidity prevalence differed by sex. Comorbidity screening and prevention strategies tailored by HIV serostatus and sex or gender may be needed.
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Affiliation(s)
- Lauren F. Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Healthcare System, Ponce de Leon Center, Atlanta, Georgia
| | - Frank J. Palella
- Division of Infectious Diseases, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - C. Christina Mehta
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - JaNae Holloway
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Valentina Stosor
- Division of Infectious Diseases, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Jordan E. Lake
- Department of Medicine, University of Texas Health Sciences Center, Houston
| | - Todd T. Brown
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth F. Topper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Susanna Naggie
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Tonya N. Taylor
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Seble Kassaye
- Georgetown University Medical Center, Washington, DC
| | - Audrey L. French
- Division of Infectious Diseases, CORE Center, Stroger Hospital of Cook County, Chicago, Illinois
| | - Adaora A. Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Margaret A. Fischl
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham
| | - Susan L. Koletar
- Division of Infectious Diseases, The Ohio State University Medical Center, Columbus
| | - Phyllis C. Tien
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco
- Medical Service, Department of Veterans Affairs, San Francisco, California
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Healthcare System, Ponce de Leon Center, Atlanta, Georgia
| | - Anandi N. Sheth
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
- Grady Healthcare System, Ponce de Leon Center, Atlanta, Georgia
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Abelman RA, Nguyen TTJ, Ma Y, Bacchetti P, Messerlian G, French AL, Sharma A, Minkoff H, Plankey M, Grunfeld C, Tien PC. Body Composition Changes Over the Menopausal Transition in Women With and Without Human Immunodeficiency Virus. Clin Infect Dis 2023; 77:265-271. [PMID: 36974507 PMCID: PMC10371311 DOI: 10.1093/cid/ciad165] [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: 01/04/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Women are at risk for weight gain during the transition to menopause, but few have examined the contribution of menopause to weight gain in women with human immunodeficiency virus (WWH). METHODS From 2000 to 2013, participants (621 WWH; 218 without HIV [WWOH]) from the Women's Interagency HIV Study were categorized by menopausal phase using serial measures of anti-Müllerian hormone (AMH). Multivariable linear mixed models examined the association of menopausal phase with body mass index (BMI) and waist circumference (WC) trajectory, stratified by HIV status. RESULTS In models controlled for chronologic age, the estimated effects (95% confidence interval) of menopausal phase on annual rate of BMI change across early perimenopause, late perimenopause, and menopause, respectively, compared to premenopause were -0.55% (-.80 to -.30), -0.29% (-.61 to .03), and -0.67% (-1.12 to -.20) in WWH, whereas estimated effects were 0.43% (-.01 to .87) and 0.15% (-.42 to .71) across early and late perimenopause, respectively, and -0.40% (-1.24 to .45) across menopause in WWOH. The estimated effects on rate of WC change were negative across early perimenopause (-0.21% [-.44 to .03]) and menopause (-0.12% [-.5 to .26]) and positive across late perimenopause (0.18% [-.10 to .45]) in WWH, and positive across all 3 menopausal phases in WWOH, but these effects were not statistically significant. CONCLUSIONS In WWH, the menopausal transition was associated with BMI and WC trajectories that were mostly in a negative direction and opposite from WWOH after adjusting for age, suggesting that HIV blunts weight gain during the menopausal transition.
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Affiliation(s)
- Rebecca A Abelman
- Department of Medicine, University of California, San Francisco, USA
| | | | - Yifei Ma
- Department of Medicine, University of California, San Francisco, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Geralyn Messerlian
- Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island, USA
| | - Audrey L French
- Department of Medicine, Stroger Hospital, Cook County Health, Chicago, Illinois, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, New York, USA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Carl Grunfeld
- Department of Medicine, University of California, San Francisco, USA
- Medical Service, Department of Veterans Affairs Medical Center, San Francisco, California, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, USA
- Medical Service, Department of Veterans Affairs Medical Center, San Francisco, California, USA
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Lin SH, Khan SM, Zhou W, Brown DW, Vergara C, Wolinsky SM, Martínez-Maza O, Margolick JB, Martinson JJ, Hussain SK, Engels EA, Machiela MJ. Mosaic chromosomal alterations detected in men living with HIV and the relationship to non-Hodgkin lymphoma. AIDS 2023; 37:1307-1313. [PMID: 36927626 PMCID: PMC10500031 DOI: 10.1097/qad.0000000000003545] [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] [Indexed: 03/18/2023]
Abstract
OBJECTIVES People with HIV (PWH) have an elevated risk of non-Hodgkin lymphoma (NHL) and other diseases. Studying clonal hematopoiesis (CH), the clonal expansion of mutated hematopoietic stem cells, could provide insights regarding elevated NHL risk. DESIGN Cohort analysis of participants in the Multicenter AIDS Cohort Study ( N = 5979). METHODS Mosaic chromosomal alterations (mCAs), a type of CH, were detected from genotyping array data using MoChA. We compared CH prevalence in men with HIV (MWH) to HIV-uninfected men using logistic regression, and among MWH, assessed the associations of CH with NHL incidence and overall mortality using Poisson regression. RESULTS Comparing MWH to HIV-uninfected men, we observed no difference in the frequency of autosomal mCAs (3.9% vs. 3.6%, P -value = 0.09) or mosaic loss of the Y chromosome (mLOY) (1.4% vs. 2.9%, P -value = 0.13). Autosomal mCAs involving copy-neutral loss of heterozygosity (CN-LOH) of chromosome 14q were more common in MWH. Among MWH, mCAs were not associated with subsequent NHL incidence (autosomal mCA P -value = 0.65, mLOY P -value = 0.48). However, two MWH with diffuse large B-cell lymphoma had overlapping CN-LOH mCAs on chromosome 19 spanning U2AF2 (involved in RNA splicing), and one MWH with Burkitt lymphoma had high-frequency mCAs involving chromosome 1 gain and chromosome 17 CN-LOH (cell fractions 22.1% and 25.0%, respectively). mCAs were not associated with mortality among MWH (autosomal mCA P -value = 0.52, mLOY P -value = 0.93). CONCLUSIONS We found limited evidence for a relationship between HIV infection and mCAs. Although mCAs were not significantly associated with NHL, mCAs detected in several NHL cases indicate a need for further investigation.
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Affiliation(s)
- Shu-Hong Lin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Sairah M Khan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Weiyin Zhou
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Derek W Brown
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Candelaria Vergara
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD
| | | | - Otoniel Martínez-Maza
- UCLA AIDS Institute and Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, CA
| | - Joseph B Margolick
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD
| | | | - Shehnaz K Hussain
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
| | - Mitchell J Machiela
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville
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Lam JO, Hou CE, Gilsanz P, Lee C, Lea AN, Satre DD, Silverberg MJ. Undiagnosed Cognitive Impairment and Impact on Instrumental Activities of Daily Living Among People With HIV Infection in Primary Care. Open Forum Infect Dis 2023; 10:ofad284. [PMID: 37342311 PMCID: PMC10279416 DOI: 10.1093/ofid/ofad284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/18/2023] [Indexed: 06/22/2023] Open
Abstract
Background Little is known about the prevalence of undiagnosed cognitive impairment and its impact on instrumental activities of daily living (IADL) among people with HIV (PWH) in primary care. Methods PWH were recruited from an integrated health care setting in the United States. PWH were eligible for recruitment if they were ≥50 years old, taking antiretroviral therapy (ie, ≥1 antiretroviral therapy [ART] prescription fill in the past year), and had no clinical diagnosis of dementia. Participants completed a cognitive screen (St. Louis University Mental Status exam) and a questionnaire on IADL (modified Lawton-Brody). Results Study participants (n = 47) were mostly male (85.1%), 51.1% White, 25.5% Black, 17.0% Hispanic, and the average age (SD) was 59.7 (7.0) years. Overall, 27 (57.5%) participants were categorized as cognitively normal, 17 (36.2%) as having mild cognitive impairment, and 3 (6.4%) as having possible dementia. Of the 20 participants with mild cognitive impairment or possible dementia, 85.0% were men, the average age (SD) was 60.4 (7.1) years; 45.0% were White, 40.0% were Black, 10.0% were Hispanic, and 30.0% reported difficulty with at least 1 IADL. Most (66.7%) attributed difficulty with IADL primarily (33.3%) or in part (33.3%) to cognitive problems. Conclusions Undiagnosed cognitive impairment is frequent among ART-treated PWH, with possible elevated risk among Black PWH, and may be accompanied by difficulty with IADL. Efforts are needed to optimize identification of factors contributing to cognitive and IADL difficulties among ART-treated PWH in primary care.
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Affiliation(s)
- Jennifer O Lam
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Craig E Hou
- South San Francisco Medical Center, Kaiser Permanente Northern California, South San Francisco, California, USA
| | - Paola Gilsanz
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Alexandra N Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Gardner AR, Ma Y, Bacchetti P, Price JC, Kuniholm MH, French AL, Gange S, Adimora AA, Minkoff H, Kassaye S, Ofotokun I, Rosenberg W, Kovacs AAZ, Tien PC. Longitudinal Assessment of the Enhanced Liver Fibrosis Score in the Era of Contemporary HIV and Hepatitis C Virus Treatment. J Infect Dis 2023; 227:1274-1281. [PMID: 35951669 PMCID: PMC10226657 DOI: 10.1093/infdis/jiac315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The trajectory of liver fibrosis is not well understood in the contemporary era of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) therapy. METHODS We assessed the Enhanced Liver Fibrosis (ELF) score, aspartate transaminase-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) in 116 women with HIV/HCV coinfection over a 4-year period. Random-effects linear regression models examined the rate of fibrosis change 1-2 years before starting HCV treatment, within 1 year before starting (peri-HCV treatment), within 1 year after and 1-2 years post-HCV treatment in unadjusted and adjusted models including age, race, and changes from pretreatment of factors that might affect fibrosis (eg, alcohol, integrase strand inhibitor [INSTI] use, waist circumference, CD4 count). RESULTS INSTI use nearly doubled from pre- to peri-HCV treatment. In unadjusted analysis, there was a 3.3% rate of rise in ELF pre-HCV treatment, 2.2% and 3.6% rate of decline during the peri- and 1-year post-HCV treatment period, respectively, followed by a 0.3% rise. Similar findings were observed for APRI and FIB-4. There was little effect on the estimated fibrosis trajectories after adjustment. CONCLUSIONS The apparent lack of decline in biomarkers of liver fibrosis beyond 1 year after HCV cure suggests that continued monitoring of liver fibrosis and interventions to mitigate progression in people with HIV after HCV cure remains essential.
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Affiliation(s)
| | - Yifei Ma
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Jennifer C Price
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, USA
| | - Audrey L French
- Department of Medicine, Stroger Hospital, Cook County Health, Chicago, Illinois, USA
| | - Stephen Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adaora A Adimora
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Seble Kassaye
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Igho Ofotokun
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - William Rosenberg
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London, United Kingdom
| | - Andrea A Z Kovacs
- Department of Pediatrics, University of Southern California, Los Angeles, California, USA
| | - Phyllis C Tien
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Infectious Disease Section, Department of Veterans Affairs Medical Center, San Francisco, California, USA
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Wang Z, Peters BA, Bryant M, Hanna DB, Schwartz T, Wang T, Sollecito CC, Usyk M, Grassi E, Wiek F, Peter LS, Post WS, Landay AL, Hodis HN, Weber KM, French A, Golub ET, Lazar J, Gustafson D, Sharma A, Anastos K, Clish CB, Burk RD, Kaplan RC, Knight R, Qi Q. Gut microbiota, circulating inflammatory markers and metabolites, and carotid artery atherosclerosis in HIV infection. MICROBIOME 2023; 11:119. [PMID: 37237391 PMCID: PMC10224225 DOI: 10.1186/s40168-023-01566-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Alterations in gut microbiota have been implicated in HIV infection and cardiovascular disease. However, how gut microbial alterations relate to host inflammation and metabolite profiles, and their relationships with atherosclerosis, have not been well-studied, especially in the context of HIV infection. Here, we examined associations of gut microbial species and functional components measured by shotgun metagenomics with carotid artery plaque assessed by B-mode carotid artery ultrasound in 320 women with or at high risk of HIV (65% HIV +) from the Women's Interagency HIV Study. We further integrated plaque-associated microbial features with serum proteomics (74 inflammatory markers measured by the proximity extension assay) and plasma metabolomics (378 metabolites measured by liquid chromatography tandem mass spectrometry) in relation to carotid artery plaque in up to 433 women. RESULTS Fusobacterium nucleatum, a potentially pathogenic bacteria, was positively associated with carotid artery plaque, while five microbial species (Roseburia hominis, Roseburia inulinivorans, Johnsonella ignava, Odoribacter splanchnicus, Clostridium saccharolyticum) were inversely associated with plaque. Results were consistent between women with and without HIV. Fusobacterium nucleatum was positively associated with several serum proteomic inflammatory markers (e.g., CXCL9), and the other plaque-related species were inversely associated with proteomic inflammatory markers (e.g., CX3CL1). These microbial-associated proteomic inflammatory markers were also positively associated with plaque. Associations between bacterial species (especially Fusobacterium nucleatum) and plaque were attenuated after further adjustment for proteomic inflammatory markers. Plaque-associated species were correlated with several plasma metabolites, including the microbial metabolite imidazole-propionate (ImP), which was positively associated with plaque and several pro-inflammatory markers. Further analysis identified additional bacterial species and bacterial hutH gene (encoding enzyme histidine ammonia-lyase in ImP production) associated with plasma ImP levels. A gut microbiota score based on these ImP-associated species was positively associated with plaque and several pro-inflammatory markers. CONCLUSION Among women living with or at risk of HIV, we identified several gut bacterial species and a microbial metabolite ImP associated with carotid artery atherosclerosis, which might be related to host immune activation and inflammation. Video Abstract.
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Affiliation(s)
- Zheng Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - MacKenzie Bryant
- Department of Pediatrics, University of California, La Jolla, San Diego, CA, USA
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tara Schwartz
- Department of Pediatrics, University of California, La Jolla, San Diego, CA, USA
| | - Tao Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Mykhaylo Usyk
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Evan Grassi
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Fanua Wiek
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lauren St Peter
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Howard N Hodis
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Audrey French
- Department of Internal Medicine, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jason Lazar
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Robert D Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rob Knight
- Department of Pediatrics, University of California, La Jolla, San Diego, CA, USA
- Department of Bioengineering, University of California, La Jolla, San Diego, CA, USA
- Department of Computer Science and Engineering, University of California, La Jolla, San Diego, CA, USA
- Center for Microbiome Innovation, University of California, La Jolla, San Diego, CA, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Henderson ER, Haberlen SA, Coulter RW, Weinstein AM, Meanley S, Brennan-Ing M, Mimiaga MJ, Turan JM, Turan B, Teplin LA, Egan JE, Plankey MW, Friedman MR. The role of social support on cognitive function among midlife and older adult MSM. AIDS 2023; 37:803-811. [PMID: 36728912 PMCID: PMC10157348 DOI: 10.1097/qad.0000000000003464] [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] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study examines the association between social support and cognitive function among midlife and older MSM living with or without HIV. DESIGN We analyzed longitudinal data from participants enrolled from October 2016 to March 2019 in the Patterns of Healthy Aging Study, a substudy of the Multicenter AIDS Cohort Study. METHODS We conducted a cross-sectional analysis to estimate the association between social support and three measures of cognitive function [Trail Making Test (TMT) Part A, TMT Part B to A ratio, and Symbol Digit Modalities Tasks (SDMT)]. We also used linear mixed-effects models to estimate the association between baseline social support and cognitive function across four subsequent time points. We evaluated a multiplicative interaction term between baseline social support and time, in order to determine whether cognitive trajectories over time vary by baseline social support. RESULTS Social support was associated with lower TMT Part A scores at baseline and over the subsequent 2 years, indicating better psychomotor ability. Social support was associated with higher SDMT scores at baseline and across 2 years, indicating better information processing. We observed no association between social support and TMT B to A ratio at baseline or across 2 years, indicating no effect on set-shifting ability. Longitudinal cognition outcome trajectories did not vary by the level of baseline social support. CONCLUSION Social support and cognitive function were associated in this sample over a short time period. Further research should explore causal relationships over the lifespan.
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Affiliation(s)
- Emmett R. Henderson
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sabina A. Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Robert W.S. Coulter
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrea M. Weinstein
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, New York City, New York
| | - Matthew J. Mimiaga
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California
| | - Janet M. Turan
- Department of Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
| | - Linda A. Teplin
- Departments of Psychiatry and Behavioral Sciences and Medicine, Infectious Diseases, Feinberg School of Medicine, Chicago, Illinois
| | - James E. Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael W. Plankey
- Department of Medicine, Division of General Internal Medicine, George town University Medical Center, Washington, District of Columbia
| | - M. Reuel Friedman
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Zhang X, Hu Y, Vandenhoudt RE, Yan C, Marconi VC, Cohen MH, Justice AC, Aouizerat BE, Xu K. Cell-type specific EWAS identifies genes involved in HIV pathogenesis and oncogenesis among people with HIV infection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.21.533691. [PMID: 36993343 PMCID: PMC10055405 DOI: 10.1101/2023.03.21.533691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Epigenome-wide association studies (EWAS) of heterogenous blood cells have identified CpG sites associated with chronic HIV infection, which offer limited knowledge of cell-type specific methylation patterns associated with HIV infection. Applying a computational deconvolution method validated by capture bisulfite DNA methylation sequencing, we conducted a cell type-based EWAS and identified differentially methylated CpG sites specific for chronic HIV infection among five immune cell types in blood: CD4+ T-cells, CD8+ T-cells, B cells, Natural Killer (NK) cells, and monocytes in two independent cohorts (N total =1,134). Differentially methylated CpG sites for HIV-infection were highly concordant between the two cohorts. Cell-type level meta-EWAS revealed distinct patterns of HIV-associated differential CpG methylation, where 67% of CpG sites were unique to individual cell types (false discovery rate, FDR <0.05). CD4+ T-cells had the largest number of HIV-associated CpG sites (N=1,472) compared to any other cell type. Genes harboring statistically significant CpG sites are involved in immunity and HIV pathogenesis (e.g. CX3CR1 in CD4+ T-cells, CCR7 in B cells, IL12R in NK cells, LCK in monocytes). More importantly, HIV-associated CpG sites were overrepresented for hallmark genes involved in cancer pathology ( FDR <0.05) (e.g. BCL family, PRDM16, PDCD1LGD, ESR1, DNMT3A, NOTCH2 ). HIV-associated CpG sites were enriched among genes involved in HIV pathogenesis and oncogenesis such as Kras-signaling, interferon-α and -γ, TNF-α, inflammatory, and apoptotic pathways. Our findings are novel, uncovering cell-type specific modifications in the host epigenome for people with HIV that contribute to the growing body of evidence regarding pathogen-induced epigenetic oncogenicity, specifically on HIV and its comorbidity with cancers.
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Dalli J, Kitch D, O'Brien MP, Hunt PW, Funderburg N, Moisi D, Gupta A, Brown TT, Tien PC, Aberg JA, Shivakoti R. Pro-inflammatory and pro-resolving lipid mediators of inflammation in HIV: effect of aspirin intervention. EBioMedicine 2023; 89:104468. [PMID: 36791659 PMCID: PMC10025757 DOI: 10.1016/j.ebiom.2023.104468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/25/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Persons with HIV (PWH) have an increased risk of cardiovascular disease (CVD) compared to HIV-seronegative individuals (SN). Inflammation contributes to this risk but the role of lipid mediators, with central roles in inflammation, in HIV infection remain to be established; further aspirin reduces CVD risk in the general population through production of some of these anti-inflammatory lipid mediators, but they have not been studied in PWH. METHODS We evaluated the relationship between plasma lipid mediators (i.e. 50 lipid mediators including classic eicosanoids and specialized pro-resolving mediators (SPMs)) and HIV status; and the impact of aspirin in PWH on regulating these autacoids. Plasma samples were obtained from 110 PWH receiving antiretroviral therapy (ART) from a randomized trial of aspirin (ACTG-A5331) and 107 matched SN samples (MACS-WIHS Combined Cohort). FINDINGS PWH had lower levels of arachidonic acid-derived pro-inflammatory prostaglandins (PGs: PGE2 and PGD2) and thromboxanes (Tx: TxB2), and higher levels of select pro-resolving lipid mediators (e.g. RvD4 and MaR2n-3 DPA) compared to SN. At the interval tested, aspirin intervention was observed to reduced PGs and Tx, and while we did not observe an increase in aspirin triggered mediators, we observed the upregulation of other SPM in aspirin treated PWH, namely MaR2n-3 DPA. INTERPRETATION Together these observations demonstrate that plasma lipid mediators profiles, some with links to systemic inflammation and CVD risk, become altered in PWH. Furthermore, aspirin intervention did not increase levels of aspirin-triggered pro-resolving lipid mediators, consistent with other reports of an impaired aspirin response in PWH. FUNDING NIH.
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Affiliation(s)
- Jesmond Dalli
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Center for Inflammation and Therapeutic Innovation, Queen Mary University of London, London, UK
| | - Douglas Kitch
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - Peter W Hunt
- Department of Medicine, University of California, San Francisco School of Medicine, USA and Department of Veterans Affairs Medical Center, San Francisco, USA
| | - Nicholas Funderburg
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, USA
| | - Daniela Moisi
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, USA
| | - Amita Gupta
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Todd T Brown
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco School of Medicine, USA and Department of Veterans Affairs Medical Center, San Francisco, USA
| | - Judith A Aberg
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rupak Shivakoti
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
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Wang RJ, Nouraie M, Kunisaki KM, Huang L, Tien PC, Anastos K, Bhandari N, Bhatt SP, Bolivar H, Cribbs SK, Foronjy R, Gange SJ, Lazarous D, Morris A, Drummond MB. Lung Function in Women With and Without Human Immunodeficiency Virus. Clin Infect Dis 2023; 76:e727-e735. [PMID: 35604821 PMCID: PMC9907549 DOI: 10.1093/cid/ciac391] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/07/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prior studies have found that human immunodeficiency virus (HIV) infection is associated with impaired lung function and increased risk of chronic lung disease, but few have included large numbers of women. In this study, we investigate whether HIV infection is associated with differences in lung function in women. METHODS This was a cross-sectional analysis of participants in the Women's Interagency HIV Study, a racially and ethnically diverse multicenter cohort of women with and without HIV. In 2018-2019, participants at 9 clinical sites were invited to perform spirometry. Single-breath diffusing capacity for carbon monoxide (DLCO) was also measured at selected sites. The primary outcomes were the post-bronchodilator forced expiratory volume in 1 second (FEV1) and DLCO. Multivariable regression modeling was used to analyze the association of HIV infection and lung function outcomes after adjustment for confounding exposures. RESULTS FEV1 measurements from 1489 women (1062 with HIV, 427 without HIV) and DLCO measurements from 671 women (463 with HIV, 208 without HIV) met standards for quality and reproducibility. There was no significant difference in FEV1 between women with and without HIV. Women with HIV had lower DLCO measurements (adjusted difference, -0.73 mL/min/mm Hg; 95% confidence interval, -1.33 to -.14). Among women with HIV, lower nadir CD4 + cell counts and hepatitis C virus infection were associated with lower DLCO measurements. CONCLUSIONS HIV was associated with impaired respiratory gas exchange in women. Among women with HIV, lower nadir CD4 + cell counts and hepatitis C infection were associated with decreased respiratory gas exchange.
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Affiliation(s)
- Richard J Wang
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Mehdi Nouraie
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ken M Kunisaki
- Department of Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laurence Huang
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
| | - Phyllis C Tien
- Department of Medicine, University of California–San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - Neha Bhandari
- Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - Surya P Bhatt
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hector Bolivar
- Department of Medicine, University of Miami, Miami, Florida, USA
| | - Sushma K Cribbs
- Department of Medicine, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert Foronjy
- Department of Medicine, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deepa Lazarous
- Department of Medicine, Georgetown University, Washington, D.C., USA
| | - Alison Morris
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - M Bradley Drummond
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Sun J, Wiley D, Barrett BW, Hsu H, Palella FJ, Kwait J, Martinson J, D'Souza G. Comparison of anal pre-cancer screening strategies among men who have sex with men. Int J STD AIDS 2023; 34:87-97. [PMID: 36380689 PMCID: PMC9942485 DOI: 10.1177/09564624221137974] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE Comparison of anal pre-cancer screening strategies in men who have sex with men (MSM). METHODS MSM in the Multicenter AIDS Cohort Study underwent repeated anal cytology (aCyt), oncogenic human papillomavirus (oncHPV) testing. A subset received High-Resolution Anoscopy (HRA). We evaluated three screening strategies for their ability to predict anal histological High-Grade Squamous Intraepithelial lesion (HSIL): single aCyt, sequential aCyt, and oncHPV co-testing. Multivariable logistic regression models evaluated risk of HSIL among participants undergoing HRA within 5 years of screening. Sensitivity and specificity were estimated among participants with HRA, and results corrected for verification bias using weighted generalized estimating equations. RESULTS There were 1426 MSM with aCyt screening (48% people with HIV [PWH]) and 428 that underwent HRA. Median age was 57 years, 14% of PWH had CD4< 350 cells/mm3. HSIL probability was higher in MSM with one (39%, p < 0.01) or two abnormal aCyt results (46%, p < 0.01), versus those with normal aCyt (23-24%). Among men with abnormal aCyt, men with oncHPV+ had significantly higher risk than those who were oncHPV- (47% vs. 16%, p < 0.01). Specificity was modest with single aCyt+ (50%) but increased with sequential aCyt+ (79%) or oncHPV+ (67%). Sensitivity was high with single oncHPV+ (88%), moderate with single aCyt+ (66%) and oncHPV+ co-testing (61%), and low with sequential aCyt+ (39%). After correcting for potential verification bias, specificity increased and sensitivity decreased, but inferences were similar. CONCLUSION None of the screening strategies evaluated had both sufficient specificity and sensitivity to warrant routine widespread use.
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Affiliation(s)
- Jing Sun
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Benjamin W Barrett
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hilary Hsu
- School of Nursing, 8783UCLA, Los Angeles, CA, USA
| | - Frank J Palella
- Division of Infectious Diseases, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Jeremy Martinson
- Department of Infectious Diseases and Microbiology, 51303University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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45
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Fujita AW, Ramakrishnan A, Mehta CC, Yusuf OB, Wilson T, Shoptaw S, Carrico AW, Adimora AA, Eaton E, Cohen MH, Cohen J, Adedimeji A, Plankey M, Jones D, Chandran A, Colasanti JA, Sheth AN. Substance Use Treatment Utilization Among Women With and Without Human Immunodeficiency Virus. Open Forum Infect Dis 2023; 10:ofac684. [PMID: 36655189 PMCID: PMC9835749 DOI: 10.1093/ofid/ofac684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background Substance use (SU) contributes to poor health outcomes, yet limited data exist to inform strategies to optimize SU treatment among persons with human immunodeficiency virus (HIV). We describe SU and SU treatment utilization among women with and without HIV in the Women's Interagency HIV Study (WIHS). Methods We included data from women enrolled in WIHS from 2013 to 2020. Current SU was self-reported, nonmedical use of drugs in the past year, excluding use of only marijuana. SU treatment utilization was self-reported use of a drug treatment program in the past year. Multivariable regression models were used to investigate associations between participant characteristics and SU treatment. Results Among 2559 women (1802 women living with HIV [WWH], 757 women without HIV), 14% reported current SU. Among those with current SU (n = 367), 71% reported crack/cocaine followed by 40% reporting opioids, and 42% reported any treatment in the past year. The most common treatments were methadone (64%), Narcotics Anonymous (29%), inpatient programs (28%), and outpatient programs (16%). Among women using opioids (n = 147), 67% reported methadone use in the past year compared to 5% using buprenorphine/naloxone. Multivariable analysis showed lower odds of treatment utilization among WWH with concurrent alcohol or marijuana use. Visiting a psychiatrist/counselor was associated with higher odds of treatment. Among WWH, SU treatment was not associated with HIV-related clinical outcomes. Conclusions Treatment utilization was high, especially for methadone use. Our results highlight opportunities for accessing SU treatment for WWH, such as the need to prioritize buprenorphine and comprehensive, wraparound services in HIV care settings.
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Affiliation(s)
- Ayako W Fujita
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Aditi Ramakrishnan
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Infectious Diseases, School of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - C Christina Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Oyindamola B Yusuf
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tracey Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Adaora A Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ellen Eaton
- Division of Infectious Diseases, Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Jennifer Cohen
- Department of Medicine, Infectious Diseases, University of California, San Francisco, San Francisco, California, USA
| | - Adebola Adedimeji
- Division of Health Behavior Research and Implementation Science, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Plankey
- Division of General Internal Medicine, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Deborah Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Infectious Disease Program, Grady Health System, Atlanta, Georgia, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Barrett BW, McGowan K, Landon C, Zhang J, Haberlen S, Abraham AG. Cumulative exposure to viremia: Methods for the implementation of standardized variables in longitudinal HIV studies. MethodsX 2023; 10:102146. [PMID: 37025652 PMCID: PMC10070818 DOI: 10.1016/j.mex.2023.102146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Measures of viremic exposure over time, including HIV viral copy-years or durable viremic suppression, may be more relevant measures of viral load exposure for comorbid outcomes and mortality than single time point viral load measures. However, there are many subjective decisions that go into creating a cumulative variable such as HIV viral copy-years, including the appropriate anchoring point to begin accumulating exposure, the handling of viral load levels below an assay's lower limit of detection (LLD), the handling of gaps in the viral load trajectory, and when to apply the log10 transformation (before or after the accumulation calculation). Different decisions produce different values for HIV viral copy-years, and such differences could impact inferences in subsequent analyses of relationships with outcomes. In this paper, we develop several HIV viral copy-years variables that are standardized across:•Anchoring point•Handling of viral loads measured below the LLD and missing viral load measures•Application of the log10 transformation. These standardized variables may be consistently used in analyses of longitudinal cohort data. We also define a supplementary dichotomous HIV viral load exposure variable that may be used in tandem, or alternatively to, the HIV viral copy-years variables.
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Argirion I, Mahale P, Pfeiffer RM, Liu P, Adimora AA, Akiyama MJ, Bolivar HH, French A, Plankey M, Price JC, Rana A, Sheth A, Koshiol J, Seaberg EC, Kuniholm MH, Glenn J, O’Brien TR. Hepatitis B virus and hepatitis D virus infection in women with or at risk for HIV infection in the United States. Front Med (Lausanne) 2023; 10:1070420. [PMID: 36936213 PMCID: PMC10017733 DOI: 10.3389/fmed.2023.1070420] [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: 10/14/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
Hepatitis D virus (HDV) requires co-infection with hepatitis B virus (HBV). Human immunodeficiency virus (HIV) shares transmission routes with these viruses. Among 4,932 US women infected with or at-risk for HIV during 1994-2015, HBV surface antigen (HBsAg) positivity was more common in women with HIV (2.8% vs. 1.2%; p = 0.001); HDV was more common among participants enrolled during 2013-2015 (p = 0.0004) and those with resolved rather than active hepatitis C (1.9% vs. 0.5%; p = 0.02). Among HBsAg-positive women (n = 117), HDV antibody prevalence was 22% and did not vary by HIV status; HDV infection was associated with the presence of advanced fibrosis/cirrhosis at enrollment (adjusted odds ratio, 5.70; 95% confidence interval, 1.46-22.29). Our results demonstrate the importance of HDV testing in HBV-infected US women.
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Affiliation(s)
- Ilona Argirion
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
- *Correspondence: Ilona Argirion,
| | - Parag Mahale
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
| | - Ruth M. Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
| | - Ping Liu
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Adaora A. Adimora
- School of Medicine and University of North Carolina Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew J. Akiyama
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, United States
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, United States
| | - Hector H. Bolivar
- Department of Medicine, University of Miami Health System, Miami, FL, United States
| | - Audrey French
- Division of Neurology, Cook County Health, Chicago, IL, United States
- Cook County Health, Hektoen Institute of Medicine, Chicago, IL, United States
| | - Michael Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, United States
| | - Jennifer C. Price
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Aadia Rana
- Division of Infectious Diseases, University of Alabama-Birmingham Heersink School of Medicine, Birmingham, AL, United States
| | - Anandi Sheth
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States
- Grady Health System, Infectious Diseases Program, Atlanta, GA, United States
| | - Jill Koshiol
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
| | - Eric C. Seaberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mark H. Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, United States
| | - Jeffrey Glenn
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Thomas R. O’Brien
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States
- Thomas R. O’Brien,
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Price JC, Ma Y, Kuniholm MH, Adimora AA, Fischl M, French AL, Golub ET, Konkle-Parker D, Minkoff H, Ofotokun I, Plankey M, Sharma A, Tien PC. Human Immunodeficiency Virus Is Associated With Elevated FibroScan-Aspartate Aminotransferase (FAST) Score. Clin Infect Dis 2022; 75:2119-2127. [PMID: 35511608 PMCID: PMC10200299 DOI: 10.1093/cid/ciac337] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/06/2022] [Accepted: 04/27/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Whether human immunodeficiency virus (HIV) infection is associated with the development of nonalcoholic steatohepatitis (NASH) remains unclear. The FibroScan-aspartate aminotransferase (FAST) score was developed to identify patients who have histologic NASH with high nonalcoholic fatty liver disease activity score (NAS ≥4) and significant liver fibrosis (≥F2), which has been associated with higher risk of end-stage liver disease. We examined whether HIV infection is associated with elevated FAST score in a large United States (US) cohort. METHODS Vibration-controlled transient elastography was performed in 1309 women without history of chronic viral hepatitis enrolled from 10 US sites: 928 women with HIV (WWH) and 381 women without HIV (WWOH). We used multivariable logistic regression to evaluate associations of HIV, demographic, lifestyle, and metabolic factors with an elevated (>0.35) FAST score. RESULTS Median age of WWH and WWOH was 51 years and 48 years, respectively. Most (90%) WWH were on antiretroviral therapy and 72% had undetectable HIV RNA. Prevalence of elevated FAST score was higher among WWH compared to WWOH (6.3% vs 1.8%, respectively; P = .001). On multivariable analysis, HIV infection was associated with 3.7-fold higher odds of elevated FAST score (P = .002), and greater waist circumference (per 10 cm) was associated with 1.7-fold higher odds (P < .001). In analysis limited to WWH, undetectable HIV RNA and current protease inhibitor use were independently associated with lower odds of elevated FAST score. CONCLUSIONS Our findings suggest that HIV is an independent risk factor for NASH with significant activity and fibrosis. Studies validating FAST score in persons with HIV are warranted.
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Grants
- U01 AI031834 NIAID NIH HHS
- U01 HL146208 NHLBI NIH HHS
- U01 HL146192 NHLBI NIH HHS
- U01 HL146242 NHLBI NIH HHS
- R01 DA044111 NIDA NIH HHS
- U01 HL146193 NHLBI NIH HHS
- R01 DK109823 NIDDK NIH HHS
- U01 AI103390 NIAID NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U01 HL146241 NHLBI NIH HHS
- P30 AI027767 NIAID NIH HHS
- P30 AI050409 NIAID NIH HHS
- U01 HL146333 NHLBI NIH HHS
- U01 HL146245 NHLBI NIH HHS
- K24 AI108516 NIAID NIH HHS
- U01 HL146205 NHLBI NIH HHS
- P30 MH116867 NIMH NIH HHS
- P30 AI073961 NIAID NIH HHS
- U01 HL146201 NHLBI NIH HHS
- U01 HL146204 NHLBI NIH HHS
- U01 HL146202 NHLBI NIH HHS
- UL1 TR001881 NCATS NIH HHS
- U01 HL146240 NHLBI NIH HHS
- U01 HL146203 NHLBI NIH HHS
- UL1 TR003098 NCATS NIH HHS
- P30 AI050410 NIAID NIH HHS
- Women’s Interagency HIV Study
- Multicenter AIDS Cohort Study
- WIHS Combined Cohort Study
- Atlanta Clinical Research Site
- Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood
- Baltimore CRS (Todd Brown and Joseph Margolick)
- Bronx CRS (Kathryn Anastos and Anjali Sharma)
- Brooklyn CRS (Deborah Gustafson and Tracey Wilson)
- Data Analysis and Coordination Center (Gypsyamber D’Souza, Stephen Gange, and Elizabeth Golub)
- Chicago–Cook County CRS (Mardge Cohen and Audrey French)
- Chicago-Northwestern CRS (Steven Wolinsky)
- Northern California CRS (Bradley Aouizerat, Jennifer Price, and Phyllis Tien)
- Los Angeles CRS (Roger Detels and Matthew Mimiaga)
- Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein)
- Miami CRS (Maria Alcaide, Margaret Fischl, and Deborah Jones)
- Pittsburgh CRS (Jeremy Martinson and Charles Rinaldo)
- University of Alabama at Birmingham
- University of North Carolina CRS (Adaora Adimora)
- National Heart, Lung, and Blood Institute
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- National Institute on Aging
- National Institute of Dental and Craniofacial Research
- National Institute of Allergy and Infectious Diseases
- National Institute of Neurological Disorders and Stroke
- National Institute of Mental Health
- National Institute on Drug Abuse
- National Institute of Nursing Research
- National Cancer Institute
- National Institute on Alcohol Abuse and Alcoholism
- National Institute on Deafness and Other Communication Disorders
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Institute on Minority Health and Health Disparities
- University of California, San Francisco
- Clinical and Translational Science Award
- Johns Hopkins University, Institute for Clinical and Translational Research
- University of California, Los Angeles, Clinical and Translational Science Institute
- Atlanta, Center for AIDS Research
- Miami CFAR
- University of North Carolina CFAR
- University of Alabama at Birmingham CFAR
- Miami, Center for HIV and Research in Mental Health
- NIAID
- NIDDK
- American College of Gastroenterology Junior Faculty Development Award
- NIH
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Affiliation(s)
- Jennifer C Price
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Yifei Ma
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, USA
| | - Adaora A Adimora
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Margaret Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Audrey L French
- Department of Medicine, CORE Center/Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deborah Konkle-Parker
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Ighovwerha Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Veterans Affairs, San Francisco, California, USA
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Drummond MB, Edmonds A, Ramirez C, Stosor V, Barjaktarevic I, Morris A, McCormack MC, Bhatt SP, Alcaide ML, Cribbs SK, D’Souza G, Bhandari N, Kunisaki KM, Huang L, Kassaye SG, Foronjy R, Sharma A, Westreich DJ, Adimora AA. Association Between HIV and Prevalence and Manifestations of Asthma: Analysis of the Multicenter AIDS Cohort Study and Women's Interagency HIV Study. J Acquir Immune Defic Syndr 2022; 91:419-428. [PMID: 36083508 PMCID: PMC9649933 DOI: 10.1097/qai.0000000000003088] [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: 04/25/2022] [Accepted: 08/17/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The association between HIV and asthma prevalence and manifestations remains unclear, with few studies including women. SETTING A retrospective observational cohort study from the Multicenter AIDS Cohort Study and Women's Interagency HIV Study. METHODS Asthma was defined in 2 ways: (1) self-report and (2) robust criteria requiring all the following: lack of fixed airflow obstruction, presence of wheeze on the St. George's Respiratory Questionnaire (SGRQ), and report of asthma therapies. Estimates of asthma prevalence and asthma-related manifestations were compared by HIV serostatus. RESULTS A total of 1815 men and 2122 women were included. Asthma prevalence did not differ between people with HIV (PWH) and people without HIV regardless of definition: self-report (men, 12.0% vs. 11.2%; women, 24.3% vs. 27.5%) and robust criteria (men, 5.0% vs. 3.4%; women, 12.8% vs. 13.2%). Among men with asthma, worse respiratory symptom burden was reported among those with HIV, regardless of asthma definition. Among women with self-reported asthma, those with HIV had less respiratory symptom burden. Regardless of serostatus, women with robust-defined asthma had similar respiratory symptoms across SGRQ domains and similar frequencies of phlegm, shortness of breath, and wheezing. CONCLUSIONS Among PWH and people without HIV, asthma prevalence was 2-fold to 3-fold higher using self-reported definition rather than robust definition. In men and women, HIV was not associated with increased asthma prevalence. In men, HIV was associated with more respiratory symptoms when asthma was self-reported; the relationship was attenuated with the robust criteria. Further studies are needed to explore asthma phenotypes among PWH.
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Affiliation(s)
- M. Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Edmonds
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Catalina Ramirez
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Valentina Stosor
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Chicago, IL
| | - Igor Barjaktarevic
- Division of Pulmonary Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Alison Morris
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Meredith C. McCormack
- Division of Pulmonary Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Maria L. Alcaide
- Department of Medicine, OB/GYN, and Public Health, University of Miami Miller School of Medicine, Miami, FL
| | - Sushma K. Cribbs
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA, USA; Atlanta Veterans Affairs Medical Center, Atlanta, GA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Neha Bhandari
- Division of Pulmonary and Critical Care Medicine, Cook County Health, Chicago, IL
| | - Ken M. Kunisaki
- Pulmonary, Allergy, Critical Care and Sleep Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
| | - Laurence Huang
- Divisions of Pulmonary and Critical Care Medicine and HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA
| | - Seble G. Kassaye
- Department of Medicine, Georgetown University Medical Center, Georgetown University, Washington, DC
| | - Robert Foronjy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Anjali Sharma
- Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY
| | - Daniel J. Westreich
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Meanley S, Egan JE, Ware D, Brennan-Ing M, Haberlen SA, Detels R, Palella F, Friedman MR, Plankey MW. Self-Reported Combination HIV Prevention Strategies Enacted by a Prospective Cohort of Midlife and Older Men Who Have Sex with Men in the United States: A Latent Class Analysis. AIDS Patient Care STDS 2022; 36:462-473. [PMID: 36394465 PMCID: PMC9839341 DOI: 10.1089/apc.2022.0167] [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] [Indexed: 11/18/2022] Open
Abstract
Insights into combination HIV prevention (CHP) strategies to reduce HIV incidence among midlife and older adult men who have sex with men (MSM) are limited. The current study is a secondary data analysis evaluating CHP in a sample of sexually active midlife and older adult MSM (N = 566) from the Multicenter AIDS Cohort Study Healthy Aging Substudy. Stratified by HIV serostatus, we used latent class analyses to identify CHP classes based on self-reported sociobehavioral and biobehavioral prevention strategies that participants and their male partners used in the prior 6 months. We identified three CHP classes among men living without HIV (MLWOH), including the following: high CHP overall (43.0%), high anal sex abstention (15.0%), and low prevention overall (42.0%). Among men living with HIV (MLWH), we identified four CHP classes, including the following: high CHP overall (20.9%), high CHP/low condom use (27.1%), high condom reliance (22.3%), and low prevention overall (29.7%). There were small differences by sociodemographic characteristics and sexual behavior practices between the classes; however, poppers use was often linked to being in high CHP groups. Our findings support that CHP is not one-size-fits-all for midlife and older adult MSM. There remains a need to scale up clinical providers' sexual health communication practices to assist midlife and older MSM incorporate prevention strategies, particularly biobehavioral prevention strategies that align with their patients' lived experiences.
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Affiliation(s)
- Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - James E. Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Deanna Ware
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York City, New York, USA
| | - Sabina A. Haberlen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Roger Detels
- Department of Epidemiology and Infectious Diseases, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - Frank Palella
- Department of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mackey R. Friedman
- Department of Infectious Diseases and Microbiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Michael W. Plankey
- Department of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA
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