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Bryant VE, Fieo RA, Fiore AJ, Richards VL, Porges EC, Williams R, Lu H, Zhou Z, Cook RL. Subjective Cognitive Complaints: Predictors and Health Outcomes in People Living with HIV. AIDS Behav 2022; 26:1163-1172. [PMID: 34550502 DOI: 10.1007/s10461-021-03469-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
There is a paucity of research on the prevalence of subjective cognitive complaints in people living with human immunodeficiency virus, along with the predictors and outcomes related to these complaints. We assessed demographics, substance use and psychiatric predictors, and HIV-related outcomes associated with subjective cognitive complaint items from the Cognitive Difficulties Scale. The sample consisted of 889 people living with HIV in the survey-based Florida Cohort. Results of multivariable regression models indicated that age (45-54), hazardous alcohol consumption, more frequent marijuana use and psychiatric symptoms (depression, anxiety, PTSD) were significant predictors of subjective cognitive complaints. Subjective cognitive complaints were associated with lower adherence to antiretroviral therapy in bivariate analyses, but this relationship was no longer significant after controlling for depression, race, alcohol and drug use. Further research into the relationship between depressive and subjective cognitive complaints may provide additional avenues for intervention.
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Yee LM, Kacanek D, Brightwell C, Haddad LB, Jao J, Powis KM, Yao TJ, Barr E, Broadwell C, Siminski S, Seage GR, Chadwick EG. Marijuana, Opioid, and Alcohol Use Among Pregnant and Postpartum Individuals Living With HIV in the US. JAMA Netw Open 2021; 4:e2137162. [PMID: 34860242 PMCID: PMC8642784 DOI: 10.1001/jamanetworkopen.2021.37162] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/14/2021] [Indexed: 11/15/2022] Open
Abstract
Importance Amid the opioid epidemic and evolving legal and social changes with marijuana, little is known about substance use among pregnant and postpartum people living with HIV. Objectives To evaluate trends in marijuana, alcohol, and opioid use during pregnancy and the first year postpartum among US people living with HIV and the differences in substance use based on marijuana legalization status. Design, Setting, and Participants Data from the Surveillance Monitoring for Antiretroviral Toxicities (SMARTT) study of the Pediatric HIV/AIDS Cohort Study were analyzed. SMARTT-enrolled, pregnant people living with HIV at 22 US sites from January 1, 2007, to July 1, 2019, with self-reported substance use data available in pregnancy, 1 year postpartum, or both were assessed. Exposures Calendar year and state marijuana legalization status. Main Outcomes and Measures The prevalence of any use of each of the following substances was calculated by calendar year, separately for pregnancy and postpartum: marijuana, alcohol, opioid, and concomitant alcohol and marijuana. Log binomial models were fit using general estimating equations to evaluate the mean annual change, accounting for repeat pregnancies. The study also evaluated differences in substance use by state recreational or medical marijuana legalization status. Results Substance use data were available for 2926 pregnancies from 2310 people living with HIV (mean [SD] age, 28.8 [6.1] years; 822 [28.1%] Hispanic, 1859 [63.5%] non-Hispanic Black, 185 [6.3%] White, 24 [0.8%] of more than 1 race, 24 [0.8%] of other race or ethnicity [individuals who identified as American Indian, Asian, or Native Hawaiian or other Pacific Islander], and 12 [0.4%] with unknown or unreported race or ethnicity). Between 2007 and 2019, marijuana use during pregnancy increased from 7.1% to 11.7%, whereas alcohol and opioid use in pregnancy were unchanged. Postpartum alcohol (44.4%), marijuana (13.6%), and concomitant alcohol and marijuana (10.0%) use were common; marijuana use increased from 10.2% to 23.7% from 2007 to 2019, whereas postpartum alcohol use was unchanged. The adjusted mean risk of marijuana use increased by 7% (95% CI, 3%-10%) per year during pregnancy and 11% (95% CI, 7%-16%) per year postpartum. Postpartum concomitant alcohol and marijuana use increased by 10% (95% CI, 5%-15%) per year. Differences in substance use were not associated with recreational legalization, but increased marijuana use was associated with medical marijuana legalization. Conclusions and Relevance In this cohort study, opioid use among pregnant people living with HIV remained stable, whereas marijuana use during pregnancy and postpartum increased over time and in states with legalized medical marijuana. These patterns of increasing marijuana use among pregnant and postpartum people living with HIV suggest that enhanced clinical attention is warranted, given the potential maternal and child health implications of substance use.
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Affiliation(s)
- Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Chase Brightwell
- Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lisa B. Haddad
- Center for Biomedical Research, Population Council, New York, New York
| | - Jennifer Jao
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kathleen M. Powis
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Tzy-Jyun Yao
- Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Emily Barr
- Department of Pediatric Infectious Diseases, University of Colorado School of Medicine, Aurora
| | - Carly Broadwell
- Center for Biostatistics in AIDS Research, Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - George R. Seage
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ellen G. Chadwick
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Frazier EL, Esser MB, McKnight-Eily LR, Zhou W, Chavez PR. Alcohol use among HIV-positive women of childbearing age, United States, 2013-2014. AIDS Care 2021; 33:1024-1036. [PMID: 32808534 PMCID: PMC11000390 DOI: 10.1080/09540121.2020.1808161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
More than one-quarter of the adults living with diagnosed HIV infection in the US are women. Binge drinking (i.e., ≥4 alcoholic drinks per occasion for women) is associated with poor HIV treatment compliance, HIV incidence, and unplanned pregnancy. However, little is known about the prevalence of binge drinking among women of childbearing age who are living with HIV (WLWH) and health risk behaviours among those who binge drink. Using the 2013-2014 data cycles of Medical Monitoring Project, we assessed the weighted prevalence of drinking patterns by socio-demographic, clinical and reproductive characteristics of 946 WLWH. Logistic regression was used to calculate unadjusted and adjusted prevalence ratios and 95% confidence intervals. Overall, 39% of WLWH reported current drinking and 10% reported binge drinking. Compared to non-drinkers, binge drinkers were less likely to adhere to antiretroviral therapy (ART) or be virally suppressed. In multivariate analyses, binge drinking among WLWH was associated with smoking, drug use, and reduced ART adherence compared to non-drinkers, increasing the likelihood of negative clinical outcomes. WLWH may benefit from a comprehensive approach to reducing binge drinking including alcohol screening and brief interventions and evidence-based policy strategies that could potentially improve adherence to HIV treatment.
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Affiliation(s)
- Emma L Frazier
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
| | - Marissa B Esser
- Excessive Alcohol Use Prevention Team, National Center for Chronic Disease and Prevention and Health Promotion, Centers for Disease and Prevention
| | - Lela R McKnight-Eily
- Prenatal Alcohol, Opioid, and Substance Exposure Team, National Center on Birth Defects and Developmental Disabilities
| | - Wen Zhou
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
- ICF International, Atlanta
| | - Pollyanna R Chavez
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention
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Abstract
OBJECTIVES We examined how patient perceptions of alcohol risk, provider discussions about alcohol, and treatment of hepatitis C virus (HCV) differed among HIV-HCV coinfected patients in primary care. METHODS Between April, 2016 and April, 2017, we conducted a screening survey with patients in an HIV primary care clinic in Seattle, Washington, who had chronic HCV coinfection or a history of chronic HCV infection who had successfully cleared their infection with treatment. RESULTS Of 225 participants, 84 (37%) were active drinkers (drank ≥2-4 times/mo in past 3 months). Of those with little to no use for ≥3 months, 65 (29%) were former drinkers with a history of alcohol use and 76 were abstainers with no such history. Former drinkers and abstainers were more likely than active drinkers to perceive that any drinking was unsafe (69% vs 58% vs 31%; P < 0.001). Former drinkers were more likely to report a physician's recommendation to stop drinking than active drinkers (63% vs 47%; P = 0.05). The great majority (87%) of former drinkers decided to stop or reduce drinking on their own (most often in response to a nonhealth life event) and only 13% acknowledged doing so on their doctor's prompting. HCV treatment was not associated with former or active drinking status. CONCLUSIONS Our findings underscore the importance of educating not only HIV-HCV patients about the effects of alcohol use but also HIV clinicians about delivering consistent counseling about alcohol avoidance. Understanding the reasons that HIV-HCV coinfected persons make changes in their alcohol use could drive novel interventions that reduce the negative consequences of drinking.
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Howell A, Lambert A, Pinkston MM, Blevins CE, Hayaki J, Herman DS, Moitra E, Stein MD, Kim HN. Sustained Sobriety: A Qualitative Study of Persons with HIV and Chronic Hepatitis C Coinfection and a History of Problematic Drinking. AIDS Behav 2021; 25:1083-1093. [PMID: 33064248 PMCID: PMC7979443 DOI: 10.1007/s10461-020-03067-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 12/16/2022]
Abstract
For persons diagnosed with HIV and who are coinfected with hepatitis C virus (HCV), chronic liver disease is a leading cause of death and excessive consumption of alcohol can be a contributing factor. Little is known about the factors these individuals identify as key to achieving sustained sobriety. In this qualitative study, fourteen HIV/HCV coinfected persons who endorsed past problematic drinking were interviewed about their path to sustained sobriety. In open-ended interviews, participants often described their drinking in the context of polysubstance use and their decision to become sober as a singular response to a transcendent moment or a traumatic event. All articulated specific, concrete strategies for maintaining sobriety. The perceived effect of the HIV or HCV diagnosis on sobriety was inconsistent, and medical care as an influence on sobriety was rarely mentioned. Qualitative interviews may offer new insights on interventions and support strategies for heavy-drinking persons with HIV/HCV coinfection.
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Affiliation(s)
- Abigail Howell
- Department of Medicine, University of Washington, 325 Ninth Avenue Box 359930, Seattle, WA, 98104, USA
| | - Audrey Lambert
- Section of General Internal Medicine, CARE Unit, Boston Medical Center, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Megan M Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Claire E Blevins
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jumi Hayaki
- Department of Psychology, College of the Holy Cross, Worcester, MA, USA
| | - Debra S Herman
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - H Nina Kim
- Department of Medicine, University of Washington, 325 Ninth Avenue Box 359930, Seattle, WA, 98104, USA.
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Dinani A, Khan A, Dieterich D. Emerging prevalence of fatty liver disease in HIV. Future Virol 2021. [DOI: 10.2217/fvl-2020-0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Fatty liver disease is a growing concern in people living with HIV, the main drivers are alcoholic liver disease and nonalcoholic fatty liver disease. It has shown to negatively impact HIV care continuum and result in notable non-HIV related morbidity and mortality. With the advancement in antiretroviral therapy and effective direct acting antivirals, fatty liver disease is surfacing as the next big challenge in this population like that observed in the general population. This review article summarizes the gravity of these two common diseases in HIV-infected people and aims to sheds light on an unmet need to develop effective methods to identify, screen and manage fatty liver disease in this unique population.
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Affiliation(s)
- Amreen Dinani
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ali Khan
- Department of Internal Medicine, Icahn School of Medicine, Mount Sinai West, New York, NY 10019, USA
| | - Douglas Dieterich
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Shokoohi M, Bauer GR, Kaida A, Logie CH, Carter A, Lacombe-Duncan A, Loutfy M. A Latent Class Analysis of the Social Determinants of Health Impacting Heavy Alcohol Consumption Among Women Living with HIV in Canada: The Canadian HIV Women's Sexual and Reproductive Health Cohort Study. AIDS Behav 2019; 23:3226-3236. [PMID: 30863979 DOI: 10.1007/s10461-019-02454-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
We used longitudinal data from the 2013-2017 Canadian HIV Women's Sexual and Reproductive Health Cohort Study (N = 1422) to assess the clustered impact of social determinants of health (SDoH) on hazardous drinking. Two measures of alcohol use were defined: (i) weekly alcohol use, with > 7 drinks/week as heavy drinking, and (ii) monthly binge drinking (≥ 6 drinks at one sitting), with ≥ 1/month as frequent binging. Twelve SDoH indicators were classified using latent class analysis: no/least adversities, discrimination/stigma, economic hardship, and most SDoH adversities. Inverse-probability weighted multinomial logistic regression was used to report relative-risk ratio (RRR). Women living with HIV (WLWH) in no/least adversity class had a substantially lower likelihood of both heavy weekly alcohol use and frequent binging than those in discrimination/stigma, economic hardship, and most SDoH adversities classes, with RRR estimates ranging from 0.02 to 0.18. Findings indicate the need to address SDoH to reduce hazardous drinking among WLWH.
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O'Connor E, Zeffiro T. Is treated HIV infection still toxic to the brain? PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2019; 165:259-284. [PMID: 31481166 DOI: 10.1016/bs.pmbts.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Clinically apparent HIV infection, accompanied by CNS opportunistic infections and HIV encephalopathy, was often associated with profound structural and functional brain effects prior to the introduction of anti-retroviral therapy (ART). With treatment, HIV structural and functional brain effects are smaller and have not been as easily detected. With near complete elimination of CNS opportunistic infections, the HIV neuroimaging research community now grapples with the problem of detecting subtler structural and functional changes against a background of persisting confounds, such as comorbidities and clinical features common in the HIV infected population. This situation also raises the question of whether imaging measure changes that are reported as HIV brain effects are purely related to viral infection, rather than originating from confounding effects that might include age, substance use, hepatitis C coinfection, cerebrovascular risk factors, ART, premorbid cognitive skills and illness duration. In addition to cohort characteristics, variation in image acquisition and analysis techniques may also contribute to study outcome heterogeneity. We review the potential effects of these confounds on detection of HIV infection effects and discuss strategies to avoid or mitigate the effects of these confounds. We then present a systematic approach to measurement, design and analysis in HIV neuroimaging studies, combining both experimental and statistical control techniques to determine if HIV infection effects persist, fluctuate or worsen in groups achieving viral suppression from ART.
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Affiliation(s)
- Erin O'Connor
- University of Maryland School of Medicine, Baltimore, MD, United States.
| | - Thomas Zeffiro
- University of Maryland School of Medicine, Baltimore, MD, United States.
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Elliott JC, Brincks AM, Feaster DJ, Hasin DS, Del Rio C, Lucas GM, Rodriguez AE, Nijhawan AE, Metsch LR. Psychosocial Factors Associated with Problem Drinking Among Substance Users with Poorly Controlled HIV Infection. Alcohol Alcohol 2018; 53:603-610. [PMID: 29596589 DOI: 10.1093/alcalc/agy021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 03/05/2018] [Indexed: 02/05/2023] Open
Abstract
Aims We aimed to identify psychosocial factors related to problem drinking among patients with poorly controlled human immunodeficiency virus (HIV) infection. Short Summary We aimed to identify psychosocial factors related to problem drinking among those with poorly controlled HIV infection. Increased levels of interpersonal conflict were associated with greater severity of alcohol problems. Poorer mental health, medical mistrust and less satisfaction with one's physician related to excessive drinking. Methods This secondary analysis used baseline data from a large multisite randomized controlled trial of substance users whose HIV infection was currently poorly controlled, from 11 urban hospitals across the USA. Participants were HIV-infected adult inpatients (n = 801; 67% male, 75% African American) with substance use histories. Participants self-reported on their drinking, perceived health, mental health, social relationships and patient-provider relationship. Structural equation models examined psychosocial factors associated with problem drinking, controlling for demographic covariates. Results Increased levels of interpersonal conflict were associated with greater severity of alcohol problems. Poorer mental health, medical mistrust and less satisfaction with one's physician were associated with excessive drinking. Conclusions Several psychosocial factors, including interpersonal conflict, poor mental health (i.e. anxiety, depression and somatization), medical mistrust and less satisfaction with one's provider, were associated with problem drinking among HIV-infected substance users with poorly controlled HIV infection. The co-occurrence of these concerns highlights the need for comprehensive services (including attention to problem drinking, social services, mental health and quality medical care) in this at-risk group.
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Affiliation(s)
- Jennifer C Elliott
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA
| | - Ahnalee M Brincks
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.,New York State Psychiatric Institute, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gregory M Lucas
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allan E Rodriguez
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ank E Nijhawan
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Cook JA, Burke-Miller JK, Steigman PJ, Schwartz RM, Hessol NA, Milam J, Merenstein DJ, Anastos K, Golub ET, Cohen MH. Prevalence, Comorbidity, and Correlates of Psychiatric and Substance Use Disorders and Associations with HIV Risk Behaviors in a Multisite Cohort of Women Living with HIV. AIDS Behav 2018; 22:3141-3154. [PMID: 29460130 PMCID: PMC6153984 DOI: 10.1007/s10461-018-2051-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We used the World Health Organization’s Composite International Diagnostic Interview to determine the prevalence, comorbidity, and correlates of lifetime and 12-month behavioral health disorders in a multisite cohort of 1027 women living with HIV in the United States. Most (82.6%) had one or more lifetime disorders including 34.2% with mood disorders, 61.6% with anxiety disorders, and 58.3% with substance use disorders. Over half (53.9%) had at least one 12-month disorder, including 22.1% with mood disorders, 45.4% with anxiety disorders, and 11.1% with substance use disorders. Behavioral health disorder onset preceded HIV diagnosis by an average of 19 years. In multivariable models, likelihood of disorders was associated with women’s race/ethnicity, employment status, and income. Women with 12-month behavioral health disorders were significantly more likely than their counterparts to engage in subsequent sexual and substance use HIV risk behaviors. We discuss the complex physical and behavioral health needs of women living with HIV.
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Affiliation(s)
- Judith A Cook
- Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, 4th Floor, M/C 912, Chicago, IL, 60612, USA.
| | - Jane K Burke-Miller
- Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, 4th Floor, M/C 912, Chicago, IL, 60612, USA
| | - Pamela J Steigman
- Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, 4th Floor, M/C 912, Chicago, IL, 60612, USA
| | - Rebecca M Schwartz
- Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, Great Neck, NY, USA
| | - Nancy A Hessol
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, USA
| | - Joel Milam
- Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles, CA, USA
| | | | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Mardge H Cohen
- Department of Medicine, Cook County Hospital Health and Hospital System, Chicago, IL, USA
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Shokoohi M, Bauer GR, Kaida A, Lacombe-Duncan A, Kazemi M, Gagnier B, de Pokomandy A, Loutfy M. Substance use patterns among women living with HIV compared with the general female population of Canada. Drug Alcohol Depend 2018; 191:70-77. [PMID: 30086425 DOI: 10.1016/j.drugalcdep.2018.06.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/14/2018] [Accepted: 06/17/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND HIV infection and substance use synergistically impact health outcomes of people with HIV. In this study, we assessed the prevalence of substance use among women living with HIV (WLWH) and compared them with expected values from general data. METHODS Cigarette smoking, frequency of alcohol consumption, last-month non-prescribed cannabis use (vs. last-year use), and last 3 months regular (≥once/week) and occasional (<once/week) use of crack/cocaine, speed (amphetamine), and heroin (vs. last-year use) were examined in WLWH from the 2013-2015 Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS; N = 1422) and compared with general population women from the 2013-2014 Canadian Community Health Survey (CCHS; N = 46,831). Age/ethnoracial-standardized prevalence differences (SPD) and 95% confidence intervals (CI) were reported. RESULTS Compared to expected estimates from general population women, a higher proportion of WLWH reported daily cigarette smoking (SPD: 26.8% [95% CI: 23.9, 29.7]), smoking ≥20 cigarettes/day (SPD: 11.6% [9.8, 13.6]), regular non-prescribed cannabis use (SPD: 8.0% [4.1, 8.6]), regular crack/cocaine use (SPD: 16.7% [13.1, 20.9]), regular/occasional speed use (SPD: 2.4% [1.2, 4.7]), and heroin use (SPD: 11.2% [8.3, 15.0]). However, WLWH reported lower frequencies of alcohol consumption and binge drinking than their counterparts in the general population. CONCLUSIONS Cigarette smoking and illicit drug use, but not alcohol use or binge drinking, were more prevalent in WLWH than would be expected for Canadian women with a similar age and ethnoracial group profile. These findings may indicate the need for women-centered harm reduction programs to improve health outcomes of WLWH in Canada.
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Affiliation(s)
- Mostafa Shokoohi
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
| | - Greta R Bauer
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ashley Lacombe-Duncan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Brenda Gagnier
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada; McGill University Health Centre, Montreal, Quebec, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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A qualitative study examining the benefits and challenges of incorporating patient-reported outcome substance use and mental health questionnaires into clinical practice to improve outcomes on the HIV care continuum. BMC Health Serv Res 2018; 18:419. [PMID: 29879962 PMCID: PMC5992635 DOI: 10.1186/s12913-018-3203-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/14/2018] [Indexed: 11/24/2022] Open
Abstract
Background Inadequate identification and treatment of substance use (SU) and mental health (MH) disorders hinders retention in HIV care. The objective of this study was to elicit stakeholder input on integration of SU/MH screening using computer-assisted patient-reported outcomes (PROs) into clinical practice. Methods We conducted semi-structured interviews with HIV-positive patients who self-reported SU/MH symptoms on a computer-assisted PROs (n = 19) and HIV primary care providers (n = 11) recruited from an urban academic HIV clinic. Interviews were audio-recorded and transcribed. We iteratively developed codes and organized key themes using editing style analysis. Results Two themes emerged: (1) Honest Disclosure: Some providers felt PROs might improve SU/MH disclosure; more were concerned that patients would not respond honestly if their provider saw the results. Patients were also divided, stating PROs could help overcome stigma but that it could be harder to disclose SU/MH to a computer versus a live person. (2) Added Value in the Clinical Encounter: Most providers felt PROs would fill a practice gap. Patients had concerns regarding confidentiality but indicated PROs would help providers take better care of them. Conclusions Both patients and providers indicated that PROs are potentially useful clinical tools to improve detection of SU/MH. However, patients and providers expressed conflicting viewpoints about disclosure of SU/MH using computerized PROs. Future studies implementing PROs screening interventions must assess concerns over confidentiality and honest disclosure of SU/MH to understand the effectiveness of PROs as a clinical tool. More research is also needed on patient-centered integration of the results of PROs in HIV care. Electronic supplementary material The online version of this article (10.1186/s12913-018-3203-x) contains supplementary material, which is available to authorized users.
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The Importance of Context: Neighborhood Drinking Norms and Heavy Drinking Among HIV Patients. J Acquir Immune Defic Syndr 2018; 72:e55-7. [PMID: 26959191 DOI: 10.1097/qai.0000000000000982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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14
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Bilal U, McCaul ME, Crane HM, Mathews WC, Mayer KH, Geng E, Napravnik S, Cropsey KL, Mugavero MJ, Saag MS, Hutton H, Lau B, Chander G. Predictors of Longitudinal Trajectories of Alcohol Consumption in People with HIV. Alcohol Clin Exp Res 2018; 42:561-570. [PMID: 29265385 DOI: 10.1111/acer.13583] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 12/12/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our aim was to describe alcohol consumption trajectories in a cohort of people living with HIV and determine clinical and sociodemographic predictors of each trajectory. METHODS This is a prospective cohort study of 7,906 patients in the 7 Centers for AIDS Research Network of Integrated Clinical Systems sites. Alcohol consumption was categorized as none, moderate, and alcohol misuse. Predictors included age, race/ethnicity, depressive or anxiety symptoms, illicit drug use (opioids, methamphetamines, cocaine/crack), marijuana use, hepatitis C virus (HCV) infection, HIV transmission risk factor, and HIV disease progression. We estimated sex-stratified alcohol consumption trajectories and their predictors. RESULTS We found 7 trajectories of alcohol consumption in men: stable nondrinking and increased drinking (71% and 29% of initial nondrinking); stable moderate, reduced drinking, and increased alcohol misuse (59%, 21%, and 21% of initial moderate alcohol use); and stable alcohol misuse and reduced alcohol misuse (75% and 25% of initial alcohol misuse). Categories were similar in women, except lack of an increase to alcohol misuse trajectory among women that begin with moderate use. Older men and women were more likely to have stable nondrinking, while younger men were more likely to increase to or remain in alcohol misuse. Minorities, people with depressive or anxiety symptoms, HCV-infected individuals, and people who injected drugs were more likely to reduce use. Illicit drug use was associated with a reduction in overall drinking, while marijuana use was associated with stable moderate drinking or misuse. CONCLUSIONS Longitudinal trajectories of increasing alcohol use and stable misuse highlight the need to integrate routine screening and alcohol misuse interventions into HIV primary care.
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Affiliation(s)
- Usama Bilal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Heidi M Crane
- Department of Medicine, UW School of Medicine, University of Washington, Seattle, Washington
| | | | - Kenneth H Mayer
- School of Medicine, Harvard University, Boston, Massachusetts.,School of Public Health, Harvard University, Boston, Massachusetts.,Fenway Health, Boston, Massachusetts
| | - Elvin Geng
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Karen L Cropsey
- Department of Medicine, University of Alabama, Birmingham, Alabama
| | | | - Michael S Saag
- Department of Medicine, University of Alabama, Birmingham, Alabama
| | - Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Geetanjali Chander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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15
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Abstract
Human immunodeficiency virus (HIV) enters the brain early after infecting humans and may remain in the central nervous system despite successful antiretroviral treatment. Many neuroimaging techniques were used to study HIV+ patients with or without opportunistic infections. These techniques assessed abnormalities in brain structures (using computed tomography, structural magnetic resonance imaging (MRI), diffusion MRI) and function (using functional MRI at rest or during a task, and perfusion MRI with or without a contrast agent). In addition, single-photon emission computed tomography with various tracers (e.g., thallium-201, Tc99-HMPAO) and positron emission tomography with various agents (e.g., [18F]-dexoyglucose, [11C]-PiB, and [11C]-TSPO tracers), were applied to study opportunistic infections or HIV-associated neurocognitive disorders. Neuroimaging provides diagnoses and biomarkers to quantitate the severity of brain injury or to monitor treatment effects, and may yield insights into the pathophysiology of HIV infection. As the majority of antiretroviral-stable HIV+ patients are living longer, age-related comorbid disorders (e.g., additional neuroinflammation, cerebrovascular disorders, or other dementias) will need to be considered. Other highly prevalent conditions, such as substance use disorders, psychiatric illnesses, and the long-term effects of combined antiretroviral therapy, all may lead to additional brain injury. Neuroimaging studies could provide knowledge regarding how these comorbid conditions impact the HIV-infected brain. Lastly, specific molecular imaging agents may be needed to assess the central nervous system viral reservoir.
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Affiliation(s)
- Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; Department of Medicine and Department of Neurology, John A. Burns School of Medicine, University of Hawaii, Manoa, United States.
| | - Dinesh K Shukla
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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16
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Gurung S, Ventuneac A, Cain D, Mirzayi C, Ferraris C, Rendina HJ, Sparks MA, Parsons JT. Alcohol and substance use diagnoses among HIV-positive patients receiving care in NYC clinic settings. Drug Alcohol Depend 2017; 180:62-67. [PMID: 28881318 PMCID: PMC5648608 DOI: 10.1016/j.drugalcdep.2017.07.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Substance use among HIV-positive persons exacerbates health problems. This study sought to estimate the prevalence of alcohol and drug-use diagnoses and examined hypothesized predictors associated with alcohol and drug-use diagnoses among HIV-positive patients in New York City (NYC). METHODS This cohort study reviewed electronic medical records (EMRs) of 4965 HIV-positive patients based on diagnostic codes. These patients attended a comprehensive care clinic in NYC in 2012. Multinomial logistic regression was used to predict the odds of classification into substance use diagnosis grouping. RESULTS Of the full sample, only 12.7% of patients had an alcohol use diagnosis documented in their EMR compared with more than one-quarter (26.4%) of patients having a recorded drug use diagnosis (p<0.001). Compared with the No Alcohol or Drugs group, the regression model showed that older age and having a recent inpatient hospital stay independently predicted being in the Alcohol Only group; years living with HIV, having an unsuppressed viral load, and having a recent inpatient hospital stay were associated with higher odds of being in the Drugs Only and Alcohol and Drugs groups; and being women and men who have sex with men (MSM) were associated with decreased odds of being in the Drugs Only and Alcohol and Drugs groups. CONCLUSIONS Substance use diagnosis was associated with viremia and low CD4 counts and hospital stays. This implies that providers should screen for substance use in HIV-positive patients with poor health. Further examination of the extent of such comorbidity is instrumental for intervention efforts.
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Affiliation(s)
- Sitaji Gurung
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA,The CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Ana Ventuneac
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA,Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, New York, NY, USA
| | - Demetria Cain
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA
| | - Chloe Mirzayi
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA,The CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Christopher Ferraris
- Institute for Advanced Medicine, Mount Sinai St. Luke’s and Mount Sinai West Hospitals, New York, NY, USA
| | - H. Jonathon Rendina
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA,Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
| | - Martha A. Sparks
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Jeffrey T. Parsons
- The Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA,Department of Psychology, Hunter College of the City University of New York (CUNY), New York, NY, USA,Health Psychology and Clinical Science Doctoral Program, The Graduate Center of the City University of New York (CUNY), New York, NY, USA
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17
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Elliott JC, Hasin DS, Des Jarlais DC. Perceived health and alcohol use in individuals with HIV and Hepatitis C who use drugs. Addict Behav 2017; 72:21-26. [PMID: 28342409 DOI: 10.1016/j.addbeh.2017.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/10/2017] [Accepted: 03/08/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Individuals who use illicit drugs are at heightened risk for HIV and/or Hepatitis C Virus (HCV). Despite the medical consequences of drinking for drug-using individuals with these infections, many do drink. In other studies, how individuals perceive their health relates to their engagement in risk behaviors such as drinking. However, among drug-using individuals with HIV and HCV, whether perceived health relates to drinking is unknown. OBJECTIVE We examine the association between perceived health and drinking among drug-using individuals with HIV and/or HCV. METHODS In a large, cross-sectional study, we utilized samples of individuals with HIV (n=476), HCV (n=1145), and HIV/HCV co-infection (n=180), recruited from drug treatment centers from 2005 to 2013. In each sample, we investigated the relationship between perceived health and drinking, using ordinal logistic regressions. We present uncontrolled models as well as models controlled for demographic characteristics. RESULTS Among samples of drug using individuals with HIV and with HCV, poorer perceived health was associated with risky drinking only when demographic characteristics were taken into account (Adjusted Odds Ratios: 1.32 [1.05, 1.67] and 1.16 [1.00, 1.34], respectively). In the smaller HIV/HCV co-infected sample, the association of similar magnitude was not significant (AOR=1.32 [0.90, 1.93]). CONCLUSIONS Drug using patients with HIV or HCV with poor perceived health are more likely to drink heavily, which can further damage health. However, when demographics are not accounted for, these effects can be masked. Patients' reports of poor health should remind providers to assess for health risk behaviors, particularly heavy drinking.
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Affiliation(s)
- Jennifer C Elliott
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, Box 123, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Box 123, New York, NY 10032, USA.
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, Box 123, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Box 123, New York, NY 10032, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168th St, New York, NY 10032, USA
| | - Don C Des Jarlais
- Icahn School of Medicine at Mount Sinai, 39 Broadway, Suite 530, New York, NY 10006, USA
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18
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Barai N, Monroe A, Lesko C, Lau B, Hutton H, Yang C, Alvanzo A, McCaul ME, Chander G. The Association Between Changes in Alcohol Use and Changes in Antiretroviral Therapy Adherence and Viral Suppression Among Women Living with HIV. AIDS Behav 2017; 21:1836-1845. [PMID: 27752873 DOI: 10.1007/s10461-016-1580-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Heavy alcohol use has adverse effects in women with HIV. We examined the association between changes in alcohol use (measured with Timeline Followback) and changes in antiretroviral therapy adherence (medication possession ratio) and viral suppression (HIV RNA), measured over 6-month intervals. Among women who were (1) non-adherent or not virologically suppressed and (2) infrequent binge drinkers or non-heavy drinkers at baseline, increasing drinking was significantly associated with lower odds of subsequently improving adherence or viral suppression (OR of becoming adherent of 0.90 in infrequent binge drinkers; OR of becoming suppressed of 0.81 and 0.75 in infrequent binge drinkers and non-heavy drinkers, respectively). Our findings suggest that for these women, increasing drinking may be a barrier to achieving viral suppression. Addressing this barrier by integrating proactive alcohol counseling strategies into routine HIV care may be key to improving viral suppression rates among women retained in HIV care.
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Affiliation(s)
- Nikita Barai
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street #8060, Baltimore, MD, 21287, USA
| | - Anne Monroe
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street #8060, Baltimore, MD, 21287, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Catherine Lesko
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cui Yang
- Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Anika Alvanzo
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street #8060, Baltimore, MD, 21287, USA
| | - Mary Elizabeth McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street #8060, Baltimore, MD, 21287, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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19
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Prevalence and Factors Associated with Hazardous Alcohol Use Among Persons Living with HIV Across the US in the Current Era of Antiretroviral Treatment. AIDS Behav 2017; 21:1914-1925. [PMID: 28285434 DOI: 10.1007/s10461-017-1740-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hazardous alcohol use is associated with detrimental health outcomes among persons living with HIV (PLWH). We examined the prevalence and factors associated with hazardous alcohol use in the current era using several hazardous drinking definitions and binge drinking defined as ≥5 drinks for men versus ≥4 for women. We included 8567 PLWH from 7 U.S. sites from 2013 to 2015. Current hazardous alcohol use was reported by 27% and 34% reported binge drinking. In adjusted analyses, current and past cocaine/crack (odd ratio [OR] 4.1:3.3-5.1, p < 0.001 and OR 1.3:1.1-1.5, p < 0.001 respectively), marijuana (OR 2.5:2.2-2.9, p < 0.001 and OR 1.4:1.2-1.6, p < 0.001), and cigarette use (OR 1.4:1.2-1.6, p < 0.001 and OR 1.3:1.2-1.5, p < 0.001) were associated with increased hazardous alcohol use. The prevalence of hazardous alcohol use remains high in the current era, particularly among younger men. Routine screening and targeted interventions for hazardous alcohol use, potentially bundled with interventions for other drugs, remain a key aspect of HIV care.
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20
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Brittain K, Remien RH, Phillips T, Zerbe A, Abrams EJ, Myer L, Mellins CA. Factors associated with alcohol use prior to and during pregnancy among HIV-infected pregnant women in Cape Town, South Africa. Drug Alcohol Depend 2017; 173:69-77. [PMID: 28199918 PMCID: PMC5429399 DOI: 10.1016/j.drugalcdep.2016.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/21/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Alcohol use during pregnancy is prevalent in South Africa, but there are few prospectively-collected data exploring patterns of consumption among HIV-infected women, which may be important to improve maternal and child health outcomes. We examined patterns of and factors associated with alcohol use prior to and during pregnancy among HIV-infected pregnant women in Cape Town, South Africa. METHODS Participants were enrolled when entering antenatal care at a large primary care clinic, and alcohol use was assessed using the AUDIT (Alcohol Use Disorders Identification Test). In analysis, the AUDIT-C scoring was used as a measure of hazardous drinking, and we examined factors associated with patterns of alcohol use in logistic regression models. RESULTS Among 580 women (median age: 28.1 years), 40% reported alcohol use during the 12 months prior to pregnancy, with alcohol use characterised by binge drinking and associated with single relationship status, experience of intimate partner violence (IPV), and lower levels of HIV-related stigma. Of this group, 65% had AUDIT-C scores suggesting hazardous alcohol use, with hazardous alcohol users more likely to report having experienced IPV and having higher levels of education. Among hazardous alcohol users, 70% subsequently reported reduced levels of consumption during pregnancy. Factors independently associated with reduced consumption included earlier gestation when entering antenatal care and report of a better patient-healthcare provider relationship. CONCLUSIONS These unique data provide important insights into alcohol use trajectories in this context, and highlight the urgent need for an increased focus on screening and intervention at primary care level.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, South Africa.
| | - Robert H. Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Tamsin Phillips
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa,Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, South Africa
| | - Allison Zerbe
- ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Elaine J. Abrams
- ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA,College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa,Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, South Africa
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
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21
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Elliott JC, Stohl M, Aharonovich E, O'Leary A, Hasin DS. Reasons for drinking as predictors of alcohol involvement one year later among HIV-infected individuals with and without hepatitis C. Ann Med 2016; 48:634-640. [PMID: 27460482 PMCID: PMC5201313 DOI: 10.1080/07853890.2016.1206668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Heavy drinking can be harmful for individuals with HIV, particularly those coinfected with hepatitis C virus (HCV). HIV patients' reasons for drinking predict short-term alcohol involvement, but whether they predict longer-term involvement is unknown. Also, it remains unknown whether these motives are differentially predictive for HIV monoinfected and HIV/HCV coinfected patients. METHOD HIV-infected heavy drinkers (n = 254) participated in a randomized trial of brief alcohol interventions, 236 (92.9%) of whom reported on baseline motives and alcohol involvement 12 months later (77.1% male, 94.9% minority, 30.6% with HCV). RESULTS Greater endorsement of baseline drinking to cope with negative affect predicted greater alcohol dependence symptoms at 12 months (incident rate ratio [IRR] = 1.80, p < 0.05), while greater endorsement of baseline drinking due to social pressure predicted fewer drinks consumed at 12 months (IRR = 0.67, p < 0.05). Coping and social reasons were both predictive for HIV monoinfected patients, whereas only coping reasons were predictive for HIV/HCV coinfected patients. DISCUSSION Drinking for coping and social reasons predict alcohol involvement 12 months later; however, social reasons may only be important for HIV monoinfected patients. Understanding patient reasons for drinking may help predict patient risk up to a year later. KEY MESSAGES Among HIV patients, drinking motives predict alcohol involvement 12 months later. For HIV monoinfected patients, drinking to cope and drinking for social reasons predict 12-month alcohol involvement. For HIV/Hepatitis C coinfected patients, coping (but not social) motives predict 12-month alcohol involvement.
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Affiliation(s)
- Jennifer C Elliott
- a Department of Psychiatry , Columbia University Medical Center , New York , USA.,b New York State Psychiatric Institute , New York , USA
| | - Malka Stohl
- b New York State Psychiatric Institute , New York , USA
| | - Efrat Aharonovich
- a Department of Psychiatry , Columbia University Medical Center , New York , USA.,b New York State Psychiatric Institute , New York , USA
| | - Ann O'Leary
- c Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Deborah S Hasin
- a Department of Psychiatry , Columbia University Medical Center , New York , USA.,b New York State Psychiatric Institute , New York , USA.,d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , USA
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22
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Fuster D, Sanvisens A, Bolao F, Rivas I, Tor J, Muga R. Alcohol use disorder and its impact on chronic hepatitis C virus and human immunodeficiency virus infections. World J Hepatol 2016; 8:1295-1308. [PMID: 27872681 PMCID: PMC5099582 DOI: 10.4254/wjh.v8.i31.1295] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/04/2016] [Accepted: 08/29/2016] [Indexed: 02/06/2023] Open
Abstract
Alcohol use disorder (AUD) and hepatitis C virus (HCV) infection frequently co-occur. AUD is associated with greater exposure to HCV infection, increased HCV infection persistence, and more extensive liver damage due to interactions between AUD and HCV on immune responses, cytotoxicity, and oxidative stress. Although AUD and HCV infection are associated with increased morbidity and mortality, HCV antiviral therapy is less commonly prescribed in individuals with both conditions. AUD is also common in human immunodeficiency virus (HIV) infection, which negatively impacts proper HIV care and adherence to antiretroviral therapy, and liver disease. In addition, AUD and HCV infection are also frequent within a proportion of patients with HIV infection, which negatively impacts liver disease. This review summarizes the current knowledge regarding pathological interactions of AUD with hepatitis C infection, HIV infection, and HCV/HIV co-infection, as well as relating to AUD treatment interventions in these individuals.
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23
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Elliott JC, Hasin DS, Stohl M, Des Jarlais DC. HIV, Hepatitis C, and Abstinence from Alcohol Among Injection and Non-injection Drug Users. AIDS Behav 2016; 20:548-54. [PMID: 26080690 DOI: 10.1007/s10461-015-1113-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Individuals using illicit drugs are at risk for heavy drinking and infection with human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV). Despite medical consequences of drinking with HIV and/or HCV, whether drug users with these infections are less likely to drink is unclear. Using samples of drug users in treatment with lifetime injection use (n = 1309) and non-injection use (n = 1996) participating in a large, serial, cross-sectional study, we investigated the associations between HIV and HCV with abstinence from alcohol. About half of injection drug users (52.8 %) and 26.6 % of non-injection drug users abstained from alcohol. Among non-injection drug users, those with HIV were less likely to abstain [odds ratio (OR) 0.55; adjusted odds ratio (AOR) 0.58] while those with HCV were more likely to abstain (OR 1.46; AOR 1.34). In contrast, among injection drug users, neither HIV nor HCV was associated with drinking. However, exploratory analyses suggested that younger injection drug users with HIV or HCV were more likely to drink, whereas older injection drug users with HIV or HCV were more likely to abstain. In summary, individuals using drugs, especially non-injection users and those with HIV, are likely to drink. Age may modify the risk of drinking among injection drug users with HIV and HCV, a finding requiring replication. Alcohol intervention for HIV and HCV infected drug users is needed to prevent further harm.
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Affiliation(s)
- Jennifer C Elliott
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Deborah S Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
- Division of Clinical Phenomenology, New York State Psychiatric Institute, New York, NY, USA.
- Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, Box 123, New York, NY, 10032, USA.
| | - Malka Stohl
- Division of Clinical Phenomenology, New York State Psychiatric Institute, New York, NY, USA
| | - Don C Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, NY, USA
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24
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Hu X, Harman J, Winterstein AG, Zhong Y, Wheeler AL, Taylor TN, Plankey M, Rubtsova A, Cropsey K, Cohen MH, Adimora AA, Milam J, Adedimeji A, Cook RL. Utilization of Alcohol Treatment Among HIV-Positive Women with Hazardous Drinking. J Subst Abuse Treat 2016; 64:55-61. [PMID: 26961420 DOI: 10.1016/j.jsat.2016.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 01/20/2016] [Accepted: 01/23/2016] [Indexed: 10/22/2022]
Abstract
Hazardous alcohol consumption has been frequently reported among women with HIV infection and is associated with a variety of negative health consequences. Treatments to reduce alcohol use may bring in health benefits. However, little is known regarding the utilization of alcohol treatment services among HIV+ women with hazardous drinking. Using data from the Women's Interagency HIV Study (WIHS), this study assessed utilization of any alcohol treatment in the past 6 months and performed multivariable logistic regression to determine correlates of receipt of any alcohol treatment. Among 474 HIV+ women reporting recent hazardous drinking, less than one in five (19%) reported recent utilization of any alcohol treatment. Alcoholics Anonymous (AA) was the most commonly reported (12.9%), followed by inpatient detoxification (9.9%) and outpatient alcohol treatment program (7.0%). Half (51%) receiving any alcohol treatment reported utilization of multiple treatments. Multivariable analyses found alcohol treatment was more often utilized by those who had social support (odds ratio [OR]=1.68, 95% confidence interval [CI]=1.00 to 2.83), fewer economic resources (income ≤$12,000 vs. >$12,000, OR=3.10, 95% CI=1.53 to 6.27), higher levels of drinking (16-35 drinks/week vs. 12-15 drinks/week, OR=3.02, 95% CI=1.47 to 6.21; 36+ drinks/week vs. 12-15 drinks/week, OR=4.41, 95% CI=2.03 to 9.59), and those who reported any illicit drug use (OR=2.77, 95% CI=1.44 to 5.34). More efforts are needed to enhance the utilization of alcohol treatment. Our findings highlight the unique profile of those who utilized alcohol treatment. Such information is vital to improve treatment delivery to address unmet need in this particular population.
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Affiliation(s)
- Xingdi Hu
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Jeffrey Harman
- Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Almut G Winterstein
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Yue Zhong
- The Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Amber L Wheeler
- Department of Medicine, University of California, San Francisco and Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Tonya N Taylor
- College of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Michael Plankey
- Georgetown University Medical Center, Department of Medicine, Division of Infectious Diseases, Washington, DC, USA
| | - Anna Rubtsova
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Karen Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital of Cook County Health and Hospital System and Rush University, Chicago, IL, USA
| | - Adaora A Adimora
- Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joel Milam
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert L Cook
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL, USA
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Brief Intervention Decreases Drinking Frequency in HIV-Infected, Heavy Drinking Women: Results of a Randomized Controlled Trial. J Acquir Immune Defic Syndr 2015; 70:137-45. [PMID: 25967270 DOI: 10.1097/qai.0000000000000679] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Hazardous alcohol use by HIV-infected women is associated with poor HIV outcomes and HIV transmission risk behaviors. We examined the effectiveness of brief alcohol intervention (BI) among hazardous drinking women receiving care in an urban HIV clinic. METHODS Women were randomized to a 2-session BI or usual care. Outcomes assessed at baseline, 3, 6, and 12 months included 90-day frequency of any alcohol use and heavy/binge drinking (≥4 drinks per occasion), and average drinks per drinking episode. Secondary outcomes included HIV medication and appointment adherence, HIV-1 RNA suppression, and days of unprotected vaginal sex. We examined intervention effectiveness using generalized mixed-effect models and quantile regression. RESULTS Of 148 eligible women, 74 were randomized to each arm. In mixed-effects models, 90-day drinking frequency decreased among intervention group compared with control, with women in the intervention condition less likely to have a drinking day (odds ratio: 0.42; 95% confidence interval: 0.23 to 0.75). Heavy/binge drinking days and drinks per drinking day did not differ significantly between groups. Quantile regression demonstrated a decrease in drinking frequency in the middle to upper ranges of the distribution of drinking days and heavy/binge drinking days that differed significantly between intervention and control conditions. At follow-up, the intervention group had significantly fewer episodes of unprotected vaginal sex. No intervention effects were observed for other outcomes. CONCLUSIONS BI reduces frequency of alcohol use and unprotected vaginal sex among HIV-infected women. More intensive services may be needed to lower drinks per drinking day and enhance care for more severely affected drinkers.
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Elliott JC, Aharonovich E, O'Leary A, Johnston B, Hasin DS. Perceived medical risks of drinking, alcohol consumption, and hepatitis C status among heavily drinking HIV primary care patients. Alcohol Clin Exp Res 2015; 38:3052-9. [PMID: 25581660 DOI: 10.1111/acer.12570] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 09/09/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Heavy drinking poses significant risks to the health and survival of individuals infected with HIV, particularly those coinfected with hepatitis C virus (HCV). However, little is known about patients' perceptions of these risks, and whether these perceptions relate to their alcohol consumption. METHODS A sample of 254 heavily drinking HIV primary care patients (78% male; 94.5% minority; 31.8% with HCV) reported on their perceptions of the medical risks of drinking and on their alcohol consumption prior to participation in a drinking-reduction intervention trial. RESULTS In the HIV-infected sample as a whole, 62.9% reported that they had a medical problem made worse by drinking, and 64.3% reported restricting drinking to avoid future medical problems. Although patients coinfected with HIV/HCV reported greater efforts to restrict drinking to avoid future medical problems (adjusted odds ratio = 1.94), their reported drinking quantity and frequency did not differ from that of HIV mono-infected patients. Awareness of medical risk was not associated with drinking level. Effort to restrict drinking to avoid medical risk was associated with lower drinking quantity, frequency, and binge frequency (ps < 0.05), but the association with binge frequency was specific to patients without HCV. CONCLUSIONS Over one-third of HIV patients are unaware of the medical risks of drinking, and do not restrict use, suggesting the need for intervention in this group. Patients coinfected with HIV/HCV may report more effort to restrict drinking, but their reported drinking quantity and frequency suggest that they are actually drinking just as heavily as HIV mono-infected patients. Awareness of medical risk was unrelated to drinking, which suggests the need for interventions consisting of more than simple education. However, reported effort to restrict drinking did predict less drinking, suggesting the importance of patient commitment and initiative in change.
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Affiliation(s)
- Jennifer C Elliott
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Longitudinal Trends in Sexual Behaviors with Advancing Age and Menopause Among Women With and Without HIV-1 Infection. AIDS Behav 2015; 19:931-40. [PMID: 25245474 DOI: 10.1007/s10461-014-0901-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We assessed changes in self-reported sexual activity (SA) over 13 years among HIV-infected and uninfected women. The impact of aging and menopause on SA and unprotected anal or vaginal intercourse (UAVI) was examined among women in the Women's Interagency HIV Study (WIHS), stratifying by HIV status and detectable viral load among HIV-infected women. Generalized mixed linear models were fitted for each outcome, adjusted for relevant covariates. HIV-uninfected women evidenced higher levels of SA and UAVI than HIV-infected. The odds of SA declined by 62-64 % per decade of age. The odds of SA in a 6-month interval for women aged 40-57 declined by 18-22 % post-menopause (controlling for age). Among HIV+/detectable women only, the odds of any UAVI decreased by 17 % per decade of age; the odds of UAVI were unchanged pre-menopause, and then decreased by 28 % post-menopause. Elucidating the factors accounting for ongoing unprotected sex among older women should inform interventions.
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Hahn JA, Fatch R, Wanyenze RK, Baveewo S, Kamya MR, Bangsberg DR, Coates TJ. Decreases in self-reported alcohol consumption following HIV counseling and testing at Mulago Hospital, Kampala, Uganda. BMC Infect Dis 2014; 14:403. [PMID: 25038830 PMCID: PMC4223423 DOI: 10.1186/1471-2334-14-403] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/10/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alcohol use has a detrimental impact on the HIV epidemic, especially in sub-Saharan Africa. HIV counseling and testing (HCT) may provide a contact opportunity to intervene with hazardous alcohol use; however, little is known about how alcohol consumption changes following HCT. METHODS We utilized data from 2056 participants of a randomized controlled trial comparing two methods of HCT and subsequent linkage to HIV care conducted at Mulago Hospital in Kampala, Uganda. Those who had not previously tested positive for HIV and whose last HIV test was at least one year in the past were eligible. Participants were asked at baseline when they last consumed alcohol, and prior three month alcohol consumption was measured using the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) at baseline and quarterly for one year. Hazardous alcohol consumption was defined as scoring ≥3 or ≥4 for women and men, respectively. We examined correlates of alcohol use at baseline, and of hazardous and non-hazardous drinking during the year of follow-up using multinomial logistic regression, clustered at the participant level to account for repeated measurements. RESULTS Prior to HCT, 30% were current drinkers (prior three months), 27% were past drinkers (>3 months ago), and 44% were lifetime abstainers. One-third (35%) of the current drinkers met criteria for hazardous drinking. Hazardous and non-hazardous self-reported alcohol consumption declined after HCT, with 16% of baseline current drinkers reporting hazardous alcohol use 3 months after HCT. Independent predictors (p < 0.05) of continuing non-hazardous and hazardous alcohol consumption after HCT were sex (male), alcohol consumption prior to HCT (hazardous), and HIV status (negative). Among those with HIV, non-hazardous drinking was less likely among those taking antiretroviral therapy (ART). CONCLUSIONS HCT may be an opportune time to intervene with alcohol consumption. Those with HIV experienced greater declines in alcohol consumption after HCT, and non-hazardous drinking decreased for those with HIV initiating ART. HCT and ART initiation may be ideal times to intervene with alcohol consumption. Screening and brief intervention (SBI) to reduce alcohol consumption should be considered for HCT and HIV treatment venues.
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Affiliation(s)
- Judith A Hahn
- University of California, San Francisco, Box 0886, San Francisco, CA 94143-0886, USA.
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Kelso GA, Cohen MH, Weber KM, Dale SK, Cruise RC, Brody LR. Critical consciousness, racial and gender discrimination, and HIV disease markers in African American women with HIV. AIDS Behav 2014; 18:1237-46. [PMID: 24077930 DOI: 10.1007/s10461-013-0621-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Critical consciousness, the awareness of social oppression, is important to investigate as a buffer against HIV disease progression in HIV-infected African American women in the context of experiences with discrimination. Critical consciousness comprises several dimensions, including social group identification, discontent with distribution of social power, rejection of social system legitimacy, and a collective action orientation. The current study investigated self-reported critical consciousness as a moderator of perceived gender and racial discrimination on HIV viral load and CD4+ cell count in 67 African American HIV-infected women. Higher critical consciousness was found to be related to higher likelihood of having CD4+ counts over 350 and lower likelihood of detectable viral load when perceived racial discrimination was high, as revealed by multiple logistic regressions that controlled for highly active antiretroviral therapy (HAART) adherence. Multiple linear regressions showed that at higher levels of perceived gender and racial discrimination, women endorsing high critical consciousness had a larger positive difference between nadir CD4+ (lowest pre-HAART) and current CD4+ count than women endorsing low critical consciousness. These findings suggest that raising awareness of social oppression to promote joining with others to enact social change may be an important intervention strategy to improve HIV outcomes in African American HIV-infected women who report experiencing high levels of gender and racial discrimination.
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Alperen J, Brummel S, Tassiopoulos K, Mellins CA, Kacanek D, Smith R, Seage GR, Moscicki AB. Prevalence of and risk factors for substance use among perinatally human immunodeficiency virus-infected and perinatally exposed but uninfected youth. J Adolesc Health 2014; 54:341-9. [PMID: 24239286 PMCID: PMC3944021 DOI: 10.1016/j.jadohealth.2013.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 09/02/2013] [Accepted: 09/09/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE This study examined risk factors associated with recent substance use (SU) among perinatally human immunodeficiency virus (HIV)-infected (PHIV+) and perinatally exposed, uninfected (PHEU) youth and compared SU lifetime prevalence with the general population of United States (U.S.) adolescents. METHODS We conducted cross-sectional and longitudinal analyses of 511 PHIV+ and PHEU youth (mean age at study entry, 13.2 years; 51% female; 69% PHIV+; and 72% African-American) enrolled in a U.S. multisite prospective cohort study between 2007 and 2009. Substance use data were collected by audio computer-assisted self-interview. Youth Risk Behavior Surveillance System and Monitoring the Future data were used to compare SU lifetime prevalence with U.S. samples. RESULTS Perinatal HIV infection was not a statistically significant risk factor for alcohol or marijuana use. Risk factors for alcohol use among PHIV+ youth included higher severity of emotional and conduct problems and alcohol and marijuana use in the home by the caregiver or others. Risk factors for marijuana use among PHIV+ youth included marijuana use in the home, higher severity of conduct problems, and stressful life events. Similar SU risk factors among PHEU youth included SU in the home and higher severity of conduct and emotional problems. Overall lifetime prevalence of SU by age was similar to that in national surveys. CONCLUSIONS Although SU lifetime prevalence and risk factors for PHIV+ and PHEU adolescents were similar to national norms, the negative consequences are potentially greater for PHIV+ youth. Prevention efforts should begin before SU initiation and address the family and social environment and youth mental health status.
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Affiliation(s)
- Julie Alperen
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
| | - Sean Brummel
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | | | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Renee Smith
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - George R Seage
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Anna-Barbara Moscicki
- Department of Pediatrics, University of California-San Francisco, San Francisco, California
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Elliott JC, Aharonovich E, O’Leary A, Wainberg M, Hasin D. Drinking motives as prospective predictors of outcome in an intervention trial with heavily drinking HIV patients. Drug Alcohol Depend 2014; 134:290-295. [PMID: 24286967 PMCID: PMC3908664 DOI: 10.1016/j.drugalcdep.2013.10.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 10/22/2013] [Accepted: 10/22/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Heavy alcohol consumption in HIV patients is an increasing health concern. Applying the drinking motivational model to HIV primary care patients, drinking motives (drinking to cope with negative affect, for social facilitation, and in response to social pressure) were associated with alcohol consumption at a baseline interview. However, whether these motives predict continued heavy drinking or alcohol dependence in this population is unknown. METHODS Participants were 254 heavy-drinking urban HIV primary care patients (78.0% male; 94.5% African American or Hispanic) participating in a randomized trial of brief drinking-reduction interventions. Drinking motive scales, as well as measures of alcohol consumption and alcohol dependence, were administered at baseline. Consumption and dependence measures were re-administered at the end of treatment two months later. Regression analyses tested whether baseline drinking motive scale scores predicted continued heavy drinking and alcohol dependence status at the end of treatment, and whether motives interacted with treatment condition. RESULTS Baseline drinking to cope with negative affect predicted continued heavy drinking (p<0.05) and alcohol dependence, the latter in both in the full sample (adjusted odds ratio [AOR]=2.14) and among those with baseline dependence (AOR=2.52). Motives did not interact with treatment condition in predicting alcohol outcomes. CONCLUSIONS Drinking to cope with negative affect may identify HIV patients needing targeted intervention to reduce drinking, and may inform development of more effective interventions addressing ways other than heavy drinking to cope with negative affect.
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Affiliation(s)
- Jennifer C. Elliott
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032
| | - Efrat Aharonovich
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 180 Ft. Washington Avenue, New York, NY 10032,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Ann O’Leary
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333
| | - Milton Wainberg
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 180 Ft. Washington Avenue, New York, NY 10032,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
| | - Deborah Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 180 Ft. Washington Avenue, New York, NY 10032,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032
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Cook RL, Zhu F, Belnap BH, Weber KM, Cole SR, Vlahov D, Cook JA, Hessol NA, Wilson TE, Plankey M, Howard AA, Sharp GB, Richardson JL, Cohen MH. Alcohol consumption trajectory patterns in adult women with HIV infection. AIDS Behav 2013; 17:1705-12. [PMID: 22836592 PMCID: PMC3534826 DOI: 10.1007/s10461-012-0270-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
HIV-infected women with excessive alcohol consumption are at risk for adverse health outcomes, but little is known about their long-term drinking trajectories. This analysis included longitudinal data, obtained from 1996 to 2006, from 2,791 women with HIV from the Women's Interagency HIV Study. Among these women, the proportion in each of five distinct drinking trajectories was: continued heavy drinking (3 %), reduction from heavy to non-heavy drinking (4 %), increase from non-heavy to heavy drinking (8 %), continued non-heavy drinking (36 %), and continued non-drinking (49 %). Depressive symptoms, other substance use (crack/cocaine, marijuana, and tobacco), co-infection with hepatitis C virus (HCV), and heavy drinking prior to enrollment were associated with trajectories involving future heavy drinking. In conclusion, many women with HIV change their drinking patterns over time. Clinicians and those providing alcohol-related interventions might target those with depression, current use of tobacco or illicit drugs, HCV infection, or a previous history of drinking problems.
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Affiliation(s)
- Robert L Cook
- Department of Epidemiology, University of Florida, PO Box 100231, Gainesville, FL 32610, USA.
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Watson RR, Preedy VR, Zibadi S. Alcohol, HIV/AIDS, and Liver Disease. ALCOHOL, NUTRITION, AND HEALTH CONSEQUENCES 2013. [PMCID: PMC7122083 DOI: 10.1007/978-1-62703-047-2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Globally, there are over 33 million persons living with HIV/AIDS resulting in 1.8 million deaths annually. While the rate of HIV transmission is slowing, it is estimated that 2.6 million new infections occur yearly [1]. In the United States, there are approximately 1.2 million living with HIV/AIDS, with 50,000 new HIV infections and 17,000 deaths from the disease annually [2]. For those who can obtain effective antiretroviral therapy (ART), HIV/AIDS has become a chronic disease with life expectancies over 30 years [3]. Research in the last 10 years has revealed the importance of alcohol in the HIV/AIDS epidemic. Alcohol use, in moderate or hazardous amounts, has been associated with increased acquisition of HIV infection, progression of HIV infection, deleterious effects on HIV treatment, and acceleration in the comorbidities of HIV infection [4–9]. Yet alcohol remains the “forgotten drug” of the HIV/AIDS epidemic [10].
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Affiliation(s)
- Ronald Ross Watson
- Arizona Health Science Center, Mel and Enid Zuckerman College of Public, University of Arizona, 1501 N. Campbell Ave. ROOM 4335, TUCSON, 85724-5155 Arizona USA
| | - Victor R. Preedy
- Dept. Nutrition & Dietetics, King's College, Stamford St. 150, London, SE1 9NH United Kingdom
| | - Sherma Zibadi
- Division of Health Promotion Sciences, Mel and Enid Zuckerman, University of Arizona, 1295 N. Martin Avenue, Tucson, 85724 Arizona USA
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Hung YP, Lee NY, Lin SH, Chang HC, Wu CJ, Chang CM, Chen PL, Lin HJ, Wu YH, Tsai PJ, Tsai YS, Ko WC. Effects of PPARγ and RBP4 gene variants on metabolic syndrome in HIV-infected patients with anti-retroviral therapy. PLoS One 2012; 7:e49102. [PMID: 23145084 PMCID: PMC3492303 DOI: 10.1371/journal.pone.0049102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 10/03/2012] [Indexed: 11/23/2022] Open
Abstract
Background PPARγ and RBP4 are known to regulate lipid and glucose metabolism and insulin resistance. The influences of PPARγ (C1431T and Pro12Ala) and RBP4 (−803GA) polymorphisms on metabolic syndrome in HIV-infected patients receiving anti-retroviral therapy were examined in this study. Materials and Methods A cross-sectional study of HIV-1 infected adults with antiretroviral therapy for more than one year in the National Cheng Kung University Hospital was conducted. The gene polymorphisms were determined by quantitative PCR. Results Ninety-one patients were included in the study. Eighty-two (90.1%) patients were males with a mean age of 44.4 years. For the C1431T polymorphism in PPARγ, while patients with the T allele (48.4%) had trends toward lower rate of hypertriglyceridemia, the borderline significance together with insignificant power did not support the protective effect of the T allele against development of hypertriglyceridemia. For the Pro12Ala polymorphism in PPARγ, although patients with the Pro/Ala genotype (8.8%) had a higher level of serum LDL (138.0 vs. 111.5 mg/dl, P = 0.04) and trends toward higher rates of hypercholesterolemia and serum LDL>110 mg/dl, these variables were found to be independent of the Pro/Ala genotype in the multivariate analysis. For the −803GA polymorphism in RBP4, patients with the A allele (23.1%) more often had insulin resistance (HOMA>3.8; 33.3 vs. 8.7%, P = 0.01) and more often received anti-hypoglycemic drugs (14.3 vs. 1.4%, P = 0.04). The detrimental effect of the A allele in RBP4 −803GA polymorphism on development of insulin resistance was supported by the multivariate analysis adjusting for covariates. Conclusion The impacts of PPARγ C1431T and Pro12Ala polymorphisms on metabolism in HIV-infected patients are not significant. RBP4 −803GA polymorphism has increased risk of insulin resistance in HIV-infected patients with anti-retroviral therapy.
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Affiliation(s)
- Yuan-Pin Hung
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan
| | - Nan-Yao Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ho-Ching Chang
- Department of Nutrition, Chi-Mei Hospital, Tainan, Taiwan
| | - Chi-Jung Wu
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Clinical Research, National Health Research Institutes, Tainan, Taiwan
| | - Chia-Ming Chang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Po-Lin Chen
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Hsiao-Ju Lin
- Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Hui Wu
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Internal Medicine, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Pei-Jane Tsai
- Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University, Tainan, Taiwan
- Research Center of Infectious Disease and Signaling, National Cheng Kung University, Tainan, Taiwan
| | - Yau-Sheng Tsai
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
- Research Center of Infectious Disease and Signaling, National Cheng Kung University, Tainan, Taiwan
- * E-mail: (WCK); (YST)
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
- Research Center of Infectious Disease and Signaling, National Cheng Kung University, Tainan, Taiwan
- Department of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail: (WCK); (YST)
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Kabali C, Cheng DM, Brooks DR, Bridden C, Horsburgh CR, Samet JH. Recent cigarette smoking and HIV disease progression: no evidence of an association. AIDS Care 2011; 23:947-56. [PMID: 21400309 DOI: 10.1080/09540121.2010.542128] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The association between smoking and HIV disease progression has been examined in several studies; however, findings have been inconsistent. We examined the effect of recent cigarette smoking on CD4(+) T cell count/µl (CD4 count) and HIV RNA concentration (HIV viral load (VL)) among two HIV-infected cohorts with alcohol problems in Massachusetts in the periods 1997-2001 and 2001-2006 using a prospective cohort design and linear mixed models. Smoking groups were defined as: minimal or non-smokers, light smokers, moderate smokers, and heavy smokers. Age, alcohol use, injection drug use, depressive symptoms, gender, annual income, and antiretroviral therapy adherence were considered as potential confounders. Among 462 subjects, no significant differences in CD4 count or VL were found between smoking groups. Using minimal or non-smokers as the reference group, the adjusted mean differences in CD4 count were: 8.2 (95% confidence interval (CI): -17.4, 33.8) for heavy smokers; -0.1 (95% CI: -25.4, 5.1) for moderate smokers; and -2.6 (95% CI: -28.3, 3.0) for light smokers. For log10 VL, the adjusted differences were: 0.03 (95% CI: -0.12, 0.17) for heavy smokers; -0.06 (95% CI: -0.20, 0.08) for moderate smokers; and 0.14 (95% CI -0.01, 0.28) for light smokers. This study did not find an association between smoking cigarettes and HIV disease progression as measured by CD4 cell count and VL.
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Affiliation(s)
- Conrad Kabali
- Department of Epidemiology, Boston University School of Public Health, MA, USA.
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Azar MM, Springer SA, Meyer JP, Altice FL. A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug Alcohol Depend 2010; 112:178-93. [PMID: 20705402 PMCID: PMC2997193 DOI: 10.1016/j.drugalcdep.2010.06.014] [Citation(s) in RCA: 299] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 06/22/2010] [Accepted: 06/23/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Alcohol use disorders (AUDs) are highly prevalent and associated with non-adherence to antiretroviral therapy, decreased health care utilization and poor HIV treatment outcomes among HIV-infected individuals. OBJECTIVES To systematically review studies assessing the impact of AUDs on: (1) medication adherence, (2) health care utilization and (3) biological treatment outcomes among people living with HIV/AIDS (PLWHA). DATA SOURCES Six electronic databases and Google Scholar were queried for articles published in English, French and Spanish from 1988 to 2010. Selected references from primary articles were also examined. REVIEW METHODS Selection criteria included: (1) AUD and adherence (N=20); (2) AUD and health services utilization (N=11); or (3) AUD with CD4 count or HIV-1 RNA treatment outcomes (N=10). Reviews, animal studies, non-peer reviewed documents and ongoing studies with unpublished data were excluded. Studies that did not differentiate HIV+ from HIV- status and those that did not distinguish between drug and alcohol use were also excluded. Data were extracted, appraised and summarized. DATA SYNTHESIS AND CONCLUSIONS Our findings consistently support an association between AUDs and decreased adherence to antiretroviral therapy and poor HIV treatment outcomes among HIV-infected individuals. Their effect on health care utilization, however, was variable.
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Meade CS, Drabkin AS, Hansen NB, Wilson PA, Kochman A, Sikkema KJ. Reductions in alcohol and cocaine use following a group coping intervention for HIV-positive adults with childhood sexual abuse histories. Addiction 2010; 105:1942-51. [PMID: 20840176 PMCID: PMC2970668 DOI: 10.1111/j.1360-0443.2010.03075.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Few interventions exist to reduce alcohol and non-injection drug use among people living with HIV/AIDS. This study tested the effects of a coping group intervention for HIV-positive adults with childhood sexual abuse histories on alcohol, cocaine and marijuana use. DESIGN Participants were assigned randomly to the experimental coping group or a time-matched comparison support group. Both interventions were delivered in a group format over 15 weekly 90-minute sessions. SETTING AND PARTICIPANTS A diverse sample of 247 HIV-positive men and women with childhood sexual abuse were recruited from AIDS service organizations and community health centers in New York City. MEASUREMENTS Substance use was assessed pre- and post-intervention and every 4 months during a 12-month follow-up period. Using an intent-to-treat analysis, longitudinal changes in substance use by condition were assessed using generalized estimating equations. FINDINGS At baseline, 42% of participants drank alcohol, 26% used cocaine and 26% used marijuana. Relative to participants in the support group, those in the coping group had greater reductions in quantity of alcohol use (Wald χ²(₄)=10.77, P = 0.029) and any cocaine use (Wald χ²(₄) = 9.81, P = 0.044) overtime. CONCLUSIONS Many HIV patients, particularly those with childhood sexual abuse histories, continue to abuse substances. This group intervention that addressed coping with HIV and sexual trauma was effective in reducing alcohol and cocaine use, with effects sustained at 12-month follow-up. Integrating mental health treatment into HIV prevention may improve outcomes.
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Affiliation(s)
- Christina S. Meade
- Department of Psychiatry & Behavioral Sciences, Division of Medical Psychology, Duke University School of Medicine,Duke Global Health Institute
| | | | | | - Patrick A. Wilson
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health
| | | | - Kathleen J. Sikkema
- Department of Psychiatry & Behavioral Sciences, Division of Medical Psychology, Duke University School of Medicine,Department of Psychology & Neuroscience, Duke University
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Abstract
Although the incidence of HIV in the United States is higher among men compared to women, the global proportion of women versus men who are infected has been approximately 50% since the late 1990s. Women have been under-represented in neuropsychological studies of HIV. A small number of studies have reported a significantly higher prevalence of neurocognitive impairment among HIV+ women compared to HIV- controls regardless of symptom status and with or without an AIDS diagnosis. Impairment was most evident on psychomotor tasks. The risk of neuropsychological impairment was increased among HIV+ women not on antiretroviral therapy. Age and depressive symptoms also increase neurocognitive risk. New neurocognitive studies of ovarian steroid hormones, PTSD and other psychiatric conditions are critical for addressing potential female-specific aspects of HIV-Associated Neurocognitive Disorder. Such studies will also address questions regarding involvement of the hippocampus and verbal memory, which may be of particular significance among HIV+ women.
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