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Ma J, Luu B, Ruderman SA, Whitney BM, Merrill JO, Mixson LS, Nance RM, Drumright LN, Hahn AW, Fredericksen RJ, Chander G, Lau B, McCaul ME, Safren S, O'Cleirigh C, Cropsey K, Mayer KH, Mathews WC, Moore RD, Napravnik S, Christopoulos K, Willig A, Jacobson JM, Webel A, Burkholder G, Mugavero MJ, Saag MS, Kitahata MM, Crane HM, Delaney JAC. Alcohol and drug use severity are independently associated with antiretroviral adherence in the current treatment era. AIDS Care 2024; 36:618-630. [PMID: 37419138 PMCID: PMC10771542 DOI: 10.1080/09540121.2023.2223899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized.
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Affiliation(s)
- J Ma
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B Luu
- Department of Medicine, University of Toronto, Toronto, Canada
| | - S A Ruderman
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B M Whitney
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J O Merrill
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L S Mixson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R M Nance
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L N Drumright
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - A W Hahn
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R J Fredericksen
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - G Chander
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B Lau
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - M E McCaul
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - S Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - C O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Harvard Medical School, Boston, MA, USA
| | - K Cropsey
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - K H Mayer
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - W C Mathews
- Department of Medicine, University of California, San Diego, CA, USA
| | - R D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - S Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - K Christopoulos
- Department of Medicine, University of California, San Francisco, CA, USA
| | - A Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J M Jacobson
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - A Webel
- Department of Child, Family, and Population Health Nursing, Unviersity of Washington, Seattle, WA, USA
| | - G Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - H M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J A C Delaney
- Department of Medicine, University of Washington, Seattle, WA, USA
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
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Coll P, Jarrín I, Martínez E, Martínez-Sesmero JM, Domínguez-Hernández R, Castro-Gómez A, Casado MŸ. Achieving the UNAIDS goals by 2030 in people living with HIV: A simulation model to support the prioritization of health care interventions. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:589-595. [PMID: 36710166 DOI: 10.1016/j.eimce.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/29/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE We simulated the impact of implementing different health interventions to improve the HIV continuum of care for people diagnosed, on treatment, and virologically suppressed in Spain for the 2020-2030 period. METHODS The model was carried out in four phases involving a multidisciplinary expert panel: (1) literature review; (2) selection/definition of the interventions and their effectiveness; (3) consensus meeting; and (4) development of an analytical decision model to project the impact of implementing/strengthening these interventions to improve the HIV continuum of care, corresponding to 2017-2019 (87% diagnosed, 97% on treatment, 90% with viral suppression), through the creation of different scenarios for 2020-2030. A total of 19 interventions were selected based on expanding the offer of HIV rapid tests and implementing training/peer programmes, electronic alerts, multidisciplinary care, and mHealth, among others. The effectiveness of the interventions was defined by the percentage increases in diagnosis, treatment, and viral suppression after their implementation, targeting the entire population and specific groups at high-risk (men who have sex with men, migrants, female sex workers, transgender people, and people who inject drugs). RESULTS Implementing eight interventions for diagnosis, three for treatment, and eight for viral suppression for the target populations during 2020-2030 would increase the continuum of care to approximately 100% diagnosed (remaining residual undetectable cases), 98% treated, and 96% virologically suppressed. CONCLUSIONS Planification, prioritization, and implementation of selected interventions based on the current HIV continuum of care could allow achievement of the 95-95-95 UNAIDS goals in Spain by 2030.
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Affiliation(s)
- Pep Coll
- IrsiCaixa-AIDS Research Institute, Germans Trias I Pujol Hospital, Badalona, Barcelona, Spain
| | - Inma Jarrín
- National Center for Epidemiology, Institute of Health Carlos III (ISCIII), Madrid, Spain; Spanish HIV/AIDS Research Network (CoRIS), Madrid, Spain; CIBER de Enfermedades Infecciosas, Madrid, Spain
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Ross EJ, Williams RS, Viamonte M, Reynolds JM, Duncan DT, Paul RH, Carrico AW. Overamped: Stimulant Use and HIV Pathogenesis. Curr HIV/AIDS Rep 2023; 20:321-332. [PMID: 37971597 DOI: 10.1007/s11904-023-00672-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW In the era of HIV treatment as prevention (TasP), more clarity is needed regarding whether people with HIV who use stimulants (i.e., methamphetamine, powder cocaine, and crack cocaine) display elevated HIV viral load and greater immune dysregulation. RECENT FINDINGS Although rates of viral suppression have improved in the TasP era, stimulant use was independently associated with elevated viral load in 23 of 28 studies included in our review. In the 12 studies examining other HIV disease markers, there was preliminary evidence for stimulant-associated alterations in gut-immune dysfunction and cellular immunity despite effective HIV treatment. Studies generally focused on documenting the direct associations of stimulant use with biomarkers of HIV pathogenesis without placing these in the context of social determinants of health. Stimulant use is a key barrier to optimizing the effectiveness of TasP. Elucidating the microbiome-gut-brain axis pathways whereby stimulants alter neuroimmune functioning could identify viable targets for pharmacotherapies for stimulant use disorders. Examining interpersonal, neighborhood, and structural determinants that could modify the associations of stimulant use with biomarkers of HIV pathogenesis is critical to guiding the development of comprehensive, multi-level interventions.
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Affiliation(s)
- Emily J Ross
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Renessa S Williams
- University of Miami School of Nursing and Health Sciences, Coral Gables, FL, USA
| | | | - John M Reynolds
- Calder Memorial Library, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dustin T Duncan
- Columbia University Mailman School of Public Health, New York City, NY, USA
| | - Robert H Paul
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Adam W Carrico
- Robert Stempel College of Public Health and Social Work, Florida International University, 11200 S.W. 8th Street, AHC5, #407, Miami, FL, 33199, USA.
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Haas CB, Jordahl KM, Nance RM, Whitney BM, Wang L, Delaney JAC, Ruderman S, Jia T, Mathews WC, Saag MS, Lee SA, Napravnik S, Jacobson JM, Chander G, McCall EM, Moore RD, Mayer KH, Mukherjee S, Lee WJ, Crane PK, Crane H, Peter I, Lindström S. Assessing the associations between known genetic variants and substance use in people with HIV in the United States. PLoS One 2023; 18:e0292068. [PMID: 37796845 PMCID: PMC10553320 DOI: 10.1371/journal.pone.0292068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The prevalence of substance use in people with HIV (PWH) in the United States is higher than in the general population and is an important driver of HIV-related outcomes. We sought to assess if previously identified genetic associations that contribute to substance use are also observed in a population of PWH. METHODS We performed genome-wide association studies (GWAS) of alcohol, smoking, and cannabis use phenotypes in a multi-ancestry population of 7,542 PWH from the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). We conducted multi-ancestry GWAS for individuals of African (n = 3,748), Admixed American (n = 1,334), and European (n = 2,460) ancestry. Phenotype data were self-reported and collected using patient reported outcomes (PROs) and three questions from AUDIT-C, an alcohol screening tool. We analyzed nine phenotypes: 1) frequency of alcohol consumption, 2) typical number of drinks on a day when drinking alcohol, 3) frequency of five or more alcoholic drinks in a 30-day period, 4) smoking initiation, 5) smoking cessation, 6) cigarettes per day, 7) cannabis use initiation, 8) cannabis use cessation, 9) frequency of cannabis use during the previous 30 days. For each phenotype we considered a) variants previously identified as associated with a substance use trait and b) novel associations. RESULTS We observed evidence for effects of previously reported single nucleotide polymorphisms (SNPs) related to alcohol (rs1229984, p = 0.001), tobacco (rs11783093, p = 2.22E-4), and cannabis use (rs2875907, p = 0.005). We also report two novel loci (19p13.2, p = 1.3E-8; and 20p11.21, p = 2.1E-8) associated with cannabis use cessation. CONCLUSIONS Our analyses contribute to understanding the genetic bases of substance use in a population with relatively higher rates of use compared to the general population.
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Affiliation(s)
- Cameron B. Haas
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Kristina M. Jordahl
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Robin M. Nance
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Bridget M. Whitney
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Lu Wang
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | | | - Stephanie Ruderman
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Tongqiu Jia
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Wm. Christopher Mathews
- Department of Medicine, University of California at San Diego, San Diego, CA, United States of America
| | - Michael S. Saag
- Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Sulggi A. Lee
- Department of Medicine, University of California at San Francisco, San Francisco, CA, United States of America
| | - Sonia Napravnik
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Jeffrey M. Jacobson
- Center for AIDS Research, Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH, United States of America
| | - Geetanjali Chander
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Elizabeth M. McCall
- Department of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Kenneth H. Mayer
- Harvard Medical School, Beth Israel Deaconess Medical Center, Fenway Health, Boston, MA, United States of America
| | - Shubhabrata Mukherjee
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Won Jun Lee
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Paul K. Crane
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Heidi Crane
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Sara Lindström
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
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Gagnon KW, Baral S, Long D, Guzman AL, Johnson B, Burkholder G, Willig J, Mugavero M, Baldwin M, Fogger S, Creger T, Cropsey K, Eaton E. Delivery of the HIV Service and Telemedicine Through Effective Patient-Reported Outcomes (+STEP) Intervention to Increase Screening and Treatment of Mental Health and Substance Use Disorders for People Living With HIV in Alabama: Protocol for an Effectiveness-Implementation Study. JMIR Res Protoc 2023; 12:e40470. [PMID: 37581919 PMCID: PMC10466153 DOI: 10.2196/40470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 03/03/2023] [Accepted: 05/13/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The syndemic of mental health (MH) and substance use disorders (SUDs) is common among persons living with HIV and jeopardizes HIV treatment adherence, engagement in care, and viral load suppression. Electronic patient-reported outcomes (ePROs), completed through tablet or computer, and telemedicine are evidence- and technology-based interventions that have been used to successfully increase screening and treatment, respectively, a model that holds promise for persons living with HIV. To date, there is limited guidance on implementing ePROs and telemedicine into HIV clinical practice even though it is well known that these evidence-based tools improve diagnosis and access to care. OBJECTIVE To address this, we aim to conduct a multicomponent intervention for persons living with HIV, including the delivery of HIV services and telemedicine through effective ePROs (+STEP), to increase screening and treatment of MH and SUD in Ryan White HIV/AIDS Program (RWHAP)-funded clinics in Alabama. METHODS Through this intervention, we will conduct a readiness, acceptability, and accessibility assessment and implement +STEP to improve the diagnosis and treatment of MH and SUD at RWHAP clinics in Alabama. To describe implementation strategies that address barriers to the uptake of +STEP in RWHAP clinics, we will conduct qualitative interviews in years 1 (early implementation), 2 (scale up), and 4 (maintenance) with patients and key staff to evaluate barriers, facilitators, and implementation strategies. Our Results will enable us to modify strategies to enhance +STEP penetration over time and inform the implementation blueprint, which we will develop for both RWHAP clinics in Alabama and future sites. We will assess the impact of implementing +STEP on diagnoses, referrals, and health care use related to MH, SUD, and HIV by comparing clinical outcomes from patients receiving these interventions (ePROs and telemedicine) with historical controls. RESULTS The first study site began implementation in April 2022. A total of 2 additional sites have initiated ePROs. Final results are expected in 2026. The results of this study will provide a foundation for future research expanding access to ePROs for improved diagnosis linked to telemedicine access to accelerate patients along the continuum of care from MH and SUD diagnosis to treatment. CONCLUSIONS Achieving the end of the HIV epidemic in the United States necessitates programs that accelerate movement across the MH and SUD care continuum from diagnosis to treatment for persons living with HIV. Scaling these services represents a path toward improved treatment outcomes with both individual health and population-level prevention benefits of sustained HIV viral suppression in the era of undetectable=untransmittable (U=U). This study will address this evidence gap through the evaluation of the implementation of +STEP to establish the necessary systems and processes to screen, identify, and better treat substance use and MH for people living with HIV. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40470.
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Affiliation(s)
- Kelly W Gagnon
- Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Center for Addiction and Pain Prevention and Intervention, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Stefan Baral
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Dustin Long
- Centers for AIDS Research, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Alfredo L Guzman
- Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Bernadette Johnson
- Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Greer Burkholder
- Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Centers for AIDS Research, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - James Willig
- Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Centers for AIDS Research, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael Mugavero
- Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Centers for AIDS Research, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Margaret Baldwin
- Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Susanne Fogger
- Nursing Family, Community and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Thomas Creger
- Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Karen Cropsey
- Center for Addiction and Pain Prevention and Intervention, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ellen Eaton
- Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Center for Addiction and Pain Prevention and Intervention, University of Alabama at Birmingham, Birmingham, AL, United States
- Centers for AIDS Research, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
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Gandhi RT, Bedimo R, Hoy JF, Landovitz RJ, Smith DM, Eaton EF, Lehmann C, Springer SA, Sax PE, Thompson MA, Benson CA, Buchbinder SP, Del Rio C, Eron JJ, Günthard HF, Molina JM, Jacobsen DM, Saag MS. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2022 Recommendations of the International Antiviral Society-USA Panel. JAMA 2023; 329:63-84. [PMID: 36454551 DOI: 10.1001/jama.2022.22246] [Citation(s) in RCA: 161] [Impact Index Per Article: 161.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Importance Recent advances in treatment and prevention of HIV warrant updated recommendations to guide optimal practice. Objective Based on a critical evaluation of new data, to provide clinicians with recommendations on use of antiretroviral drugs for the treatment and prevention of HIV, laboratory monitoring, care of people aging with HIV, substance use disorder and HIV, and new challenges in people with HIV, including COVID-19 and monkeypox virus infection. Evidence Review A panel of volunteer expert physician scientists were appointed to update the 2020 consensus recommendations. Relevant evidence in the literature (PubMed and Embase searches, which initially yielded 7891 unique citations, of which 834 were considered relevant) and studies presented at peer-reviewed scientific conferences between January 2020 and October 2022 were considered. Findings Initiation of antiretroviral therapy (ART) is recommended as soon as possible after diagnosis of HIV. Barriers to care should be addressed, including ensuring access to ART and adherence support. Integrase strand transfer inhibitor-containing regimens remain the mainstay of initial therapy. For people who have achieved viral suppression with a daily oral regimen, long-acting injectable therapy with cabotegravir plus rilpivirine given as infrequently as every 2 months is now an option. Weight gain and metabolic complications have been linked to certain antiretroviral medications; novel strategies to ameliorate these complications are needed. Management of comorbidities throughout the life span is increasingly important, because people with HIV are living longer and confronting the health challenges of aging. In addition, management of substance use disorder in people with HIV requires an evidence-based, integrated approach. Options for preexposure prophylaxis include oral medications (tenofovir disoproxil fumarate or tenofovir alafenamide plus emtricitabine) and, for the first time, a long-acting injectable agent, cabotegravir. Recent global health emergencies, like the SARS-CoV-2 pandemic and monkeypox virus outbreak, continue to have a major effect on people with HIV and the delivery of services. To address these and other challenges, an equity-based approach is essential. Conclusions and Relevance Advances in treatment and prevention of HIV continue to improve outcomes, but challenges and opportunities remain.
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Affiliation(s)
- Rajesh T Gandhi
- Massachusetts General Hospital and Harvard Medical School, Boston
| | - Roger Bedimo
- University of Texas Southwestern Medical Center, Dallas
| | - Jennifer F Hoy
- The Alfred Hospital and Monash University, Melbourne, Australia
| | | | - Davey M Smith
- University of California San Diego School of Medicine
| | | | - Clara Lehmann
- University of Cologne and German Center for Infection Research (DZIF), Bonn-Cologne
| | - Sandra A Springer
- Yale University School of Medicine, New Haven, Connecticut
- The Veterans Administration Connecticut Healthcare System, West Haven
| | - Paul E Sax
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Carlos Del Rio
- Emory University School of Medicine and Grady Health System, Atlanta, Georgia
| | - Joseph J Eron
- The University of North Carolina School of Medicine at Chapel Hill
| | - Huldrych F Günthard
- University Hospital Zurich and Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jean-Michel Molina
- University of Paris Cité, Saint-Louis and Lariboisière Hospitals, Assistance Publique Hopitaux de Paris, France
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Bertholet N, Winter MR, Heeren T, Walley AY, Saitz R. Polysubstance Use Patterns Associated With HIV Disease Severity Among Those With Substance Use Disorders: A Latent Class Analysis. J Stud Alcohol Drugs 2023; 84:79-88. [PMID: 36799677 PMCID: PMC9948140 DOI: 10.15288/jsad.21-00440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 07/20/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Polysubstance use is common among people with HIV infection (PWH) and with substance use disorder (SUD), but its effects are understudied. We aimed to identify polysubstance use patterns over time and assess their associations with HIV disease severity. METHOD In 233 PWH with current or past SUD, latent class analysis identified polysubstance use patterns based on the Alcohol Use Disorders Identification Test-Consumption and past-30-day use of cannabis, cocaine, opioids, and tranquilizers at baseline. We categorized changes in use patterns and tested associations between those changes and CD4 count and HIV viral suppression at 12 months in linear and logistic regressions. RESULTS Three patterns were identified at baseline: 18% did not use any substance (NONE--a priori defined); 63% used mostly cannabis and alcohol (CA); and 19% used opioids along with other drugs, including cocaine, tranquilizers, cannabis, and alcohol (MULTI). At 12 months, 40% moved from a high to a lower substance use class (MULTI to CA, either to NONE) or remained as NONE, 43% were in CA both times and 17% increased (NONE to CA, either to MULTI) or remained as MULTI. The adjusted mean CD4 count (for baseline covariates and baseline CD4 count) was significantly lower among participants increasing or remaining in MULTI (523, 95% CI [448, 598], cells/mm3) compared with those who decreased/abstained throughout (607, 95% CI [552, 663], p = .02). No significant difference was observed for HIV viral suppression. CONCLUSIONS We identified distinct polysubstance use patterns among PWH with SUD: cannabis/alcohol and opioids with alcohol and other drugs. Changes over time toward fewer substances/no use were associated with lower HIV disease severity based on CD4 count but not based on HIV viral suppression.
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Affiliation(s)
- Nicolas Bertholet
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Alexander Y. Walley
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Richard Saitz
- Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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8
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Achieving the UNAIDS goals by 2030 in people living with HIV: A simulation model to support the prioritization of health care interventions. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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9
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Shelton BA, Sawinski D, MacLennan PA, Lee W, Wyatt C, Nadkarni G, Fatima H, Mehta S, Crane HM, Porrett P, Julian B, Moore RD, Christopoulos K, Jacobson JM, Muller E, Eron JJ, Saag M, Peter I, Locke JE. Associations between female birth sex and risk of chronic kidney disease development among people with HIV in the USA: A longitudinal, multicentre, cohort study. EClinicalMedicine 2022; 53:101653. [PMID: 36159042 PMCID: PMC9489495 DOI: 10.1016/j.eclinm.2022.101653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 01/28/2023] Open
Abstract
Background Women represent a meaningful proportion of new HIV diagnoses, with Black women comprising 58% of new diagnoses among women. As HIV infection also increases risk of chronic kidney disease (CKD), understanding CKD risk among women with HIV (WWH), particularly Black women, is critical. Methods In this longitudinal cohort study of people with HIV (PWH) enrolled in CFAR Network of Integrated Clinical Systems (CNICS), a multicentre study comprised of eight academic medical centres across the United States from Jan 01, 1996 and Nov 01, 2019, adult PWH were excluded if they had ≤2 serum creatinine measurements, developed CKD prior to enrollment, or identified as intersex or transgendered, leaving a final cohort of 33,998 PWH. The outcome was CKD development, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1·73 m2 calculated using the CKD-EPI equation, for ≥90 days with no intervening higher values. Findings Adjusting for demographic and clinical characteristics, WWH were 61% more likely to develop CKD than men (adjusted hazard ratio [aHR]: 1·61, 95% CI: 1·46-1·78, p<0·001). This difference persisted after further adjustment for APOL1 risk variants (aHR female sex: 1·92, 95% CI: 1·63-2·26, p<0·001) and substance abuse (aHR female sex: 1·70, 95% CI: 1·54-1·87, p<0·001). Interpretation WWH experienced increased risk of CKD. Given disparities in care among patients with end-stage kidney disease, efforts to engage WWH in nephrology care to improve chronic disease management are critical. Funding US National Institutes of Health.
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Affiliation(s)
- Brittany A. Shelton
- Department of Public Health, University of Tennessee, Knoxville, TN, United States
| | | | - Paul A. MacLennan
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Wonjun Lee
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Girish Nadkarni
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Huma Fatima
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Shikha Mehta
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Heidi M. Crane
- University of Washington School of Medicine, United States
| | - Paige Porrett
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Bruce Julian
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | | | | | | | - Elmi Muller
- Stellenbosch University, Medicine and Health Sciences, South Africa
| | - Joseph J. Eron
- University of North Carolina at Chapel Hill School of Medicine, United States
| | - Michael Saag
- University of Alabama at Birmingham Heersink School of Medicine, United States
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jayme E. Locke
- University of Alabama at Birmingham Heersink School of Medicine, United States
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10
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Garner BR, Gotham HJ, Knudsen HK, Zulkiewicz BA, Tueller SJ, Berzofsky M, Donohoe T, Martin EG, Brown LL, Gordon T. The Prevalence and Negative Impacts of Substance Use Disorders among People with HIV in the United States: A Real-Time Delphi Survey of Key Stakeholders. AIDS Behav 2022; 26:1183-1196. [PMID: 34586532 PMCID: PMC8940836 DOI: 10.1007/s10461-021-03473-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 02/06/2023]
Abstract
Although HIV and substance use disorders (SUDs) constitute a health syndemic, no research to date has examined the perceived negative impacts of different SUDs for people with HIV (PWH). In May 2019, 643 stakeholders in the U.S., representing clients of AIDS service organizations (ASOs), ASO staff, and HIV/AIDS Planning Council members, participated in an innovative Stakeholder-Engaged Real-Time Delphi (SE-RTD) survey focused on the prevalence and individual-level negative impact of five SUDs for PWH. The SE-RTD method has advantages over conventional survey methods by efficiently sharing information, thereby reducing the likelihood that between-group differences are simply due to lack of information, knowledge, and/or understanding. The population-level negative impacts were calculated by weighting each SUD's individual-level negative impact on indicators of the HIV Care Continuum and other important areas of life by the perceived prevalence of each SUD. Overall, we found these SUDs to have the greatest population-level negative impact scores (possible range 0-24): alcohol use disorder (population-level negative impact = 6.9; perceived prevalence = 41.9%), methamphetamine use disorder (population-level negative impact = 6.5; perceived prevalence = 3.2%), and opioid use disorder (population-level negative impact = 6.4; perceived prevalence = 34.6%). Beyond further demonstration of the need to better integrate SUD services within HIV settings, our findings may help inform how finite funding is allocated for addressing the HIV-SUD syndemic within the U.S. Based on our findings, such future efforts should prioritize the integration of evidence-based treatments that help address use disorders for alcohol, methamphetamine, and opioids.
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Affiliation(s)
- Bryan R. Garner
- RTI International, Research Triangle Park, P. O. Box 12194, Durham, NC 27709 USA
| | - Heather J. Gotham
- Stanford University School of Medicine, 1520 Page Mill Road MC 5265, Palo Alto, CA 94304 USA
| | - Hannah K. Knudsen
- University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY 40508 USA
| | | | - Stephen J. Tueller
- RTI International, Research Triangle Park, P. O. Box 12194, Durham, NC 27709 USA
| | - Marcus Berzofsky
- RTI International, Research Triangle Park, P. O. Box 12194, Durham, NC 27709 USA
| | - Tom Donohoe
- Pacific AIDS Education and Training Center, University of California Los Angeles, Los Angeles, CA 90024 USA
| | - Erika G. Martin
- Rockefeller College of Public Affairs and Policy at the University at Albany, Both part of the State University of New York, 1400 Washington Avenue, Milne 300E, Albany, NY 12222 USA
| | - L. Lauren Brown
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Meharry Medical College, Nashville, TN USA
- Infectious Disease Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
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11
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Bischoff-Grethe A, Ellis RJ, Tapert SF, Paulus MP, Grant I. Prior Methamphetamine Use Disorder History Does Not Impair Interoceptive Processing of Soft Touch in HIV Infection. Viruses 2021; 13:v13122476. [PMID: 34960745 PMCID: PMC8705776 DOI: 10.3390/v13122476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Interoception, defined as the sense of the internal state of one’s body, helps motivate goal-directed behavior. Prior work has shown that methamphetamine (METH) use disorder is associated with altered interoception, and that this may contribute to risky behavior. As people with HIV (PWH) may also experience disrupted bodily sensations (e.g., neuropathy), an important question is whether PWH with a history of METH use disorder might exhibit greater impairment of interoceptive processing. Methods: Eighty-three participants stratified by HIV infection and a past history of methamphetamine use disorder experienced a soft touch paradigm that included slow brush strokes on the left forearm and palm during blood-oxygen level-dependent functional MRI acquisition. To assess differences in interoception and reward, voxelwise analyses were constrained to the insula, a hub for the evaluation of interoceptive cues, and the striatum, which is engaged in reward processing. Results: Overall, individuals with a history of METH use disorder had an attenuated neural response to pleasant touch in both the insula and striatum. Longer abstinence was associated with greater neural response to touch in the insula, suggesting some improvement in responsivity. However, only PWH with no METH use disorder history had lower brain activation in the insula relative to non-using seronegative controls. Conclusions: Our findings suggest that while METH use disorder history and HIV infection independently disrupt the neural processes associated with interoception, PWH with METH use disorder histories do not show significant differences relative to non-using seronegative controls. These findings suggest that the effects of HIV infection and past methamphetamine use might not be additive with respect to interoceptive processing impairment.
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Affiliation(s)
- Amanda Bischoff-Grethe
- Department of Psychiatry, University of California, San Diego 9500 Gilman Drive, MC 0738 La Jolla, San Diego, CA 92093, USA; (S.F.T.); (I.G.)
- Correspondence:
| | - Ronald J. Ellis
- Department of Neurosciences, University of California, La Jolla, San Diego, CA 92093, USA;
| | - Susan F. Tapert
- Department of Psychiatry, University of California, San Diego 9500 Gilman Drive, MC 0738 La Jolla, San Diego, CA 92093, USA; (S.F.T.); (I.G.)
| | | | - Igor Grant
- Department of Psychiatry, University of California, San Diego 9500 Gilman Drive, MC 0738 La Jolla, San Diego, CA 92093, USA; (S.F.T.); (I.G.)
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12
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Crane HM, Nance R, Whitney BM, Ruderman S, Tsui JI, Chander G, McCaul ME, Lau B, Mayer KH, Batey DS, Safren SA, Moore RD, Eron JJ, Napravnik S, Mathews WC, Fredericksen RJ, Hahn AW, Mugavero MJ, Lober WB, Saag MS, Kitahata MM, Delaney JAC. Drug and alcohol use among people living with HIV in care in the United States by geographic region. AIDS Care 2021; 33:1569-1576. [PMID: 33486978 PMCID: PMC9104760 DOI: 10.1080/09540121.2021.1874274] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Substance use in the U.S. varies by geographic region. Opioid prescribing practices and marijuana, heroin, and methamphetamine availability are evolving differently across regions. We examined self-reported substance use among people living with HIV (PLWH) in care at seven sites from 2017-2019 to understand current regional substance use patterns. We calculated the percentage and standardized percentage of PLWH reporting current drug use and at-risk and binge alcohol use by U.S. Census Bureau geographic region and examined associations in adjusted logistic regression analyses. Among 7,686 PLWH, marijuana use was the most prevalent drug (30%), followed by methamphetamine/crystal (8%), cocaine/crack (7%), and illicit opioids (3%). One-third reported binge alcohol use (32%). Differences in percent of current use by region were seen for marijuana (24-41%) and methamphetamine/crystal (2-15%), with more use in the West and Northeast, and binge alcohol use (26-40%). In adjusted analyses, PLWH in the Midwest were significantly less likely to use methamphetamine/crystal (aOR: 0.13;0.06-0.25) or illicit opioids (aOR:0.16;0.05-0.53), and PLWH in the Northeast were more likely to use cocaine/crack (aOR:1.59;1.16-2.17), compared to PLWH in the West. Understanding differences in substance use patterns in the current era, as policies continue to evolve, will enable more targeted interventions in clinical settings among PLWH.
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Affiliation(s)
- Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Robin Nance
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Judith I. Tsui
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Kenneth H. Mayer
- Fenway Institute and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - D Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami FL, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - W Chris Mathews
- Department of Medicine, University of California at San Diego, San Diego, CA, USA
| | | | - Andrew W Hahn
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William B Lober
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Joseph AC Delaney
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Manitoba, Manitoba, Canada
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13
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Amin-Esmaeili M, Susukida R, Johnson RM, Farokhnia M, Crum RM, Thrul J, Mojtabai R. Patterns of reduced use and abstinence in multi-site randomized controlled trials of pharmacotherapies for cocaine and methamphetamine use disorders. Drug Alcohol Depend 2021; 226:108904. [PMID: 34304121 DOI: 10.1016/j.drugalcdep.2021.108904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many individuals with cocaine or methamphetamine use disorders who enter treatment do not achieve abstinence but reduce their use of the target drug. We aimed to compare change in pattern of drug use (i.e., achieving "abstinence", "reduced use" or no reduction in use) among participants in randomized controlled trials (RCTs) of treatment of cocaine and methamphetamine use disorder, irrespective of the type of treatment. METHODS The data were drawn from 10 multi-site pharmacotherapy RCTs of cocaine (n = 1,134) and methamphetamine (n = 555) use disorders. The outcome patterns and their sociodemographic and clinical correlates were compared in cocaine and methamphetamine RCTs, using multinomial logistic regression models. Analyses were adjusted for missing data, clustering within RCTs, socio-demographic and baseline clinical characteristics, and treatment arms. RESULTS Those in cocaine RCTs were more likely to experience reduced use compared to participants in methamphetamine RCTs (20.6% vs. 13.2%, respectively), but less likely to experience "abstinence" (7.6% vs. 20.3%; Chi-squared = 14.20, df = 2, P < 0.001). Differences in "abstinence" persisted after adjustment for baseline covariates. Association of sociodemographic and clinical correlates with outcomes differed in cocaine and methamphetamine RCTs. CONCLUSION A sizeable proportion of individuals in RCTs of pharmacological treatment for stimulant use disorder who do not attain "abstinence" nevertheless reduce their use. The outcome patterns of drug use are different for cocaine and methamphetamine use disorders and reliance on abstinence as the sole outcome may obscure these differences.
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Affiliation(s)
- Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, 1336616357, Iran.
| | - Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, 21205, USA.
| | - Mehdi Farokhnia
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore, Bethesda, MD, USA.
| | - Rosa M Crum
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore, MD, 21205, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St. Baltimore, MD, 21287, USA.
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St. Baltimore, MD, 21287, USA.
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14
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Satyanarayana S, Rogers BG, Bainter SA, Christopoulos KA, Fredericksen RJ, Mathews WC, Moore RD, Mugavero MJ, Napravnik S, Carrico AW, Mimiaga MJ, Mayer KH, Crane HM, Safren SA. Longitudinal Associations of Syndemic Conditions with Antiretroviral Therapy Adherence and HIV Viral Suppression Among HIV-Infected Patients in Primary Care. AIDS Patient Care STDS 2021; 35:220-230. [PMID: 34097465 PMCID: PMC8336208 DOI: 10.1089/apc.2021.0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Psychosocial syndemic conditions have received more attention regarding their deleterious effects on HIV acquisition risk than for their potential impact on HIV treatment and viral suppression. To examine syndemic conditions' impact on the HIV care continuum, we analyzed data collected from people living with HIV (N = 14,261) receiving care through The Centers for AIDS Research Network of Integrated Clinical Systems at seven sites from 2007 to 2017 who provided patient-reported outcomes ∼4-6 months apart. Syndemic condition count (depression, anxiety, substance use, and hazardous drinking), sexual risk group, and time in care were modeled to predict antiretroviral therapy (ART) adherence and viral suppression (HIV RNA <400 copies/mL) using multilevel logistic regression. Comparing patients with each other, odds of ART adherence were 61.6% lower per between-patient syndemic condition [adjusted odds ratio (AOR) = 0.384; 95% confidence interval (CI), 0.362-0.408]; comparing patients with themselves, odds of ART adherence were 36.4% lower per within-patient syndemic condition (AOR = 0.636 95% CI, 0.606-0.667). Odds of viral suppression were 29.3% lower per between-patient syndemic condition (AOR = 0.707; 95% CI, 0.644-0.778) and 27.7% lower per within-patient syndemic condition (AOR = 0.723; 95% CI, 0.671-0.780). Controlling for the effects of adherence (AOR = 5.522; 95% CI, 4.67-6.53), each additional clinic visit was associated with 1.296 times higher odds of viral suppression (AOR = 1.296; 95% CI, 1.22-1.38), but syndemic conditions were not significant. Deploying effective interventions within clinics to identify and treat syndemic conditions and bolster ART adherence and continued engagement in care can help control the HIV epidemic, even within academic medical settings in the era of increasingly potent ART.
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Affiliation(s)
- Satyanand Satyanarayana
- Department of Psychology, University of Miami, Coral Gables, Florida, USA.,Address correspondence to: Satyanand Satyanarayana, JD, MS, Department of Psychology, University of Miami, Coral Gables, FL 33124, USA
| | - Brooke G. Rogers
- Department of Psychology, University of Miami, Coral Gables, Florida, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sierra A. Bainter
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | | | - Rob J. Fredericksen
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - William C. Mathews
- Department of Medicine, UCSD School of Medicine, San Diego, California, USA
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael J. Mugavero
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Medicine, UAB School of Medicine, Birmingham, Alabama, USA
| | - Sonia Napravnik
- Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Adam W. Carrico
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA
| | - Matthew J. Mimiaga
- UCLA Center for LGBTQ Advocacy, Research, and Health (C-LARAH), Los Angeles, California, USA.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, California, USA.,The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
| | - Kenneth H. Mayer
- The Fenway Institute at Fenway Health, Boston, Massachusetts, USA.,Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Heidi M. Crane
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, Coral Gables, Florida, USA.,The Fenway Institute at Fenway Health, Boston, Massachusetts, USA
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15
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Rivera AV, Harriman G, Carrillo SA, Braunstein SL. Trends in Methamphetamine Use Among Men Who Have Sex with Men in New York City, 2004-2017. AIDS Behav 2021; 25:1210-1218. [PMID: 33185774 DOI: 10.1007/s10461-020-03097-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
Abstract
Methamphetamine (meth) use among men who have sex with men (MSM) has been documented to be associated with HIV transmission among those who are HIV-negative and worsening HIV outcomes among those who are HIV-positive. Recent media reports have suggested recent increases in meth use in New York City (NYC), particularly among Hispanic/Latino and Black MSM. Using serial cross-sectional data from 2004 to 2017, we aim to describe trends in meth use and describe racial/ethnic patterns among MSM in NYC. Overall, we observed a decrease in meth use among MSM from 2004 to 2011 and an increase from 2011 to 2017. When stratified by race/ethnicity, use among White MSM decreased. Beginning in 2008, use among both Hispanic/Latino and Black MSM increased over time. These data provide more evidence that meth use may be increasing in Hispanic/Latino and Black MSM. Culturally-tailored and status-neutral interventions should be explored.
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16
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Fulcher JA, Javanbakht M, Shover CL, Ragsdale A, Brookmeyer R, Shoptaw S, Gorbach PM. Comparative impact of methamphetamine and other drug use on viral suppression among sexual minority men on antiretroviral therapy. Drug Alcohol Depend 2021; 221:108622. [PMID: 33631545 PMCID: PMC8321435 DOI: 10.1016/j.drugalcdep.2021.108622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Substance use decreases the likelihood of achieving undetectable HIV viremia; however, the comparative effects by drug have not been fully described. In this study, we compare the effects of methamphetamine use versus other drugs on viremia in sexual minority men on antiretroviral therapy (ART). METHODS HIV-positive participants currently on ART (N = 230) were selected from an ongoing cohort of diverse young sexual minority men (mSTUDY) enrolled from August 2014 to May 2018. Substance use and sociodemographic factors associated with viremia outcomes were assessed using ordinal regression analysis with generalized estimating equations. Viremia outcomes were grouped as undetectable (<20 copies/mL), low level suppressed (21-200 copies/mL), or not suppressed (>200 copies/mL). RESULTS The prevalence of drug use across 825 study visits was 73 %, with methamphetamine use most prevalent (50 %). After adjusting for unstable housing and ART adherence, methamphetamine use, either alone (adjusted OR = 1.87; 95 % CI 1.03-3.40) or with other drugs (adjusted OR = 1.82; 95 % CI 1.12-2.95), was associated with higher odds of increasing viremia compared to no drug use. Other drug use excluding methamphetamine did not show a similar association (adjusted OR = 1.29; 95 % CI 0.80-2.09). Among our study population, nearly half the instances of viremia could be reduced if methamphetamine was discontinued (attributable fraction = 46 %; 95 % CI 3-71 %). CONCLUSIONS Methamphetamine use, either alone or in combination with other drugs, is associated with failure of viral suppression among sexual minority men on ART independent of adherence and sociodemographic factors. This accounts for nearly half of the observed instances of unsuppressed viremia in this study.
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Affiliation(s)
- Jennifer A. Fulcher
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.,VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90095, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
| | - Chelsea L. Shover
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
| | - Amy Ragsdale
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
| | - Ron Brookmeyer
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Pamina M. Gorbach
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
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17
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Pullen SD, Del Rio C, Brandon D, Colonna A, Denton M, Ina M, Lancaster G, Schmidtke AG, Marconi VC. An Innovative Physical Therapy Intervention for Chronic Pain Management and Opioid Reduction Among People Living with HIV. Biores Open Access 2020; 9:279-285. [PMID: 33376634 PMCID: PMC7757684 DOI: 10.1089/biores.2020.0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Chronic pain management has become a treatment priority for people living with HIV (PLH), and PLH may be at increased risk for opioid addiction. Physical therapy (PT) has been shown to be effective as a nonpharmacological method of chronic pain management; however, there is a gap in research examining the role of PT for chronic pain, especially as it relates to opioid reduction, in this patient population. This retrospective study evaluated pain level and opioid use before and after PT intervention among HIV-positive adults with chronic pain on chronic opioid therapy (n = 22). The study was conducted at a multidisciplinary AIDS clinic in Atlanta, GA. Outcome measures were self-reported pain on the numerical rating scale (0–10) and morphine milligram equivalents (MMEs), which measure opioid use. A majority of patients (77%) demonstrated a decrease in pain by the conclusion of the study period; however, only 18.2% of patients reported decreased pain as well as a decrease in MMEs. The most common PT treatments used among the patients with a decrease in pain and/or opioid use included home exercise programs, manual therapy, and self-pain management education. Eighty percent of the participants who did not decrease opioid use reported a decrease or elimination of pain by the end of the PT intervention. This reflects the need for careful consideration of the complexity of opioid use and addiction, and the importance of a multidisciplinary team to best serve the needs of PLH aiming to decrease chronic pain and opioid use.
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Affiliation(s)
- Sara D Pullen
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Carlos Del Rio
- Division of Infectious Disease, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Daniel Brandon
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Ann Colonna
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Meredith Denton
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Matthew Ina
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Grace Lancaster
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Anne-Grace Schmidtke
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Vincent C Marconi
- Division of Infectious Disease, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia
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