1
|
Gant Z, Johnson Lyons S, Jin C, Dailey A, Nwangwu-Ike N, Satcher Johnson A. Geographic Differences in Social Determinants of Health Among US-Born and Non-US-Born Hispanic/Latino Adults With Diagnosed HIV Infection, United States and Puerto Rico, 2017. Public Health Rep 2021; 136:685-698. [PMID: 33563091 DOI: 10.1177/0033354920970539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE HIV disproportionately affects Hispanic/Latino people in the United States, and factors other than individual attributes may be contributing to these differences. We examined differences in the distribution of HIV diagnosis and social determinants of health (SDH) among US-born and non-US-born Hispanic/Latino adults in the United States and Puerto Rico. METHODS We used data reported to the Centers for Disease Control and Prevention's National HIV Surveillance System (NHSS) to determine US census tract-level HIV diagnosis rates and percentages among US-born and non-US-born Hispanic/Latino adults aged ≥18 for 2017. We merged data from the US Census Bureau's American Community Survey with NHSS data to examine regional differences in federal poverty level, education, median household income, employment, and health insurance coverage among 8648 US-born (n = 3328) and non-US-born (n = 5320) Hispanic/Latino adults. RESULTS A comparison of US-born and non-US-born men by region showed similar distributions of HIV diagnoses. The largest percentages occurred in census tracts where ≥19% of residents lived below the federal poverty level, ≥18% did not finish high school, the median household income was <$40 000 per year, ≥6% were unemployed, and ≥16% did not have health insurance. A comparison of US-born and non-US-born women by region showed similar distributions. CONCLUSION The findings of higher numbers of HIV diagnoses among non-US-born Hispanic/Latino adults than among US-born Hispanic/Latino adults, regional similarities in patterns of SDH and HIV percentages and rates, and Hispanic/Latino adults faring poorly in each SDH category are important for understanding SDH barriers that may be affecting Hispanic/Latino adults with HIV in the United States.
Collapse
Affiliation(s)
- Zanetta Gant
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shacara Johnson Lyons
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - André Dailey
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ndidi Nwangwu-Ike
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anna Satcher Johnson
- 1242 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
2
|
Kamalyan L, Hussain MA, Diaz MM, Umlauf A, Franklin DR, Cherner M, Mindt MR, Fortuny LAI, Grant I, Heaton RK, Marquine MJ. Neurocognitive impairment in Spanish-speaking Latinos living with HIV in the US: Application of the neuropsychological norms for the US-Mexico border region in Spanish (NP-NUMBRS). Clin Neuropsychol 2021; 35:433-452. [PMID: 31847711 PMCID: PMC7453430 DOI: 10.1080/13854046.2019.1701084] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/01/2019] [Accepted: 11/29/2019] [Indexed: 02/07/2023]
Abstract
Objective Latinos in the US are at increased risk for HIV-associated neurocognitive impairment (NCI). Most studies of US Latinos living with HIV have included primarily English-speakers only. We investigated the rate, pattern, and correlates of HIV-associated NCI in native Spanish-speaking Latinos living in the US near the Mexican border. Methods Participants included 407 native Spanish-speaking Latinos (Age: M = 37.65, SD = 10.0; Education: M = 10.75, SD = 4.1; 53% male): 153 persons living with HIV (PLWH; 56% AIDS) and 254 healthy controls. All participants completed comprehensive neuropsychological assessments in Spanish. Raw neuropsychological test scores from seven domains were converted to demographically-adjusted T-scores using norms developed with healthy controls. Global and domain NCI were defined per established criteria. Among PLWH we applied norms developed for non-Hispanic (NH) Whites and Blacks, and investigated correlates of global NCI, including HIV disease characteristics and psychiatric comorbidities. Results Utilizing population specific norms, rates of global NCI were significantly higher among PLWH (39%) than healthy controls (17%), comparable to previously published rates. In contrast, rates of global NCI in the same group of PLWH were significantly different when NH White norms (63%, p < 0.0001) and NH Black norms were used (18%, p < 0.0001). Among PLWH without a history of lifetime substance use disorder, more years of antiretroviral exposure were significantly associated with decreased rates of global NCI. Conclusions Present findings lend support to the validity of newly developed norms for native Spanish-speakers living near the US-Mexico border, and underscore the importance of utilizing appropriate norms to accurately identify HIV-associated NCI.
Collapse
Affiliation(s)
- Lily Kamalyan
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
| | - Mariam A. Hussain
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
| | - Monica M. Diaz
- Department of Neurosciences, University of California, San Diego
| | - Anya Umlauf
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Donald R. Franklin
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Mariana Cherner
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Monica Rivera Mindt
- Department of Psychology & Latin American Latino Studies Institute, Fordham University and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Igor Grant
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Robert K. Heaton
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| | - María J. Marquine
- Department of Psychiatry, HIV Neurobehavioral Research Program, University of California, San Diego
| |
Collapse
|
3
|
Fields JA, Spencer B, Swinton M, Qvale EM, Marquine MJ, Alexeeva A, Gough S, Soontornniyomkij B, Valera E, Masliah E, Achim CL, Desplats P. Alterations in brain TREM2 and Amyloid-β levels are associated with neurocognitive impairment in HIV-infected persons on antiretroviral therapy. J Neurochem 2018; 147:784-802. [PMID: 30152135 PMCID: PMC6310632 DOI: 10.1111/jnc.14582] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 12/27/2022]
Abstract
Neuroinflammation is a common pathological correlate of HIV-associated neurocognitive disorders (HAND) in individuals on antiretroviral therapy (ART). Triggering receptor expressed on myeloid cells 2 (TREM2) regulates neuroinflammation, clears extracellular Amyloid (A)-β, surveys for damaged neurons, and orchestrates microglial differentiation. TREM2 has not been studied in HIV+ brain tissues. In this retrospective study, we investigated TREM2 expression levels and localization to microglia, Aβ protein levels, and tumor necrosis factor (TNF)-α transcript levels in the frontal cortices of 52 HIV+ decedents. All donors had been on ART; 14 were cognitively normal (CN), 17 had an asymptomatic neurocognitive impairment (ANI), and 21 had a minor neurocognitive disorder (MND). Total TREM2 protein levels were increased in the soluble and decreased in the membrane-enriched fractions of MND brain tissues compared to CN; however, brains from MND Hispanics showed the most robust alterations in TREM2 as well as significantly increased TNF-α mRNA and Aβ levels when compared to CN Hispanics. Significant alterations in the expression of total TREM2 protein and transcripts for TNF-α were not observed in non-Hispanics, despite higher levels of Aβ in the non-Hispanic CN group compared to the non-Hispanic MND groups. These findings show that decreased and increased TREM2 in membrane-bound fractions and in soluble-enriched fractions, respectively, is associated with increased Aβ and neuroinflammation in this cohort of HIV+ brains, particularly those identifying as Hispanics. These findings suggest a role for TREM2 in the brain of HIV+ individuals may deserve more investigation as a biomarker for HAND and as a possible therapeutic target. OPEN SCIENCE BADGES: This article has received a badge for *Open Materials* because it provided all relevant information to reproduce the study in the manuscript. The complete Open Science Disclosure form for this article can be found at the end of the article. More information about the Open Practices badges can be found at https://cos.io/our-services/open-science-badges/.
Collapse
Affiliation(s)
- Jerel Adam Fields
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Brian Spencer
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Mary Swinton
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Emma Martine Qvale
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - María J. Marquine
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Arina Alexeeva
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Sarah Gough
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Benchawanna Soontornniyomkij
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Elvira Valera
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Eliezer Masliah
- Department of Pathology, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Cristian L. Achim
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
- Department of Pathology, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| | - Paula Desplats
- Department of Pathology, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, United States of America
| |
Collapse
|
4
|
Marquine MJ, Heaton A, Johnson N, Rivera-Mindt M, Cherner M, Bloss C, Hulgan T, Umlauf A, Moore DJ, Fazeli P, Morgello S, Franklin D, Letendre S, Ellis R, Collier AC, Marra CM, Clifford DB, Gelman BB, Sacktor N, Simpson D, McCutchan JA, Grant I, Heaton RK. Differences in Neurocognitive Impairment Among HIV-Infected Latinos in the United States. J Int Neuropsychol Soc 2018; 24:163-175. [PMID: 28874213 PMCID: PMC5777885 DOI: 10.1017/s1355617717000832] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Human immunodeficiency virus (HIV) disproportionately affects Hispanics/Latinos in the United States, yet little is known about neurocognitive impairment (NCI) in this group. We compared the rates of NCI in large well-characterized samples of HIV-infected (HIV+) Latinos and (non-Latino) Whites, and examined HIV-associated NCI among subgroups of Latinos. METHODS Participants included English-speaking HIV+ adults assessed at six U.S. medical centers (194 Latinos, 600 Whites). For overall group, age: M=42.65 years, SD=8.93; 86% male; education: M=13.17, SD=2.73; 54% had acquired immunodeficiency syndrome. NCI was assessed with a comprehensive test battery with normative corrections for age, education and gender. Covariates examined included HIV-disease characteristics, comorbidities, and genetic ancestry. RESULTS Compared with Whites, Latinos had higher rates of global NCI (42% vs. 54%), and domain NCI in executive function, learning, recall, working memory, and processing speed. Latinos also fared worse than Whites on current and historical HIV-disease characteristics, and nadir CD4 partially mediated ethnic differences in NCI. Yet, Latinos continued to have more global NCI [odds ratio (OR)=1.59; 95% confidence interval (CI)=1.13-2.23; p<.01] after adjusting for significant covariates. Higher rates of global NCI were observed with Puerto Rican (n=60; 71%) versus Mexican (n=79, 44%) origin/descent; this disparity persisted in models adjusting for significant covariates (OR=2.40; CI=1.11-5.29; p=.03). CONCLUSIONS HIV+ Latinos, especially of Puerto Rican (vs. Mexican) origin/descent had increased rates of NCI compared with Whites. Differences in rates of NCI were not completely explained by worse HIV-disease characteristics, neurocognitive comorbidities, or genetic ancestry. Future studies should explore culturally relevant psychosocial, biomedical, and genetic factors that might explain these disparities and inform the development of targeted interventions. (JINS, 2018, 24, 163-175).
Collapse
Affiliation(s)
| | - Anne Heaton
- Department of Psychiatry, University of California, San Diego
| | - Neco Johnson
- Advancing Diversity through Aging Research (ADAR) Program, San Diego State University
| | | | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego
| | - C. Bloss
- Department of Psychiatry, University of California, San Diego
| | - T. Hulgan
- Department of Medicine, Vanderbilt University
| | - Anya Umlauf
- Department of Psychiatry, University of California, San Diego
| | - David J. Moore
- Department of Psychiatry, University of California, San Diego
| | - Pariya Fazeli
- Department of Psychology, University of Alabama Birmingham
| | | | - Donald Franklin
- Department of Psychiatry, University of California, San Diego
| | - Scott Letendre
- Department of Medicine, University of California, San Diego
| | - Ron Ellis
- Department of Neurosciences, University of California, San Diego
| | | | | | - David. B. Clifford
- Department of Neurology, University of Washington
- Department of Medicine, University of Washington
| | | | - Ned Sacktor
- Department of Neurology, Johns Hopkins University
| | | | | | - Igor Grant
- Department of Psychiatry, University of California, San Diego
| | | |
Collapse
|
5
|
Young JD, Patel M. HIV Subspecialty Care in Correctional Facilities Using Telemedicine. JOURNAL OF CORRECTIONAL HEALTH CARE 2016; 21:177-85. [PMID: 25788612 DOI: 10.1177/1078345815572863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the United States, prisons and jails contain a population at high risk for HIV infection with a relatively large proportion known to be HIV positive. However, many incarcerated persons lack access to subspecialty HIV care due to barriers of geography and travel. Telemedicine clinics can remove these barriers, increasing access to expert, multidisciplinary care. With telemedicine, correctional facilities can provide up-to-date, evidence-based HIV management, which may lead to improved compliance, greater virologic suppression, improved CD4 T-cell counts, fewer adverse drug interactions, and decreased transmission in the community. While HIV care in prisons is an example of harnessing this technology, telemedicine can be used for the diagnosis and management of multiple acute and chronic diseases for underserved populations.
Collapse
Affiliation(s)
- Jeremy D Young
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Mahesh Patel
- Division of Infectious Diseases, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
6
|
Marquine MJ, Sakamoto M, Dufour C, Rooney A, Fazeli P, Umlauf A, Gouaux B, Franklin D, Ellis R, Letendre S, Cherner M, Heaton RK, Grant I, Moore DJ. The impact of ethnicity/race on the association between the Veterans Aging Cohort Study (VACS) Index and neurocognitive function among HIV-infected persons. J Neurovirol 2015; 22:442-54. [PMID: 26679535 DOI: 10.1007/s13365-015-0411-6] [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: 06/10/2015] [Revised: 11/18/2015] [Accepted: 12/01/2015] [Indexed: 01/04/2023]
Abstract
The Veterans Aging Cohort Study (VACS) Index was developed as a risk index for health outcomes in HIV, and it has been consistently associated with mortality. It shows a significant, yet relatively weak, association with neurocognitive impairment, and little is known about its utility among ethnic/racial minority groups. We examined whether the association between the VACS Index and neurocognition differed by ethnic/racial group. Participants included 674 HIV-infected individuals (369 non-Hispanic whites, 111 non-Hispanic blacks, and 194 Hispanics). Neurocognitive function was assessed via a comprehensive battery. Scaled scores for each neurocognitive test were averaged to calculate domain and global neurocognitive scores. Models adjusting for demographics and HIV disease characteristics not included in the VACS Index showed that higher VACS Index scores (indicating poorer health) were significantly associated with worse global neurocognition among non-Hispanic whites. This association was comparable in non-Hispanic blacks, but nonsignificant among Hispanics (with similar results for English and Spanish speaking). We obtained comparable findings in analyses adjusting for other covariates (psychiatric and medical comorbidities and lifestyle factors). Analyses of individual neurocognitive domains showed similar results in learning and delayed recall. For other domains, there was an effect of the VACS Index and no significant interactions with race/ethnicity. Different components of the VACS Index were associated with global neurocognition by race/ethnicity. In conclusion, the association between the VACS Index and neurocognitive function differs by ethnic/racial group. Identifying key indicators of HIV-associated neurocognitive impairment by ethnic/racial group might play an important role in furthering our understanding of the biomarkers of neuroAIDS.
Collapse
Affiliation(s)
- M J Marquine
- Department of Psychiatry, University of California, San Diego, CA, USA.
| | - M Sakamoto
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - C Dufour
- Department of Medicine, University of California, San Diego, CA, USA
| | - A Rooney
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - P Fazeli
- Psychology Department, University of Alabama, Birmingham, CA, USA
| | - A Umlauf
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - B Gouaux
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - D Franklin
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - R Ellis
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - S Letendre
- Department of Medicine, University of California, San Diego, CA, USA
| | - M Cherner
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - R K Heaton
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - I Grant
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - D J Moore
- Department of Psychiatry, University of California, San Diego, CA, USA
| | | |
Collapse
|
7
|
A Data-Driven Simulation of HIV Spread Among Young Men Who Have Sex With Men: Role of Age and Race Mixing and STIs. J Acquir Immune Defic Syndr 2015; 70:186-94. [PMID: 26102448 DOI: 10.1097/qai.0000000000000733] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Young men who have sex with men (YMSM) in the United States have a high HIV incidence with substantial racial disparities that are poorly understood. We use a data-driven simulation model to understand the impact of network-level mechanisms and sexually transmitted infections on the spread of HIV among YMSM. METHODS We designed and parameterized a stochastic agent-based network simulation model using results of a longitudinal cohort study of YMSM in Chicago. Within this model, YMSM formed and dissolved partnerships over time, and partnership types were stratified by length of partnership, sex, and age of the partner. In each partnership, HIV, gonorrhea, and chlamydia could be transmitted. Counterfactual scenarios were run to examine drivers of HIV. RESULTS Over a 15-year simulation, the HIV epidemic among YMSM continued to rise, with Latino/white YMSM facing a steeper increase in the HIV burden compared with black YMSM. YMSM in partnerships with older MSM, in particular black YMSM with older black MSM, were at highest risk for HIV, and 1 infection prevented with an older partner would prevent 0.8 additional infections among YMSM. Additionally, racial disparities in HIV were driven by differences in the HIV prevalence of YMSM partners. Finally, of all HIV infections among YMSM, 14.6% were attributable to NG and CT infections. CONCLUSION Network-level mechanisms and sexually transmitted infections play a significant role in the spread of HIV and in racial disparities among YMSM. HIV prevention efforts should target YMSM across race, and interventions focusing on YMSM partnerships with older MSM might be highly effective.
Collapse
|
8
|
Heaton RK, Franklin DR, Deutsch R, Letendre S, Ellis RJ, Casaletto K, Marquine MJ, Woods SP, Vaida F, Atkinson JH, Marcotte TD, McCutchan JA, Collier AC, Marra CM, Clifford DB, Gelman BB, Sacktor N, Morgello S, Simpson DM, Abramson I, Gamst AC, Fennema-Notestine C, Smith DM, Grant I. Neurocognitive change in the era of HIV combination antiretroviral therapy: the longitudinal CHARTER study. Clin Infect Dis 2015; 60:473-80. [PMID: 25362201 PMCID: PMC4303775 DOI: 10.1093/cid/ciu862] [Citation(s) in RCA: 275] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/19/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) can show variable clinical trajectories. Previous longitudinal studies of HAND typically have been brief, did not use adequate normative standards, or were conducted in the context of a clinical trial, thereby limiting our understanding of incident neurocognitive (NC) decline and recovery. METHODS We investigated the incidence and predictors of NC change over 16-72 (mean, 35) months in 436 HIV-infected participants in the CNS HIV Anti-Retroviral Therapy Effects Research cohort. Comprehensive laboratory, neuromedical, and NC assessments were obtained every 6 months. Published, regression-based norms for NC change were used to generate overall change status (decline vs stable vs improved) at each study visit. Survival analysis was used to examine the predictors of time to NC change. RESULTS Ninety-nine participants (22.7%) declined, 265 (60.8%) remained stable, and 72 (16.5%) improved. In multivariable analyses, predictors of NC improvements or declines included time-dependent treatment status and indicators of disease severity (current hematocrit, albumin, total protein, aspartate aminotransferase), and baseline demographics and estimated premorbid intelligence quotient, non-HIV-related comorbidities, current depressive symptoms, and lifetime psychiatric diagnoses (overall model P < .0001). CONCLUSIONS NC change is common in HIV infection and appears to be driven by a complex set of risk factors involving HIV disease, its treatment, and comorbid conditions.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - J. Hampton Atkinson
- University of California, San Diego
- Veterans Affairs San Diego Healthcare System, California
| | | | | | | | | | | | | | - Ned Sacktor
- Johns Hopkins University, Baltimore, Maryland
| | - Susan Morgello
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | | | | | | |
Collapse
|
9
|
Khanna A, Goodreau SM, Wohlfeiler D, Daar E, Little S, Gorbach PM. Individualized diagnosis interventions can add significant effectiveness in reducing human immunodeficiency virus incidence among men who have sex with men: insights from Southern California. Ann Epidemiol 2014; 25:1-6. [PMID: 25453725 DOI: 10.1016/j.annepidem.2014.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 09/24/2014] [Accepted: 09/28/2014] [Indexed: 01/04/2023]
Abstract
PURPOSE In this article, we examine the effectiveness of a variety of HIV diagnosis interventions in recently HIV-diagnosed men who have sex with men (MSM). These interventions use the preventive potential of postdiagnosis behavior change (PDBC), as measured by the reduction in the number of new infections. Empirical evidence for PDBC was presented in the behavioral substudy of the Southern California Acute Infection and Early Disease Research Program. In previous modeling work, we demonstrated the existing preventive effects of PDBC. However, a large proportion of new infections among MSM are either undiagnosed or diagnosed late, and the preventive potential of PDBC is not fully utilized. METHODS We derive empirical, stochastic, network-based models to examine the effectiveness of several diagnosis interventions that account for PDBC among MSM over a 10-year period. These interventions involve tests with shorter detection windows, more frequent testing, and individualized testing regimens. RESULTS We find that individualized testing interventions (i.e., testing individuals every three partners or 3 months, whichever is first, or every six partners or 6 months, whichever is first) result in significantly fewer new HIV infections than the generalized interventions we consider. CONCLUSIONS This work highlights the potential of individualized interventions for new public health policies in HIV prevention.
Collapse
Affiliation(s)
- Aditya Khanna
- Department of Medicine, University of Chicago, Chicago, IL.
| | | | - Dan Wohlfeiler
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA
| | - Eric Daar
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Susan Little
- Department of Medicine, University of California, San Diego, CA
| | - Pamina M Gorbach
- Fielding School of Public Health, David Geffen School of Medicine, University of California, Los Angeles, CA
| |
Collapse
|
10
|
Khanna AS, Goodreau SM, Gorbach PM, Daar E, Little SJ. Modeling the impact of post-diagnosis behavior change on HIV prevalence in Southern California men who have sex with men (MSM). AIDS Behav 2014; 18:1523-31. [PMID: 24165985 PMCID: PMC4004722 DOI: 10.1007/s10461-013-0646-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Our objective here is to demonstrate the population-level effects of individual-level post-diagnosis behavior change (PDBC) in Southern Californian men who have sex with men (MSM), recently diagnosed with HIV. While PDBC has been empirically documented, the population-level effects of such behavior change are largely unknown. To examine these effects, we develop network models derived from the exponential random graph model family. We parameterize our models using behavioral data from the Southern California Acute Infection and Early Disease Research Program, and biological data from a number of published sources. Our models incorporate vital demographic processes, biology, treatment and behavior. We find that without PDBC, HIV prevalence among MSM would be significantly higher at any reasonable frequency of testing. We also demonstrate that higher levels of HIV risk behavior among HIV-positive men relative to HIV-negative men observed in some cross-sectional studies are consistent with individual-level PDBC.
Collapse
Affiliation(s)
- Aditya S Khanna
- International Clinical Research Center, Department of Global Health, University of Washington, P.O. Box 359927, 325 Ninth Avenue, Seattle, WA, 98104, USA,
| | | | | | | | | |
Collapse
|
11
|
Hodcroft E, Hadfield JD, Fearnhill E, Phillips A, Dunn D, O'Shea S, Pillay D, Leigh Brown AJ. The contribution of viral genotype to plasma viral set-point in HIV infection. PLoS Pathog 2014; 10:e1004112. [PMID: 24789308 PMCID: PMC4006911 DOI: 10.1371/journal.ppat.1004112] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/22/2014] [Indexed: 12/24/2022] Open
Abstract
Disease progression in HIV-infected individuals varies greatly, and while the environmental and host factors influencing this variation have been widely investigated, the viral contribution to variation in set-point viral load, a predictor of disease progression, is less clear. Previous studies, using transmission-pairs and analysis of phylogenetic signal in small numbers of individuals, have produced a wide range of viral genetic effect estimates. Here we present a novel application of a population-scale method based in quantitative genetics to estimate the viral genetic effect on set-point viral load in the UK subtype B HIV-1 epidemic, based on a very large data set. Analyzing the initial viral load and associated pol sequence, both taken before anti-retroviral therapy, of 8,483 patients, we estimate the proportion of variance in viral load explained by viral genetic effects to be 5.7% (CI 2.8-8.6%). We also estimated the change in viral load over time due to selection on the virus and environmental effects to be a decline of 0.05 log10 copies/mL/year, in contrast to recent studies which suggested a reported small increase in viral load over the last 20 years might be due to evolutionary changes in the virus. Our results suggest that in the UK epidemic, subtype B has a small but significant viral genetic effect on viral load. By allowing the analysis of large sample sizes, we expect our approach to be applicable to the estimation of the genetic contribution to traits in many organisms.
Collapse
Affiliation(s)
- Emma Hodcroft
- Institute of Evolutionary Biology, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | - Jarrod D. Hadfield
- Institute of Evolutionary Biology, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | | | - Andrew Phillips
- Infection and Population Health, University College London, Royal Free Hospital, London, United Kingdom
| | - David Dunn
- MRC Clinical Trials Unit Aviation House, London, United Kingdom
| | - Siobhan O'Shea
- Department of Infectious Diseases, King's College London, London, United Kingdom
| | - Deenan Pillay
- Research Department of Infection, University College London, London, United Kingdom
| | - Andrew J. Leigh Brown
- Institute of Evolutionary Biology, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | | |
Collapse
|
12
|
Poon KK, Dang BN, Davila JA, Hartman C, Giordano TP. Treatment outcomes in undocumented Hispanic immigrants with HIV infection. PLoS One 2013; 8:e60022. [PMID: 23555868 PMCID: PMC3608625 DOI: 10.1371/journal.pone.0060022] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 02/21/2013] [Indexed: 11/24/2022] Open
Abstract
Objective Little is known about the treatment outcomes of undocumented Hispanic immigrants with HIV infection. We sought to compare the treatment outcomes of undocumented and documented patients 12-months after entering HIV care. Methods We conducted a retrospective cohort study of antiretroviral-naive patients 18 years and older attending their first visit at Thomas Street Health Center in Houston, Texas, between 1/1/2003 and 6/30/2008. The study population of 1,620 HIV-infected adults included 186 undocumented Hispanic, 278 documented Hispanic, 986 Black, and 170 White patients. The main outcome measures were retention in care (quarter years with at least one completed HIV primary care provider visit) and HIV suppression (HIV RNA <400 copies/mL), both measured 12-months after entering HIV care. Results Undocumented Hispanic patients had lower median initial CD4 cell count (132 cells/mm3) than documented Hispanic patients (166 cells/mm3; P = 0.186), Black patients (226 cells/mm3; P<0.001), and White patients (264 cells/mm3; P = 0.001). However, once in care, undocumented Hispanic patients did as well or better than their documented counterparts. One year after entering HIV care, undocumented Hispanics achieved similar rates of retention in care and HIV suppression as documented Hispanic and White patients. Of note, black patients were significantly less likely to have optimal retention in care (adjusted odds ratio [aOR] 0.65, CI = 0.45–0.94) or achieve HIV suppression (aOR 0.32, CI = 0.17–0.61) than undocumented Hispanics. Conclusions Undocumented Hispanic persons with HIV infection enter care with more advanced disease than documented persons, suggesting testing and/or linkage to care efforts for this difficult-to-reach population need intensification. Once diagnosed, however, undocumented Hispanics have outcomes as good as or better than other racial/ethnic groups. Safety net providers for undocumented immigrants are vital for maintaining individual and public health.
Collapse
Affiliation(s)
- Kenneth K. Poon
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Bich N. Dang
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
| | - Jessica A. Davila
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
| | - Christine Hartman
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
| | - Thomas P. Giordano
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- VA Health Services Research and Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
- * E-mail:
| |
Collapse
|
13
|
CD4+ CD8+ T cell reference values in the Mexico City population. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2012; 20:306-8. [PMID: 23239806 DOI: 10.1128/cvi.00523-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Due to the importance of determining the proportions of lymphocyte subpopulations in Mexicans as reference values for flow cytometry, the aim of this study was to establish CD4(+) and CD8(+) T cell reference values for healthy Mexicans according to gender and age. Our results may serve as reference standards for the Mexican city population.
Collapse
|
14
|
del Rio C. Latinos and HIV care in the Southeastern United States: new challenges complicating longstanding problems. Clin Infect Dis 2012; 53:488-9. [PMID: 21844032 DOI: 10.1093/cid/cir440] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
15
|
Dennis AM, Napravnik S, Seña AC, Eron JJ. Late entry to HIV care among Latinos compared with non-Latinos in a southeastern US cohort. Clin Infect Dis 2012; 53:480-7. [PMID: 21844031 DOI: 10.1093/cid/cir434] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Late diagnosis of human immunodeficiency virus (HIV) infection remains common despite advances in therapy and prognosis. The southeastern United States is a rapidly growing Latino settlement area where ethnic disparities may contribute to late presentation to care. METHODS We assessed demographic and clinical factors between racial/ethnic groups at the time of HIV care initiation in the University of North Carolina Center for AIDS Research Clinical Cohort. We identified independent predictors of late presentation, defined as a CD4(+) T lymphocyte (CD4) count <350 cells/mm(3) or an AIDS-defining event (ADE), using log-linear binomial regression. RESULTS During the period 1999-2009, 853 patients initiated HIV care, of whom 11% were Latino, 28% were white, and 61% were black. Median initial CD4 counts were lower for Latino patients (186 cells/mm(3)) than white patients (292 cells/mm(3); P = .006) and black patients (302 cells/mm(3); P = .02). Latino persons were more likely to be late presenters than white or black persons (76% vs 58%; P < .001) and accounted for 86%, 75%, and 50% of all presenting cases of active tuberculosis, histoplasmosis, and toxoplasmosis, respectively. Latino ethnicity, older age, male sex, and earlier entry year were independently associated with late presentation (P < .05 for all). In multivariable analyses, Latino persons were 1.29 times more likely to present to care late than white or black persons (95% confidence interval, 1.15-1.45). CONCLUSIONS Latinos are more likely to initiate HIV care later in the course of illness than are black and white persons and account for a majority of several ADEs. Strategies to improve earlier HIV testing among Latinos in new settlement areas are needed.
Collapse
Affiliation(s)
- Ann M Dennis
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7030, USA.
| | | | | | | |
Collapse
|
16
|
Armstrong WS, del Rio C. Gender, race, and geography: do they matter in primary human immunodeficiency virus infection? J Infect Dis 2011; 203:437-8. [PMID: 21245158 DOI: 10.1093/infdis/jiq088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
17
|
Losina E, Schackman BR, Sadownik SN, Gebo KA, Walensky RP, Chiosi JJ, Weinstein MC, Hicks PL, Aaronson WH, Moore RD, Paltiel AD, Freedberg KA. Racial and sex disparities in life expectancy losses among HIV-infected persons in the united states: impact of risk behavior, late initiation, and early discontinuation of antiretroviral therapy. Clin Infect Dis 2010; 49:1570-8. [PMID: 19845472 DOI: 10.1086/644772] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Most persons with human immunodeficiency virus (HIV) infection in the United States present to care with advanced disease, and many patients discontinue therapy prematurely. We sought to evaluate sex and racial/ethnic disparities in life-years lost as a result of risk behavior, late presentation, and early discontinuation of HIV care, and we compared these survival losses for HIV-infected persons with losses attributable to high-risk behavior and HIV disease itself. METHODS With use of a state-transition model of HIV disease, we simulated cohorts of HIV-infected persons and compared them with uninfected individuals who had similar demographic characteristics. We estimated non-HIV-related mortality with use of risk-adjusted standardized mortality ratios, as well as years of life lost because of late presentation and early discontinuation of antiretroviral therapy (ART) for HIV infection. Data from the national HIV Research Network, stratified by sex and race/ethnicity, were used for estimating CD4+ cell counts at ART initiation. RESULTS For HIV-uninfected persons in the United States who have risk profiles similar to those of individuals with HIV infection, the projected life expectancy, starting at 33 years of age, was 34.58 years, compared with 42.91 years for the general US population. Those with HIV infection lost an additional 11.92 years of life if they received HIV care concordant with guidelines; late treatment initiation resulted in 2.60 additional years of life lost, whereas premature ART discontinuation led to 0.70 more years of life lost. Losses from late initiation and early discontinuation were greatest for Hispanic individuals (3.90 years). CONCLUSIONS The high-risk profile of HIV-infected persons, HIV infection itself, as well as late initiation and early discontinuation of care, all lead to substantial decreases in life expectancy. Survival disparities resulting from late initiation and early discontinuation of therapy are most pronounced for Hispanic HIV-infected men and women. Interventions focused on risk behaviors, as well as on earlier linkage to and better retention in care, will lead to improved survival for HIV-infected persons in the United States.
Collapse
Affiliation(s)
- Elena Losina
- Divisions of General Medicine, Department of Medicine, MA 02114, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Bhatta MP, Vermund SH, Hoesley CJ. Human immunodeficiency virus infection in Alabama women: sociodemographic, behavioral, and reproductive health characteristics and factors associated with lack of human immunodeficiency virus-1 viral control. Am J Med Sci 2010; 339:133-140. [PMID: 20087169 DOI: 10.1097/maj.0b013e3181c300f9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection among women in the southern United States is on the rise. This study examined sociodemographic profile and behavioral risk factors for HIV and sexually transmitted infections and assessed factors associated with HIV-1 viral control in a cohort of 280 HIV-infected Alabama women aged 17 to 66 years. METHODS Women receiving care for HIV infection at a university outpatient HIV clinic were enrolled in the study. Women completed a self-administered questionnaire on demographics and behavioral risk factors at enrollment. They were followed up with appointments at least every 6 months with Papanicolaou smears, cervicovaginal lavages, cervical and vaginal swabs, and blood specimens collected at each visit. RESULTS Of the women in the study, 69% were black, had mean age of 36 years, and approximately three fourths were mothers with annual household income <$20,000. White women were likely to have been HIV infected for a longer period (50.2 versus 36.3 months; P = 0.02) and had significantly lower viral loads at enrollment (P = 0.04) than black women. Factors associated with lack of HIV-1 control (> or =10,000 RNA copies/mL) at enrollment included black race/ethnicity (odds ratio [OR]: 2.8; 95% confidence interval [CI]: 1.2-6.8), CD4+ T-cell count <200 cells/microL (OR: 20.1; CI: 8.6-47.0), being diagnosed with HIV <6 months (OR: 3.5; CI: 1.4-8.9) and not being on any antiretroviral therapy (OR: 2.5; CI: 1.1-5.7). CONCLUSION Poorer HIV-1 viral control in black women at enrollment may indicate suboptimal access to HIV testing, delays in receipt of medical care after HIV-1 diagnosis, and/or some underlying biologic or social race-related influence.
Collapse
Affiliation(s)
- Madhav P Bhatta
- Department of Biostatistics, Epidemiology and Environmental Health Science, Kent State University, OH 44242, USA.
| | | | | |
Collapse
|
19
|
Lemly DC, Shepherd BE, Hulgan T, Rebeiro P, Stinnette S, Blackwell RB, Bebawy S, Kheshti A, Sterling TR, Raffanti SP. Race and sex differences in antiretroviral therapy use and mortality among HIV-infected persons in care. J Infect Dis 2009; 199:991-8. [PMID: 19220139 DOI: 10.1086/597124] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND There are conflicting data regarding race, sex, and mortality among persons infected with human immunodeficiency virus (HIV). We studied all-cause mortality among persons in care during the highly-active antiretroviral therapy (HAART) era. METHODS This retrospective cohort study included patients who made>or=1 clinic visit from January 1998 through December 2005. RESULTS Of 2605 patients (with 6657 person-years of follow-up), 38% were black and 24% were female. The percentage of time in care while receiving HAART was lower for blacks than for nonblacks (47% vs. 76%; P<.001) and for females than for males (57% vs. 71%; P=.01). There were 253 deaths (38 per 1000 person-years). After adjustment for characteristics at baseline, death was associated with black race (hazard ratio [HR], 1.33; P .04), female sex (HR, 1.53; P .007), injection drug use (IDU) as a risk factor for HIV infection (HR, 1.61; P .009), older age (HR, 1.45 per 10 years; P<.001), a lower CD4 cell count (HR, 0.59 for 200 vs. 350 cells/mm3; P<.001) and a higher HIV type 1 RNA level (HR, 1.35; P<.001). After adjustment for the length of time that HAART was received, black race (HR, 1.00; P .99) and IDU (HR, 1.37; P .09) were no longer associated with death, but female sex was (HR, 1.62; P=.002). CONCLUSIONS Race-associated differences in mortality likely resulted from HAART use. Women had an increased risk of death even after adjustment for HAART use. Addressing racial disparities will require improved HAART utilization. Increased mortality among women requires further study.
Collapse
Affiliation(s)
- Diana C Lemly
- School of Medicine, Department of Biostatistics, Vanderbilt University, Nashville, TN 37203, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Carabin H, Keesee MS, Machado LJ, Brittingham T, Williams L, Sonleitner NK, Anderson KG, Cajina A, Foster MW. Estimation of the prevalence of AIDS, opportunistic infections, and standard of care among patients with HIV/AIDS receiving care along the U.S.-Mexico border through the Special Projects of National Significance: a cross-sectional study. AIDS Patient Care STDS 2008; 22:887-95. [PMID: 19025483 DOI: 10.1089/apc.2007.0176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is high demand for care among the Hispanic population in states along the U.S.-Mexico border. The objective is to describe the standard of care received by people living with HIV/AIDS (PLWH/A) at enrollment into one of five Special Projects of National Significance (SPNS) Sites located along the U.S.-Mexico border. This cross-sectional study describes the presence of opportunistic infections (OIs), AIDS status and two types of standard of care received by 707 PLWH/A participating in SPNS. Patients receiving care through SPNS in one of the five sites between June 1, 2002 and December 31, 2003 were invited to participate to the medical chart review component of the study. The association between sociodemographic variables and the prevalence of OIs and AIDS at enrollment was estimated using multivariate hierarchical logistic models. More than one quarter of the 707 participants had at least one OI recorded and 58% of new and 60% of existing patients had AIDS at enrollment in SPNS. The association between being Hispanic and having higher prevalence of OI and AIDS at entry varied by SPNS site. Standard of care was well followed overall. This is the first study describing HIV stage and OI prevalences and standard of care in PLWH/A in all U.S.-Mexico bordering states. Being of Hispanic ethnicity may not fully explain discrepancy in access to care along the border.
Collapse
Affiliation(s)
- Hélène Carabin
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Marguerite S. Keesee
- K20 Center for Educational and Community Renewal, University of Oklahoma, Norman, Oklahoma
- Center for Applied Social Research, University of Oklahoma, Norman, Oklahoma
| | - Linda J. Machado
- Section of Infectious Disease, Department of Internal Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Timothy Brittingham
- Center for Applied Social Research, University of Oklahoma, Norman, Oklahoma
| | - Lynda Williams
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Center for Applied Social Research, University of Oklahoma, Norman, Oklahoma
| | - Nancy K. Sonleitner
- Center for Applied Social Research, University of Oklahoma, Norman, Oklahoma
- Department of Sociology, Anthropology, Social Work, and Criminal Justice. The University of Tennessee at Martin, Martin, Tennessee
| | - Kermyt G. Anderson
- Center for Applied Social Research, University of Oklahoma, Norman, Oklahoma
| | - Adan Cajina
- Health Resources and Services Administration, HIV/AIDS Bureau, Special Projects of National Significance, Rockville, Maryland
| | - Morris W. Foster
- Center for Applied Social Research, University of Oklahoma, Norman, Oklahoma
| |
Collapse
|
21
|
Linas BP, Zheng H, Losina E, Rockwell A, Walensky RP, Cranston K, Freedberg KA. Optimizing resource allocation in United States AIDS drug assistance programs. Clin Infect Dis 2006; 43:1357-64. [PMID: 17051505 DOI: 10.1086/508657] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Accepted: 06/15/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND US acquired immunodeficiency syndrome (AIDS) Drug Assistance programs (ADAPs) provide medications to low-income patients with human immunodeficiency virus (HIV) infection/AIDS. Nationally, ADAPs are in a fiscal crisis. Many states have instituted waiting lists, often serving clients on a first-come, first-served basis. We hypothesized that CD4 cell count-based ADAP eligibility would improve ADAP outcomes, allowing them to serve more-diverse patient populations and to prioritize persons who are at greatest risk of HIV-related mortality. METHODS We used Massachusetts ADAP administrative data to create a retrospective cohort of Massachusetts ADAP clients from fiscal year 2003. We then used a model-based analysis to apply potential eligibility criteria for a limited program and to compare characteristics of patients included under CD4 cell count-based and first-come, first-served eligibility criteria. RESULTS In fiscal year 2003, Massachusetts ADAPs served 3560 clients at a direct cost of 10.3 million dollars. With use of CD4 cell count-based eligibility (with an eligibility criterion of a current or nadir CD4 cell count < or = 350 cells/microL), it would have served 2253 clients (37% fewer than in fiscal year 2003) and appreciated savings of 2.7 million dollars. Given the same budget constraint and using first-come, first-served eligibility, Massachusetts ADAPs would have served 2406 clients (32% fewer than in fiscal year 2003). The first-come, first-served approach would have excluded patients with median CD4 cell count of 257 cells/microL (interquartile range, 124-377 cells/microL) in favor of serving patients with median CD4 cell count of 659 cells/microL (interquartile range, 511-841 cells/microL). In addition, a CD4 cell count-based scheme would have served a greater proportion of nonwhite individuals (65% vs. 55%; P<.0001), non-English speakers (24% vs. 19%; P=.03), and unemployed people (69% vs. 61%; P=.0009), compared with the population that would have been served by a first-come, first-served policy. CONCLUSIONS With limited resources, ADAPs will serve more-diverse populations and patients with significantly more advanced HIV disease by using CD4 cell count-based enrollment criteria rather than a first-come, first-served approach.
Collapse
Affiliation(s)
- Benjamin P Linas
- Division of General Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
| | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
HIV-AIDS has disproportionately affected minority populations in the United States. Significant disparities in case rates and mortality have been noted. This article reviews the magnitude of the problem and the many factors involved in the development and perpetuation of these disparities. Possible measures to help correct the problem are also reviewed.
Collapse
|
23
|
Campo RE, Alvarez D, Santos G, Latorre J. Antiretroviral treatment considerations in Latino patients. AIDS Patient Care STDS 2005; 19:366-74. [PMID: 15989432 DOI: 10.1089/apc.2005.19.366] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Latinos in the United States have been disproportionately affected by HIV, with a higher rate of infection, later diagnosis, and a higher death rate than Caucasians. Complicating the issue is that "Latino" is a broad term that encompasses diverse ethnic and racial groups, requiring a targeted approach to prevention and management of HIV infection. This article explores the demographics of HIV infection among Latinos in the United States, discusses cultural beliefs among Latinos that have an impact on prevention and access to care, and reviews strategies for managing HIV infection in this population.
Collapse
Affiliation(s)
- Rafael E Campo
- University of Miami School of Medicine, Miami, Florida, USA.
| | | | | | | |
Collapse
|
24
|
Giard M, Gambotti L, Besson H, Fabry J, Vanhems P. Facteurs associés à une prise en charge tardive des patients infectés par le VIH : revue de la littérature. SANTE PUBLIQUE 2004; 16:147-56. [PMID: 15185592 DOI: 10.3917/spub.041.0147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In the United States, Australia and Europe, many HIV infected individuals are still diagnosed and/or treated late in the course of the disease. This literature review of studies published over a ten year period between 1993 and 2003 has identified the following principle factors associated with the late diagnosis of HIV: male gender, aged older than 45 years, heterosexual intercourse, the lack of previous screening. It also identified the factors linked to the delay in beginning anti-retroviral treatment as being male gender, the lack of awareness or denial of the possibility of HIV infection, intravenous drug use, lack of post-screening follow-up or counseling, lack of social protection, and the lack of regular medical visits and care. Early detection and suitable early treatment of the HIV virus are the main determining factors which will effectively contribute to the control and maintenance of the virus in as much as they are focused upon these particular at-risk populations.
Collapse
Affiliation(s)
- M Giard
- Laboratoire d'Epidémiologie et de Santé Publique, INSERM U271, et Service d'Epidémiologie, Hôpital Edouard Herriot, Faculté de Médecine, 8, avenue Rockefeller, 69373 Lyon, France
| | | | | | | | | |
Collapse
|
25
|
Wood E, Montaner JSG, Bangsberg DR, Tyndall MW, Strathdee SA, O'Shaughnessy MV, Hogg RS. Expanding access to HIV antiretroviral therapy among marginalized populations in the developed world. AIDS 2003; 17:2419-27. [PMID: 14600512 DOI: 10.1097/00002030-200311210-00003] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|