1
|
Tang B, Ellis RJ, Vaida F, Umlauf A, Franklin DR, Dastgheyb R, Rubin LH, Riggs PK, Iudicello JE, Clifford DB, Moore DJ, Heaton RK, Letendre SL. Biopsychosocial phenotypes in people with HIV in the CHARTER cohort. Brain Commun 2024; 6:fcae224. [PMID: 39077377 PMCID: PMC11285184 DOI: 10.1093/braincomms/fcae224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/22/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024] Open
Abstract
Neuropsychiatric complications such as neurocognitive impairment and depression are common in people with HIV despite viral suppression on antiretroviral therapy, but these conditions are heterogeneous in their clinical presentations and associated disability. Identifying novel biopsychosocial phenotypes that account for neurocognitive performance and depressive and functional symptoms will better reflect the complexities encountered in clinical practice and may have pathological and therapeutic implications. We classified 1580 people with HIV based on 17 features, including 7 cognitive domains, 4 subscales of the Beck depression inventory-II, 5 components of the patient's assessment of own functioning inventory, and dependence in instrumental and basic activities of daily living. A two-stage clustering procedure consisting of dimension reduction with self-organizing maps and Mahalanobis distance-based k-means clustering algorithms was applied to cross-sectional data. Baseline demographic and clinical characteristics were compared between the phenotypes, and their prediction on the biopsychosocial phenotypes was evaluated using multinomial logistic regression. Four distinct phenotypes were identified. Participants in Phenotype 1 overall did well in all domains. Phenotype 2 had mild-to-moderate depressive symptoms and the most substance use disorders. Phenotype 3 had mild-to-moderate cognitive impairment, moderate depressive symptoms, and the worst daily functioning; they also had the highest proportion of females and non-HIV conditions that could affect cognition. Phenotype 4 had mild-to-moderate cognitive impairment but with relatively good mood, and daily functioning. Multivariable analysis showed that demographic characteristics, medical conditions, lifetime cocaine use disorder, triglycerides, and non-antiretroviral therapy medications were important variables associated with biopsychosocial phenotype. We found complex, multidimensional biopsychosocial profiles in people with HIV that were associated with different risk patterns. Future longitudinal work should determine the stability of these phenotypes, assess factors that influence transitions from one phenotype to another, and characterize their biological associations.
Collapse
Affiliation(s)
- Bin Tang
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Ronald J Ellis
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
- Department of Neurosciences, University of California San Diego, San Diego, CA 92093, USA
| | - Florin Vaida
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Donald R Franklin
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Patricia K Riggs
- Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| | - Jennifer E Iudicello
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - David B Clifford
- Department of Neurology, Washington University at St. Louis, St. Louis, MO 63110, USA
| | - David J Moore
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
| | - Scott L Letendre
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093, USA
- Department of Medicine, University of California San Diego, San Diego, CA 92093, USA
| |
Collapse
|
2
|
Yeh JC, Uebelacker LA, Pinkston MM, Anderson BJ, Busch AM, Abrantes AM, Baker JV, Stein MD. Anger and substance use in HIV-positive patients with chronic pain. AIDS Care 2023; 35:271-279. [PMID: 35727161 PMCID: PMC9768096 DOI: 10.1080/09540121.2022.2090490] [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: 09/19/2021] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
Chronic pain increases the risk of substance use in people living with HIV (PLWH). Depression and anxiety have also been identified as risk factors for substance use among PLWH. Relatedly, other negative mood states, such as anger, may influence chronic pain among PLWH. The current cross-sectional study examined whether the distinct negative mood state of anger is associated with substance use among 187 PLWH who report chronic pain. Using negative binomial regression analyses, we found higher levels of anger were positively associated with alcohol use. Higher levels of anger were inversely associated with benzodiazepine use. No association was found between anger and marijuana use, and there were no significant interactions between anger and pain severity on substance use. Our findings suggest that anger is an independent risk factor for substance use among PLWH and chronic pain. Addressing anger may be useful when adapting behavioral therapies in the treatment of pain among PLWH.
Collapse
Affiliation(s)
- Jih-Cheng Yeh
- Department of Health Law, Policy, and Management, Boston
University School of Public Health, Boston, MA, United States
| | - Lisa A. Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical
School of Brown University, Providence RI, USA
- Department of Family Medicine, Alpert Medical School of
Brown University, Providence, RI, USA
- Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906
USA
| | - Megan M. Pinkston
- Department of Psychiatry and Human Behavior, Alpert Medical
School of Brown University, Providence RI, USA
- Department of Medicine, Alpert Medical School of Brown
University, Providence, RI, USA
- Lifespan Physicians Group, The Miriam Hospital, Providence
RI, USA
| | | | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis
MN, USA
- Department of Medicine, University of Minnesota - Twin
Cities, Minneapolis MN, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical
School of Brown University, Providence RI, USA
- Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906
USA
| | - Jason V. Baker
- Department of Medicine, University of Minnesota - Twin
Cities, Minneapolis MN, USA
- Division of Infectious Diseases, Hennepin County Medical
Center, Minneapolis, MN
| | - Michael D. Stein
- Department of Health Law, Policy, and Management, Boston
University School of Public Health, Boston, MA, United States
- Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906
USA
| |
Collapse
|
3
|
Osman E, Hardaker G, Glenn LE. Implementing structural equation modelling and multiple mediator models for management information systems. THE INTERNATIONAL JOURNAL OF INFORMATION AND LEARNING TECHNOLOGY 2022. [DOI: 10.1108/ijilt-09-2022-0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
PurposeOverall quantitative research aims to observe certain fundamental principles of logic and scientific frame of reasoning. There continues to be challenges on how quantitative research is conducted in the field of information systems.Design/methodology/approachStructured equation modelling (SEM) research identifies concerns about the standard of scientific enquiry method, the issue of the misconception of sustaining the consequent and the issue of collective validity. Therefore, rigor and robustness in instrument validity, constructs validity and path analysis validity maybe better achieved by attending to these three concerns. Measuring a multiple mediator construct in a hypothetical model continues to be a challenge for researchers in information systems research and related fields.FindingsThis paper aims to provide a thoughtful assessment of the contemporary issues of structural equation modelling methodology (SEMM), by providing rigid and robust SEMM that has several stages in specifying valid multiple mediators construct and the process to measuring in a path analysis model. This paper attempts to develop each stage of the methodology using relevant research to construct a methodology specified to test effects in multiple mediators in SEM using AMOS software. The methodology developed contains the two main phases; first is prior to data collection phase and the second phase is after the data collection, the use of this methodology design, for implementation, intended to support high methodological standards and subsequent quality in MIS research findings.Originality/valueThe research paper provides SEMM that has several stages in specifying valid multiple mediators construct and the process to measuring in a path analysis model.
Collapse
|
4
|
Sherrill-Mix S, Yang M, Aldrovandi GM, Brenchley JM, Bushman FD, Collman RG, Dandekar S, Klatt NR, Lagenaur LA, Landay AL, Paredes R, Tachedjian G, Turpin JA, Serrano-Villar S, Lozupone CA, Ghosh M. A Summary of the Sixth International Workshop on Microbiome in HIV Pathogenesis, Prevention, and Treatment. AIDS Res Hum Retroviruses 2022; 38:173-180. [PMID: 34969255 PMCID: PMC9009592 DOI: 10.1089/aid.2021.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In October of 2020, researchers from around the world met online for the sixth annual International Workshop on Microbiome in HIV Pathogenesis, Prevention, and Treatment. New research was presented on the roles of the microbiome on immune response and HIV transmission and pathogenesis and the potential for alterations in the microbiome to decrease transmission and affect comorbidities. This article presents a summary of the findings reported.
Collapse
Affiliation(s)
- Scott Sherrill-Mix
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Address correspondence to: Scott Sherrill-Mix, Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, 424 Johnson Pavilion, 3610 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Michelle Yang
- Department of Epidemiology, The George Washington University, Washington, District of Columbia, USA
| | - Grace M. Aldrovandi
- Department of Pediatrics, University of California, Los Angeles, California, USA
| | | | - Frederic D. Bushman
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ronald G. Collman
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Satya Dandekar
- Department of Medical Microbiology and Immunology, University of California, Davis, Davis, California, USA
| | - Nichole R. Klatt
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Alan L. Landay
- Division of Gerontology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Roger Paredes
- Institut de Recerca de la SIDA IrsiCaixa i Unitat VIH, Universitat Autònoma de Barcelona, Universitat de Vic, Catalonia, Spain
| | | | - Jim A. Turpin
- Divison of AIDS, NIAID, NIH, Bethesda, Maryland, USA
| | - Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | - Mimi Ghosh
- Department of Epidemiology, The George Washington University, Washington, District of Columbia, USA
| |
Collapse
|
5
|
Yu CL, Yang FC, Yang SN, Tseng PT, Stubbs B, Yeh TC, Hsu CW, Li DJ, Liang CS. Psilocybin for End-of-Life Anxiety Symptoms: A Systematic Review and Meta-Analysis. Psychiatry Investig 2021; 18:958-967. [PMID: 34619818 PMCID: PMC8542741 DOI: 10.30773/pi.2021.0209] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/23/2021] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To systematically examine the effectiveness and tolerability of psilocybin for treating end-of-life anxiety symptoms. METHODS The Medline, Embase, CENTRAL, and PsycINFO databases were searched up to November 25, 2020. We enrolled clinical trials investigating psilocybin for treating end-of-life anxiety symptoms. Meta-analysis was conducted using random-effects model. RESULTS Overall, five studies were included, revealing that psilocybin was superior to the placebo in treating state anxiety at 1 day (Hedges' g, -0.70; 95% confidence interval, -1.01 to -0.39) and 2 weeks (-1.03; -1.47 to -0.60) after treatment. Psilocybin was more effective than placebo in treating trait anxiety at 1 day (-0.71; -1.15 to -0.26), 2 weeks (-1.08; -1.80 to -0.36), and 6 months (-0.84; -1.37 to -0.30) after treatment. Psilocybin was associated with transient elevation in systolic (19.00; 13.58-24.41 mm Hg) and diastolic (8.66; 5.18-12.15 mm Hg) blood pressure compared with placebo. The differences between psilocybin and placebo groups with regard to allcause discontinuation, serious adverse events, and heart rates were nonsignificant. CONCLUSION Psilocybin-assisted therapy could ameliorate end-of-life anxiety symptoms without serious adverse events. Because of the small sample sizes of the included studies and high heterogeneity on long-term outcomes, future randomized controlled trials with large sample sizes are needed.
Collapse
Affiliation(s)
- Chia-Ling Yu
- Department of Pharmacy, Chang-Gung Memorial Hospital, Linkou, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Szu-Nian Yang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan.,Graduate Institute of Health and Welfare Policy, National Yang Ming University, Taipei, Taiwan
| | - Ping-Tao Tseng
- WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK.,Positive Ageing Research Institute (PARI), Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.,Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Chih-Sung Liang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|
6
|
Jabour SM, Chander G, Riekert KA, Keruly JC, Herne K, Hutton H, Beach MC, Lau B, Moore RD, Monroe AK. The Patient Reported Outcomes as a Clinical Tool (PROACT) Pilot Study: What Can be Gained by Sharing Computerized Patient-Reported Mental Health and Substance Use Symptoms with Providers in HIV Care? AIDS Behav 2021; 25:2963-2972. [PMID: 33559775 DOI: 10.1007/s10461-021-03175-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
Substance use and mental health (SU/MH) disorders are insufficiently recognized in HIV care. We examined whether conveying SU/MH screening results to patients and providers increased SU/MH discussions and action plans. Intervention participants completed a computerized patient-reported questionnaire before their HIV visit; screened positive on ≥ 1 measure: depression, anxiety, PTSD symptoms, at-risk alcohol use, or drug use; and reviewed screening results to decide which to prioritize with their provider. Screening results and clinical recommendations were conveyed to providers via medical record. A historic control included patients with positive screens but no conveyance to patient or provider. The patient-provider encounter was audio-recorded, transcribed, and coded. For the overall sample (n = 70; 38 control, 32 intervention), mean age (SD) was 51.8 (10.3), 61.4% were male, and 82.9% were Black. Overall, 93.8% raised SU/MH in the intervention compared to 50.0% in the control (p < 0.001). Action plans were made for 40.0% of intervention and 10.5% of control encounters (p = 0.049). Conveying screening results with clinical recommendations increased SU/MH action plans, warranting further research on this intervention to address SU/MH needs.
Collapse
|
7
|
Bagheri Z, Noorshargh P, Shahsavar Z, Jafari P. Assessing the measurement invariance of the 10-item Centre for Epidemiological Studies Depression Scale and Beck Anxiety Inventory questionnaires across people living with HIV/AIDS and healthy people. BMC Psychol 2021; 9:42. [PMID: 33750473 PMCID: PMC7941965 DOI: 10.1186/s40359-021-00546-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background Recently, extensive research has been reported the higher rate of depression and anxiety among people living with HIV/AIDS (PLWHAs) as compared to the general population. However, no single study has been carried out to investigate whether this disparity is a real difference or it happens due to lack of measurement invariance. This study aims to assess the measurement invariance of the Beck Anxiety Inventory (BAI) and 10-item Centre for Epidemiological Studies Depression Scale (CESD-10) questionnaires across PLWHAs and healthy individuals. Methods One hundred and fifty PLWHAs and 500 healthy individuals filled out the Persian version of the BAI and CESD-10 questionnaires. Multi-group multiple-indicators multiple-causes model (MG-MIMIC) was used to assess measurement invariance across PLWHAs and healthy people. Results Our findings revealed that PLWHAs and healthy individuals perceived the meaning of all the items in the BAI and CESD-10 questionnaires similarly. In addition, although depression scores were significantly higher in PLWHAs as opposed to the healthy individuals, no significant difference was observed in anxiety scores of these two groups. Conclusions The current study suggests that the BAI and CESD-10 are invariant measures across PLWHAs and healthy people which can be used for meaningful cross-group comparison. Therefore, in comparison to healthy individuals, higher depression score of PLWHAs is a real difference. It is highly recommended that health professionals develop therapeutic interventions and psychological supports to promote the mental health of PLWHAs which alleviate their depressive symptoms.
Collapse
Affiliation(s)
- Zahra Bagheri
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pegah Noorshargh
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shahsavar
- Department of English Language, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Jafari
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
8
|
Aung HL, Bloch M, Vincent T, Quan D, Jayewardene A, Liu Z, Gates TM, Brew B, Mao L, Cysique LA. Cognitive ageing is premature among a community sample of optimally treated people living with HIV. HIV Med 2021; 22:151-164. [PMID: 33085207 PMCID: PMC7984032 DOI: 10.1111/hiv.12980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/24/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Evidence of premature cognitive ageing amongst people living with HIV (PLHIV) remains controversial due to previous research limitations including underpowered studies, samples with suboptimal antiretroviral access, varying rate of virological control, high rate of AIDS, over-representation of non-community samples, and inclusion of inappropriate controls. The current study addresses these limitations, while also considering mental health and non-HIV comorbidity burden to determine whether PLHIV showed premature cognitive ageing compared with closely comparable HIV-negative controls. METHODS This study enrolled 254 PLHIV [92% on antiretroviral therapy; 84% with HIV RNA < 50 copies/mL; 15% with AIDS) and 72 HIV-negative gay and bisexual men [mean (SD) age = 49 (10.2) years] from a single primary care clinic in Sydney, Australia. Neurocognitive function was evaluated with the Cogstate Computerized Battery (CCB) at baseline and 6 months after. Linear mixed-effects (LME) models examined main and interaction effects of HIV status and chronological age on the CCB demographically uncorrected global neurocognitive z-score (GZS), adjusting for repeated testing, and then adjusting sequentially for HIV disease markers, mental health and comorbidities. RESULTS HIV status and age interacted with a lower GZS (β = -0.43, P < 0.05). Higher level of anxiety symptoms (β = -0.11, P < 0.01), historical AIDS (β = -0.12, P < 0.05) and historical HIV brain involvement (β = -0.12, P < 0.05) were associated with lower GZS. CONCLUSIONS We found a robust medium-sized premature ageing effect on cognition in a community sample with optimal HIV care. Our study supports routine screening of cognitive and mental health among PLHIV aged ≥ 50 years.
Collapse
Affiliation(s)
- HL Aung
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
- Neuroscience Research AustraliaSydneyNSWAustralia
- Faculty of MedicineUNSWSydneyNSWAustralia
| | - M Bloch
- Faculty of MedicineUNSWSydneyNSWAustralia
- Holdsworth House Medical PracticeSydneyNSWAustralia
| | - T Vincent
- Holdsworth House Medical PracticeSydneyNSWAustralia
| | - D Quan
- Holdsworth House Medical PracticeSydneyNSWAustralia
| | - A Jayewardene
- Holdsworth House Medical PracticeSydneyNSWAustralia
- Charles Perkins CentreUniversity of SydneySydneyNSWAustralia
| | - Z Liu
- Stats CentralUNSWSydneyNSWAustralia
| | - TM Gates
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
| | - B Brew
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
- Faculty of MedicineUNSWSydneyNSWAustralia
- Faculty of MedicineUniversity of Notre DameSydneyNSWAustralia
| | - L Mao
- Centre for Social Research in HealthUNSWSydneyNSWAustralia
| | - LA Cysique
- Department of Neurology and HIV Medicine, St Vincent’s Hospital and Peter Duncan Neurosciences UnitSt Vincent’s Centre for Applied Medical ResearchSydneyNSWAustralia
- Neuroscience Research AustraliaSydneyNSWAustralia
- Faculty of MedicineUNSWSydneyNSWAustralia
| |
Collapse
|
9
|
Monroe AK, Happ LP, Rayeed N, Ma Y, Jaurretche MJ, Terzian AS, Trac K, Horberg MA, Greenberg AE, Castel AD. Clinic-Level Factors Associated With Time to Antiretroviral Initiation and Viral Suppression in a Large, Urban Cohort. Clin Infect Dis 2020; 71:e151-e158. [PMID: 31701144 PMCID: PMC7583410 DOI: 10.1093/cid/ciz1098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/06/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Using the results of a site assessment survey performed at clinics throughout Washington, DC, we studied the impact of clinic-level factors on antiretroviral therapy (ART) initiation and viral suppression (VS) among people living with human immunodeficiency virus (HIV; PLWH). METHODS This was a retrospective analysis from the District of Columbia (DC) Cohort, an observational, clinical cohort of PLWH from 2011-2018. We included data from PLWH not on ART and not virally suppressed at enrollment. Outcomes were ART initiation and VS (HIV RNA < 200 copies/mL). A clinic survey captured information on care delivery (eg, clinical services, adherence services, patient monitoring services) and clinic characteristics (eg, types of providers, availability of evenings/weekends sessions). Multivariate marginal Cox regression models were generated to identify those factors associated with the time to ART initiation and VS. RESULTS Multiple clinic-level factors were associated with ART initiation, including retention in care monitoring and medication dispensing reviews (adjusted hazard ratios [aHRs], 1.34 to 1.40; P values < .05 for both). Furthermore, multiple factors were associated with VS, including retention in HIV care monitoring, medication dispensing reviews, and the presence of a peer interventionist (aHRs, 1.35 to 1.72; P values < .05 for all). In multivariable models evaluating different combinations of clinic-level factors, enhanced adherence services (aHR, 1.37; 95% confidence interval [CI], 1.18-1.58), medication dispensing reviews (aHR, 1.22; 95% CI, 1.10-1.36), and the availability of opioid treatment (aHR, 1.26; 95% CI, 1.01-1.57) were all associated with the time to VS. CONCLUSIONS The observed association between clinic-level factors and ART initiation/VS suggests that the presence of specific clinic services may facilitate the achievement of HIV treatment goals.
Collapse
Affiliation(s)
- Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Lindsey P Happ
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | | | - Yan Ma
- Department of Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Maria J Jaurretche
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Arpi S Terzian
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Kevin Trac
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, USA
| | - Alan E Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| |
Collapse
|
10
|
ART uptake and adherence among women who use drugs globally: A scoping review. Drug Alcohol Depend 2020; 215:108218. [PMID: 32916450 PMCID: PMC7899784 DOI: 10.1016/j.drugalcdep.2020.108218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the state of peer-reviewed literature surrounding uptake and adherence of antiretroviral therapy (ART) among HIV-positive women who use drugs (WWUD). METHODS Consistent with PRISMA-ScR guidelines, we conducted a scoping literature review on ART uptake and adherence among WWUD, searching PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting at least one ART uptake or adherence related result among WWUD aged 18 or older; peer-reviewed; published in English between 1996-2018. RESULTS Our search identified 6735 studies; 86 met eligibility requirements. ART uptake ranged from 30 % to 76 % and adherence ranged from 27 % to 95 %. Substance use, co-morbid psychiatric disorders, and side effects emerged as the primary ART uptake and adherence barriers among this population. Few facilitators were identified. CONCLUSION This study is the first scoping review to look at ART uptake and adherence among WWUD globally. The wide range in uptake and adherence outcomes indicates the need for gold standard assessments, which may differ between high and low resource settings. This study offers rich insight into uptake and adherence barriers and facilitators, primarily at the intrapersonal level. More research is needed to examine interventions that focus on additional levels of the SEM (e.g., community and policy levels). These review findings can inform ART interventions, future research, and offer guidance to other support services with WWUD, such as PrEP interventions.
Collapse
|
11
|
[Psychiatric aspects in treatment of HIV]. MMW Fortschr Med 2020; 162:34-37. [PMID: 32583251 DOI: 10.1007/s15006-020-0643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
12
|
Berg RC, Weatherburn P, Marcus U, Schmidt AJ. Links between transactional sex and HIV/STI-risk and substance use among a large sample of European men who have sex with men. BMC Infect Dis 2019; 19:686. [PMID: 31382923 PMCID: PMC6683343 DOI: 10.1186/s12879-019-4326-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/29/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In Europe, the highest proportion of HIV diagnoses are in gay men and other men who have sex with men (MSM). Globally, HIV prevalence is particularly high among males who report selling sex, but rates among men who buy sex from other men are less clear. This study analyzed the association of transactional sex (TS) and HIV diagnosis, sexually transmitted infection (STI) diagnoses, and various drug use; and examined the variations in TS by payment direction. METHODS We conducted a cross-sectional, non-randomized, observational study. This European MSM Internet Survey recruited MSM from 38 European countries. For descriptive purposes we stratified according to TS behavior (frequently selling sex, frequently buying sex, neither frequently selling nor buying sex in the previous 12 months), and we constructed separate multivariable logistic regression models to investigate whether engaging in TS accounted for some of the HIV- and STI diagnoses and drug use in this population. RESULTS Of almost 161,000 sexually active MSM, 12.2% engaged in TS. The multivariable logistic regression results showed that relative to not frequently engaging in TS, frequently selling sex was independently associated with a higher odds of reporting diagnosed HIV (ever, adjusted odds ratio [aOR] 1.60, confidence interval [CI] 95% 1.39 to 1.85), bacterial STIs (past 12 months, aOR 1.75 CI 95% 1.54 to 2.00), using heroin or crack cocaine or injecting drugs (aOR 3.17, CI 95% 2.70 to 3.73), and using benzodiazepines (aOR 2.13, CI 95% 1.88 to 2.41). Compared to men not engaging in frequent TS, frequently buying sex was associated with a higher odds of using benzodiazepines (aOR 2.13, CI 95% 1.88 to 2.41). CONCLUSIONS MSM who frequently sell sex suffer greater sexual- and substance use risks than other MSM, but both men who frequently sell and those who buy sex are more likely to use benzodiazepines. MSM who sell sex to other men constitute an important at-risk population who must be offered targeted health services.
Collapse
Affiliation(s)
- Rigmor C. Berg
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
- University of Tromso, Hansine Hansens veg 18, N-9019 Tromso, Norway
| | - Peter Weatherburn
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH England
| | - Ulrich Marcus
- Department of Infectious Diseases Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Axel J. Schmidt
- Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH England
| |
Collapse
|
13
|
Debalkie Animut M, Sorrie MB, Birhanu YW, Teshale MY. High prevalence of neurocognitive disorders observed among adult people living with HIV/AIDS in Southern Ethiopia: A cross-sectional study. PLoS One 2019; 14:e0204636. [PMID: 30883557 PMCID: PMC6422272 DOI: 10.1371/journal.pone.0204636] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/28/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Comprehensive care given to people living with HIV/AIDS is improving over time; however, their concurrent cognitive illness is still ignored, under screened and treated particularly in developing countries. And this problem is also striking in Ethiopia. Therefore, the objective of this study was to assess HIV-associated neurocognitive disorders and associated factors among adult people living with HIV/AIDS. METHODS An institution based cross sectional study was conducted from April to May, 2017 at Gamo Gofa zone public Hospitals. International HIV Dementia Scale was used to screen HIV associated neurocognitive disorders. Logistic regression analysis was used to assess predictors of neurocognitive disorders. RESULT A total of 684 study participants were included in this study with a response rate of 98%. Among them, 56% were females while 44% were males. The mean (±SD) age of the participants was 38.8±8.8years. The screening prevalence of HIV-associated neurocognitive disorder was 67.1% (95% CI; 63.6, 70.5). Body mass index 16 kg/m2 (AOR 4.389 (1.603-12.016)), being married (AOR 0.377 (0.213-0.666), unemployment status (AOR 3.181 (1.752-5.777) and being in WHO clinical stage T3 category/advancing stages of the disease (AOR 3.558 (1.406-9.006) were the key predictors of HIV-associated neurocognitive disorders among people living with HIV/AIDS. CONCLUSION In this study the screening prevalence of HIV-associated neurocognitive disorder is higher than the earlier reports in Ethiopia and Africa. This indicates that early screening strategies and policies for cognitive health in people living with HIV/AIDS should be given a top priority.
Collapse
Affiliation(s)
- Megbaru Debalkie Animut
- Arbaminch University College of Medicine and Health Sciences Department of Nursing, Arbaminch, Ethiopia
| | - Muluken Bekele Sorrie
- Arbaminch University College of Medicine and Health Sciences Department of Public Health, Arbaminch, Ethiopia
| | - Yinager Workineh Birhanu
- Bahir Dar University Colleges of Medicine and Health Sciences School of Nursing, Bahir Dar Ethiopia
| | - Manaye Yihune Teshale
- Arbaminch University College of Medicine and Health Sciences Department of Public Health, Arbaminch, Ethiopia
| |
Collapse
|
14
|
Bagheri Z, Taheri M, Motazedian N. The impacts of depression and anxiety on quality of life among patients with HIV/AIDS and their spouses: testing dyadic dynamics using the actor-partner interdependence model. AIDS Care 2019; 31:1500-1508. [PMID: 30884955 DOI: 10.1080/09540121.2019.1595676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
HIV/AIDS not only affects the patients, but also their entire family. This study aimed to assess the impacts of the patients' and their spouses' anxiety and depression on their quality of life (QoL) at the dyadic level. A total of 120 serodiscordant husband-wife dyads from the voluntary counselling and testing center in Shiraz, Iran, were involved in this study from February to June 2015. The WHOQOL-BREEF, CESD-10, and Beck Anxiety Inventory instruments were used, respectively, to assess the QoL, depression, and anxiety scores of the participants. The actor-partner interdependence model (APIM) was used to estimate the effects of depression and anxiety of both the people living with HIV/AIDS (PLWHA) and their spouses on their own QoL (actor effect) as well as their partners' (partner effect). The APIM analysis revealed that both PLWHAs' and their spouses' depression and anxiety showed actor effects on their own QoL. Furthermore, spouses' depression showed a significant partner effect on PLWHAs' QoL and PLWHAs' anxiety had significant partner effects on spouses' QoL. Accordingly, this data can be used to develop targeted interventions aimed at guidance and assistance of PLWHAs and their spouses to find coping strategies that improve their own QoL as well as their partners'.
Collapse
Affiliation(s)
- Zahra Bagheri
- Department of Biostatistics, Faculty of Medicine, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Marjan Taheri
- Department of Biostatistics, Faculty of Medicine, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Nasrin Motazedian
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences , Shiraz , Iran.,Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences , Shiraz , Iran
| |
Collapse
|
15
|
Nolan RA, Muir R, Runner K, Haddad EK, Gaskill PJ. Role of Macrophage Dopamine Receptors in Mediating Cytokine Production: Implications for Neuroinflammation in the Context of HIV-Associated Neurocognitive Disorders. J Neuroimmune Pharmacol 2018; 14:134-156. [PMID: 30519866 DOI: 10.1007/s11481-018-9825-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 11/19/2018] [Indexed: 12/13/2022]
Abstract
Despite the success of combination anti-retroviral therapy (cART), around 50% of HIV-infected individuals still display a variety of neuropathological and neurocognitive sequelae known as NeuroHIV. Current research suggests these effects are mediated by long-term changes in CNS function in response to chronic infection and inflammation, and not solely due to active viral replication. In the post-cART era, drug abuse is a major risk-factor for the development of NeuroHIV, and increases extracellular dopamine in the CNS. Our lab has previously shown that dopamine can increase HIV infection of primary human macrophages and increase the production of inflammatory cytokines, suggesting that elevated dopamine could enhance the development of HIV-associated neuropathology. However, the precise mechanism(s) by which elevated dopamine could exacerbate NeuroHIV, particularly in chronically-infected, virally suppressed individuals remain unclear. To determine the connection between dopaminergic alterations and HIV-associated neuroinflammation, we have examined the impact of dopamine exposure on macrophages from healthy and virally suppressed, chronically infected HIV patients. Our data show that dopamine treatment of human macrophages isolated from healthy and cART-treated donors promotes production of inflammatory mediators including IL-1β, IL-6, IL-18, CCL2, CXCL8, CXCL9, and CXCL10. Furthermore, in healthy individuals, dopamine-mediated modulation of specific cytokines is correlated with macrophage expression of dopamine-receptor transcripts, particularly DRD5, the most highly-expressed dopamine-receptor subtype. Overall, these data will provide more understanding of the role of dopamine in the development of NeuroHIV, and may suggest new molecules or pathways that can be useful as therapeutic targets during HIV infection.
Collapse
Affiliation(s)
- R A Nolan
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, 19102, USA
| | - R Muir
- Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, 19102, USA
| | - K Runner
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, 19102, USA
| | - E K Haddad
- Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, PA, 19102, USA
| | - P J Gaskill
- Department of Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, 19102, USA.
| |
Collapse
|
16
|
Daniels AK, Van Niekerk RL. The impact of a therapeutic exercise intervention on depression and body self-image in HIV-positive women in sub-Saharan Africa. HIV AIDS (Auckl) 2018; 10:133-144. [PMID: 30038525 PMCID: PMC6053174 DOI: 10.2147/hiv.s167005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Attitudes, responses, and reactions of HIV-positive women in three sub-Saharan African regions toward a therapeutic exercise intervention, aimed to determine the presence of depression and low body self-image, were captured. This provided insight into body satisfaction and desire to exercise (Stage 1, n=60), body self-image and depression (Stage 2, n=60), and overall concerns around the often adverse side effects of antiretroviral treatment (ART). A program of therapeutic (specialty) exercise was developed for the experimental design (Stage 2), to quantify the psychological side effects of these variables. METHODOLOGY Stage 1 constituted a qualitative exploration into attitudes and perceptions around ART, toxicity, health concerns, metabolic irregularities (lipodystrophy), body shape and size dissatisfaction, and cultural attitudes toward exercise. This stage deployed brief informal face-to-face interviews, based on the World Health Organization (WHO)/United Nations Fund for Population Activities (UNFPA) AIDS Inventory, in three sub-Saharan African regions (including provincial and district hospitals, nongovernmental organizations, voluntary counseling and testing/HIV and testing centers, and primary care outpatient clinics). Stage 2 of the study comprised a quantitative experimental design, conducted on a sample of HIV-positive women (mean age=39.0 years; mean years on ART=5.5; 86% black) in three selected HIV outpatient clinics in Johannesburg, South Africa. DATA ANALYSIS The collated data sets from both stages of the research were presented, analyzed, and interpreted (thematic analyses [Stage 1] and statistical analyses [Stage 2]) using the body self-image questionnaire and Beck's depression inventory. RESULTS Stage 1 outlined participants' concerns and reports around 1) body shape and size, including long-term effects of ART and 2) attitudes toward exercise, as a function of HIV status. Stage 2 represented pre- and posttest statistics, showing low statistical means for both the experiment and the control groups, with statistical significance for four out of nine items of subscales of body self-image questionnaire.
Collapse
Affiliation(s)
- Andrea K Daniels
- School of Community Psychosocial Research (COMPRES), Faculty of Health Sciences, North West University, Potchefstroom, South Africa,
| | - Rudolph L Van Niekerk
- Department of Human Movement Science, Faculty of Health Sciences, University of Fort Hare, Alice, South Africa
| |
Collapse
|
17
|
A qualitative study examining the benefits and challenges of incorporating patient-reported outcome substance use and mental health questionnaires into clinical practice to improve outcomes on the HIV care continuum. BMC Health Serv Res 2018; 18:419. [PMID: 29879962 PMCID: PMC5992635 DOI: 10.1186/s12913-018-3203-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/14/2018] [Indexed: 11/24/2022] Open
Abstract
Background Inadequate identification and treatment of substance use (SU) and mental health (MH) disorders hinders retention in HIV care. The objective of this study was to elicit stakeholder input on integration of SU/MH screening using computer-assisted patient-reported outcomes (PROs) into clinical practice. Methods We conducted semi-structured interviews with HIV-positive patients who self-reported SU/MH symptoms on a computer-assisted PROs (n = 19) and HIV primary care providers (n = 11) recruited from an urban academic HIV clinic. Interviews were audio-recorded and transcribed. We iteratively developed codes and organized key themes using editing style analysis. Results Two themes emerged: (1) Honest Disclosure: Some providers felt PROs might improve SU/MH disclosure; more were concerned that patients would not respond honestly if their provider saw the results. Patients were also divided, stating PROs could help overcome stigma but that it could be harder to disclose SU/MH to a computer versus a live person. (2) Added Value in the Clinical Encounter: Most providers felt PROs would fill a practice gap. Patients had concerns regarding confidentiality but indicated PROs would help providers take better care of them. Conclusions Both patients and providers indicated that PROs are potentially useful clinical tools to improve detection of SU/MH. However, patients and providers expressed conflicting viewpoints about disclosure of SU/MH using computerized PROs. Future studies implementing PROs screening interventions must assess concerns over confidentiality and honest disclosure of SU/MH to understand the effectiveness of PROs as a clinical tool. More research is also needed on patient-centered integration of the results of PROs in HIV care. Electronic supplementary material The online version of this article (10.1186/s12913-018-3203-x) contains supplementary material, which is available to authorized users.
Collapse
|
18
|
Hellmuth J, Colby D, Valcour V, Suttichom D, Spudich S, Ananworanich J, Prueksakaew P, Sailasuta N, Allen I, Jagodzinski LL, Slike B, Ochi D, Paul R. Depression and Anxiety are Common in Acute HIV Infection and Associate with Plasma Immune Activation. AIDS Behav 2017; 21:3238-3246. [PMID: 28484888 DOI: 10.1007/s10461-017-1788-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This observational study of 123 Thai participants sought to determine the rate and severity of affective symptoms during acute HIV infection (AHI) and possible associations to disease mechanisms. At diagnosis, just prior to starting combination antiretroviral therapy (cART), AHI participants completed assessments of depression and anxiety symptoms that were repeated at 4, 12, and 24 weeks. Blood markers of HIV infection and immune activation were measured at study entry, with optional cerebrospinal fluid measures. A high frequency of participants reported symptoms that exceeded published thresholds supportive of depression (55.0%) and anxiety (65.8%) at diagnosis, with significant reductions after starting cART. Meeting a threshold for clinically relevant depressive symptoms at study entry was associated with higher baseline plasma HIV RNA (5.98 vs. 5.50, t = 2.46, p = 0.015), lower CD4 counts (328 vs. 436 cells/mm3, t = 3.46, p = 0.001), and higher plasma neopterin, a marker of macrophage activation (2694 vs. 1730 pg/mL, Mann-Whitney U = 152.5, p = 0.011). Controlling for plasma HIV RNA and CD4 count, higher baseline plasma neopterin correlated with worse initial depression and anxiety scores. Depression and anxiety symptoms are frequent in acute HIV infection, associate with plasma immune activation, and can improve concurrent with cART.
Collapse
|
19
|
Tuthill EL, Pellowski JA, Young SL, Butler LM. Perinatal Depression Among HIV-Infected Women in KwaZulu-Natal South Africa: Prenatal Depression Predicts Lower Rates of Exclusive Breastfeeding. AIDS Behav 2017; 21:1691-1698. [PMID: 27752868 DOI: 10.1007/s10461-016-1557-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Exclusive breastfeeding (EBF) provides infants with optimal nutrition, and together with appropriate antiretroviral therapy has also been shown to decrease mother-to-child transmission of HIV from 45 to less than 1 %. However, rates of EBF are particularly low in South Africa, where rates of HIV are some of the highest in the world. Although perinatal depression has been identified as a potential barrier to EBF, little is known about its impact on EBF among HIV-infected women. A cohort study was conducted as part of a pilot randomized controlled trial (RCT) examining the effect of an Information, Motivation and Behavioral skills-based intervention promoting EBF among South African women living with HIV in their third trimester (28-42 weeks) of pregnancy. At baseline and follow-up, participants were interviewed on depression symptoms (PHQ-9), and breastfeeding intentions and behavior. Multivariate logistic regressions were conducted to determine predictors of EBF at 6-weeks postpartum. A total of 68 women were enrolled and 58 women completed both baseline and follow-up assessments. Most (80.9 %) of the sample reported at least some symptoms of depression prenatally. Rates of depression were lower postpartum (47.1 %). In multivariate models, higher prenatal depression scores significantly predicted lower likelihood of EBF at 6-weeks postpartum after adjusting for demographics, condition, and intentions (AOR = 0.68, p < 0.05). Postpartum depression was not a significant predictor of EBF rates (AOR = 0.99, p = 0.96). These findings demonstrate the negative impact of prenatal depression on breastfeeding behavior. Future interventions focused on depression are warranted to identify those at risk for sub-optimal EBF. Improving maternal psychosocial well-being could be a new frontier to improving infant and young child feeding and reducing pre/postnatal transmission.
Collapse
Affiliation(s)
- Emily L Tuthill
- UCSF School of Nursing, University of California San Francisco, 2 Koret Way, Box 0608, San Francisco, CA, 94143-0608, USA.
| | - Jennifer A Pellowski
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sera L Young
- Department of Anthropology, Institute for Policy Research Northwestern University, Evanston, IL, USA
| | - Lisa M Butler
- Department of Pediatrics, Harvard Medical School, Boston, USA
- Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, USA
| |
Collapse
|
20
|
Anxiety and Depressive Symptoms Among People Living with HIV and Childhood Sexual Abuse: The Role of Shame and Posttraumatic Growth. AIDS Behav 2016; 20:1609-20. [PMID: 26837633 DOI: 10.1007/s10461-016-1298-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is a critical need to examine protective and risk factors of anxiety and depressive symptoms among people living with HIV in order to improve quality of life. Structural equation modeling was used to examine the associations between HIV-related shame, sexual abuse-related shame, posttraumatic growth, and anxiety and depressive symptoms among a cohort of 225 heterosexual women and men who have sex with men (MSM) living with HIV who have experienced childhood sexual abuse (CSA). Higher sexual abuse-related shame was related to more anxiety and depressive symptoms for heterosexual women. Higher posttraumatic growth predicted less anxiety symptoms for only heterosexual women. Higher posttraumatic growth predicted less depressive symptoms for heterosexual women and MSM, but the magnitude of this effect was stronger for heterosexual women than MSM. Psychosocial interventions may need to be tailored to meet the specific needs of heterosexual women and MSM living with HIV and CSA.
Collapse
|
21
|
Bucciardini R, Pugliese K, Francisci D, Costantini A, Schiaroli E, Cognigni M, Tontini C, Lucattini S, Fucili L, Di Gregorio M, Mirra M, Fragola V, Pompili S, Murri R, Vella S. Validation of a self-reported HIV symptoms list: the ISS-HIV symptoms scale. AIDS Res Ther 2016; 13:18. [PMID: 27064450 PMCID: PMC4826516 DOI: 10.1186/s12981-016-0102-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/30/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To describe the development and the psychometric properties of the Istituto Superiore di Sanità-HIV symptoms scale (lSS-HIV symptoms scale). METHODS The ISS-HIV symptom scale was developed by an Italian working team including researchers, physicians and people living with HIV. The development process went through the following steps: (1) review of HIV/AIDS literature; (2) focus group; (3) pre-test analysis; (4) scale validation. RESULTS The 22 symptoms of HIV-ISS symptoms scale were clustered in five factors: pain/general discomfort (7 items); depression/anxiety (4 items); emotional reaction/psychological distress (5 items); gastrointestinal discomfort (4 items); sexual discomfort (2 items). The internal consistence reliability was for all factors within the minimum accepted standard of 0.70. CONCLUSIONS The results of this study provide a preliminary evidence of the reliability and validity of the ISS-HIV symptoms scale. In the new era where HIV infection has been transformed into a chronic diseases and patients are experiencing a complex range of symptoms, the ISS-HIV symptoms scale may represent an useful tool for a comprehensive symptom assessment with the advantage of being easy to fill out by patients and potentially attractive to physicians mainly because it is easy to understand and requires short time to interpret the results.
Collapse
Affiliation(s)
| | | | | | | | | | - Miriam Cognigni
- />Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - Chiara Tontini
- />Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | | | | | | | | | | | | | - Rita Murri
- />Institute of Infectious Diseases, Catholic University of Rome, Rome, Italy
| | | |
Collapse
|
22
|
Willie TC, Overstreet NM, Sullivan TP, Sikkema KJ, Hansen NB. Barriers to HIV Medication Adherence: Examining Distinct Anxiety and Depression Symptoms among Women Living with HIV Who Experienced Childhood Sexual Abuse. Behav Med 2016; 42:120-7. [PMID: 26010763 PMCID: PMC4710561 DOI: 10.1080/08964289.2015.1045823] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Experiencing sexual violence in childhood or adolescence is highly prevalent among some women living with HIV, often resulting in anxiety and depression symptoms in adulthood. Anxiety and depression have been associated with HIV medication nonadherence, yet little research has assessed distinct components of anxiety and depression as risk factors of HIV medication nonadherence. The current study examined distinct symptom components of anxiety and depression as predictors of HIV medication non-adherence among women living with HIV and childhood sexual abuse enrolled in a coping intervention. This secondary analysis included a sample of 85 women living with HIV and childhood sexual abuse and being prescribed antiretroviral medication who completed measures on anxiety, depression, and medication adherence. Results from a logistic regression analysis suggest that distinct components of anxiety may be related to medication nonadherence among this population. Targeted mental health interventions for this population may increase adherence to antiretroviral medication.
Collapse
Affiliation(s)
- Tiara C. Willie
- Predoctoral Fellow, Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | - Nicole M. Overstreet
- Postdoctoral fellow, Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | - Tami P. Sullivan
- Associate Professor and Director of Family Violence Research and Programs, Department of Psychiatry, Division of Prevention and Community Research, Yale University School of Medicine, New Haven, CT
| | - Kathleen J. Sikkema
- Professor and Director of Clinical Training, Department of Psychology and Neuroscience, and Duke Global Institute, Duke University, Durham, NC
| | - Nathan B. Hansen
- Associate Professor and Department Head ,Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA
| |
Collapse
|
23
|
Lifson AR, Grandits GA, Gardner EM, Wolff MJ, Pulik P, Williams I, Burman WJ. Quality of life assessment among HIV-positive persons entering the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV Med 2015; 16 Suppl 1:88-96. [PMID: 25711327 DOI: 10.1111/hiv.12237] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVES With HIV treatment prolonging survival and HIV infection now managed as a chronic illness, quality of life (QOL) is important to evaluate in persons living with HIV (PLWH). We assessed at study entry the QOL of antiretroviral-naïve PLWH with CD4 counts > 500 cells/μL in the Strategic Timing of AntiRetroviral Treatment (START) clinical trial. METHODS QOL was assessed with: (1) a visual analogue scale (VAS) for self-assessment of overall current health; (2) the Short-Form 12-Item Version 2 Health Survey(®) (SF-12V2), for which responses are summarized into eight individual QOL domains plus component summary scores for physical health [the Physical Health Component Summary (PCS)] and mental health [the Mental Health Component Summary (MCS)]. The VAS and eight domain scores were scaled from 0 to 100. Mean QOL measures were calculated overall and by demographic, clinical and behavioural factors. RESULTS A total of 4631 participants completed the VAS and 4119 the SF-12. The mean VAS score (with standard deviation) was 80.9 ± 15.7. Mean SF-12 domain scores were lowest for vitality (66.3 ± 26.4) and mental health (68.6 ± 21.4), and highest for physical functioning (89.3 ± 23.0) and bodily pain (88.0 ± 21.4). Using multiple linear regression, PCS scores were lower (P < 0.001) for Asians, North Americans, female participants, older participants, and those with less education, longer duration of known HIV infection, alcoholism/substance dependence and body mass index ≥ 30 kg/m(2) . MCS scores were highest (P < 0.001) for Africans, South Americans and older participants, and lowest for female participants, current smokers and those with alcoholism/substance dependence. CONCLUSIONS In this primarily healthy population, QOL was mostly favourable, emphasizing that it is important that HIV treatments do not negatively impact QOL. Self-assessed physical health summary scores were higher than mental health scores. Factors such as older age and geographical region had different effects on perceived physical and mental health.
Collapse
Affiliation(s)
- A R Lifson
- University of Minnesota, Minneapolis, MN, USA
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Aaron E, Bonacquisti A, Geller PA, Polansky M. Perinatal Depression and Anxiety in Women with and without Human Immunodeficiency Virus Infection. Womens Health Issues 2015; 25:579-85. [PMID: 26093677 DOI: 10.1016/j.whi.2015.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 04/02/2015] [Accepted: 04/06/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Untreated depression and anxiety during the perinatal period have significant consequences on maternal and infant health; however, few studies have examined perinatal depression and perinatal anxiety in women with human immunodeficiency virus (HIV) infection. The current study prospectively examined the prevalence of prenatal and postpartum depression and anxiety, and emotional support from family and friends, as well as childhood sexual abuse in women with and without HIV infection. METHODS Between July 2009 and January 2013, 258 pregnant women receiving care in a Philadelphia hospital were enrolled, with 162 completing both the prenatal and postpartum portions of the study. The Center for Epidemiological Studies-Depression Scale (CES-D), and the State-Trait Anxiety Inventory for Adults were used to measure depression and anxiety symptoms, respectively. An independent samples t test and multiple linear regressions were used to determine associations among depression, anxiety, and pregnancy-related variables. RESULTS Forty-nine participants (30%) were living with HIV; 113 (70%) were HIV negative. CES-D scores did not differ prenatally (p = .131) or postpartum (p = .156) between women with and without HIV. Prenatal state anxiety scores were higher in women with HIV (p = .02) but there were no differences postpartum (p = .432). In a multiple linear regression, trait anxiety predicted postpartum anxiety in the full sample (p < .001) and childhood sexual abuse predicted postpartum depression among women with HIV (p = .021). CONCLUSIONS These findings highlight the importance of identifying and treating perinatal depression and anxiety early in the prenatal period. Results also emphasize the need for providers to be aware of childhood sexual abuse as a potential correlate for depression in women with HIV.
Collapse
Affiliation(s)
- Erika Aaron
- Division of Infectious Diseases and HIV Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
| | - Alexa Bonacquisti
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | - Pamela A Geller
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania; Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Marcia Polansky
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania
| |
Collapse
|
25
|
Cardoso LD, Malbergier A. Who is not using condoms among HIV-positive patients in treatment in the largest city in Brazil? AIDS Care 2014; 27:629-36. [PMID: 25495898 DOI: 10.1080/09540121.2014.986047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Data on risky sexual behaviors in people living with HIV/AIDS (PLWHA) is still scarce in some populations around the world. The purpose of this study was to assess the factors associated with the use of condoms in a representative sample of PLWHA in outpatient treatment in the city of São Paulo. Six hundred and sixty-seven HIV-positive patients (383 men and 284 women) who were being treated at eight centers participated in this study. Data were collected using a sociodemographic survey, the Beck depression and anxiety inventories, a survey of alcohol and other drugs use, the Alcohol Use Disorders Identification Test, a sexual behavior survey, and the Sexual Risk Behavior Assessment Schedule. The majority of study participants were sexually active (almost 62% of the sample had at least one sexual partner in the last three months), and at least one-fourth engaged in unsafe sex (25.3% did not use condoms during at least one instance of anal and/or vaginal intercourse in the past three months). Multivariate logistic regression showed that engaging in unprotected sex was more likely among females (p < .001), persons with an HIV-positive partner (p < .001), and people using cannabis before sex (p = .002). These findings should stimulate health-care workers to create specific groups for women, seroconcordant couples, and cannabis users to discuss condom use, as they seem to be vulnerable groups.
Collapse
|
26
|
Increased hot flash severity and related interference in perimenopausal human immunodeficiency virus-infected women. Menopause 2014; 21:403-9. [PMID: 23820600 DOI: 10.1097/gme.0b013e31829d4c4c] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE As women with human immunodeficiency virus (HIV) are living longer, more are entering perimenopause. Prior studies suggest that HIV-infected women are more likely to have hot flashes than non-HIV-infected women. However, little is known regarding hot flash severity and hot flash-related interference with daily function, mood, and quality of life in this population. METHODS Perimenopausal HIV-infected and non-HIV-infected women matched by age, race, and menstrual patterns completed the Menopause Rating Scale (to assess hot flash severity) and the Hot Flash Related Daily Interference Scale (HFRDIS). Menopause Rating Scale and HFRDIS scores and subscores were compared between the groups. RESULTS Thirty-three HIV-infected women and 33 non-HIV-infected women who were similar in age (median [interquartile range], 47 [45-48] vs 47 [46-49] y), race (64% vs 52% nonwhite, P = 0.32), and menstrual patterns (number of periods in the past year; 5 [4-9] vs 6 [4-10], P = 0.53) were studied. Perimenopausal HIV-infected women reported greater hot flash severity (HIV vs non-HIV: 2 [1-3] vs 1 [0-3], P = 0.03) and hot flash-related interference (HFRDIS total score, 37 [10-60] vs 6 [0-20], P = 0.001). CONCLUSIONS Perimenopausal HIV-infected women experience greater hot flash severity and related interference compared with non-HIV-infected perimenopausal women. Increased distress secondary to hot flashes may reduce quality of life and negatively impact important health-promoting behaviors, including adherence to antiretroviral therapy, in HIV-infected women.
Collapse
|
27
|
Goodness TM, Palfai TP, Cheng DM, Coleman SM, Bridden C, Blokhina E, Krupitsky E, Samet JH. Depressive symptoms and antiretroviral therapy (ART) initiation among HIV-infected Russian drinkers. AIDS Behav 2014; 18:1085-93. [PMID: 24337725 DOI: 10.1007/s10461-013-0674-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The impact of depressive symptoms on ART initiation among Russian HIV-infected heavy drinkers enrolled in a secondary HIV prevention trial (HERMITAGE) was examined. We assessed 133 participants eligible for ART initiation (i.e., CD4 count <350 cells/μl) who were not on ART at baseline. Depressive symptom severity and ART use were measured at baseline, 6- and 12-months. Association between depressive symptoms and subsequent ART initiation was evaluated using GEE logistic regression adjusting for gender, past ART use, injection drug use and heavy drinking. Depressive symptom severity was not significantly associated with lower odds of initiating ART. Cognitive depression symptoms were not statistically significant (global p = 0.05); however, those with the highest level of severity had an AOR of 0.25 (95 % CI 0.09-0.71) for delayed ART initiation. Although the effect of depression severity was not significant, findings suggest a potential role of cognitive depression symptoms in decisions to initiate ART in this population.
Collapse
Affiliation(s)
- Tracie M Goodness
- Department of Psychology, Boston University, 648 Beacon Street, 4th Floor, Boston, MA, 02215, USA,
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Whetten K, Shirey K, Pence BW, Yao J, Thielman N, Whetten R, Adams J, Agala B, Ostermann J, O'Donnell K, Hobbie A, Maro V, Itemba D, Reddy E. Trauma history and depression predict incomplete adherence to antiretroviral therapies in a low income country. PLoS One 2013; 8:e74771. [PMID: 24124455 PMCID: PMC3790775 DOI: 10.1371/journal.pone.0074771] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 08/06/2013] [Indexed: 11/19/2022] Open
Abstract
Background As antiretroviral therapy (ART) for HIV becomes increasingly available in low and middle income countries (LMICs), understanding reasons for lack of adherence is critical to stemming the tide of infections and improving health. Understanding the effect of psychosocial experiences and mental health symptomatology on ART adherence can help maximize the benefit of expanded ART programs by indicating types of services, which could be offered in combination with HIV care. Methodology The Coping with HIV/AIDS in Tanzania (CHAT) study is a longitudinal cohort study in the Kilimanjaro Region that included randomly selected HIV-infected (HIV+) participants from two local hospital-based HIV clinics and four free-standing voluntary HIV counselling and testing sites. Baseline data were collected in 2008 and 2009; this paper used data from 36 month follow-up interviews (N = 468). Regression analyses were used to predict factors associated with incomplete self-reported adherence to ART. Results Incomplete ART adherence was significantly more likely to be reported amongst participants who experienced a greater number of childhood traumatic events: sexual abuse prior to puberty and the death in childhood of an immediate family member not from suicide or homicide were significantly more likely in the non-adherent group and other negative childhood events trended toward being more likely. Those with incomplete adherence had higher depressive symptom severity and post-traumatic stress disorder (PTSD). In multivariable analyses, childhood trauma, depression, and financial sacrifice remained associated with incomplete adherence. Discussion This is the first study to examine the effect of childhood trauma, depression and PTSD on HIV medication adherence in a low income country facing a significant burden of HIV. Allocating spending on HIV/AIDS toward integrating mental health services with HIV care is essential to the creation of systems that enhance medication adherence and maximize the potential of expanded antiretroviral access to improve health and reduce new infections.
Collapse
Affiliation(s)
- Kathryn Whetten
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Kristen Shirey
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
| | - Brian Wells Pence
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jia Yao
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Nathan Thielman
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University, Durham, North Carolina, United States of America
| | - Rachel Whetten
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Julie Adams
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
| | - Bernard Agala
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Jan Ostermann
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Karen O'Donnell
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Center for Child & Family Health, Duke University, Durham, North Carolina, United States of America
| | - Amy Hobbie
- Center for Health Policy, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Venance Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Elizabeth Reddy
- Department of Medicine, Division of Infectious Diseases and International Health, Duke University, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | |
Collapse
|
29
|
Schumacher JE, McCullumsmith C, Mugavero MJ, Ingle-Pang PE, Raper JL, Willig JH, You Z, Batey DS, Crane H, Lawrence ST, Wright C, Treisman G, Saag MS. Routine depression screening in an HIV clinic cohort identifies patients with complex psychiatric co-morbidities who show significant response to treatment. AIDS Behav 2013; 17:2781-91. [PMID: 23086427 DOI: 10.1007/s10461-012-0342-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study described characteristics, psychiatric diagnoses and response to treatment among patients in an outpatient HIV clinic who screened positive for depression. Depressed (25 %) were less likely to have private insurance, less likely to have suppressed HIV viral loads, had more anxiety symptoms, and were more likely to report current substance abuse than not depressed. Among depressed, 81.2 % met diagnostic criteria for a depressive disorder; 78 % for an anxiety disorder; 61 % for a substance use disorder; and 30 % for co-morbid anxiety, depression, and substance use disorders. Depressed received significantly more treatment for depression and less HIV primary care than not depressed patients. PHQ-9 total depression scores decreased by 0.63 from baseline to 6-month follow-up for every additional attended depression treatment visit. HIV clinics can routinely screen and treat depressive symptoms, but should consider accurate psychiatric diagnosis as well as co-occurring mental disorders.
Collapse
Affiliation(s)
- Joseph E Schumacher
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA,
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Kemppainen JK, MacKain S, Reyes D. Anxiety symptoms in HIV-infected individuals. J Assoc Nurses AIDS Care 2013; 24:S29-39. [PMID: 23290375 DOI: 10.1016/j.jana.2012.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 08/01/2012] [Indexed: 11/15/2022]
Abstract
Anxiety is one of the most frequent symptoms recognized by providers who care for persons living with HIV disease (PLWH). This evidence-based review of anxiety and HIV disease includes an overview of anxiety symptoms, their prevalence in PLWH, and co-existing mood and behavioral disorders. Harmful physiologic effects are also highlighted. Valid and reliable clinical measurement tools used for assessing anxiety include the Clinical Diagnostic Questionnaire, the Hamilton Anxiety Scale, the State-Trait Anxiety Scale, the Profile of Mood States, and the Hospital Anxiety and Depression Scale. Evidence supports the use of cognitive behavioral therapy as a recommended intervention for the treatment of anxiety symptoms and/or anxiety disorders in PLWH. Medications for use with more severe and disabling anxiety are discussed, as well as evidence based on expert opinion for anxiety self-management.
Collapse
|
31
|
Lyons A, Pitts M, Grierson J. Exploring the psychological impact of HIV: health comparisons of older Australian HIV-positive and HIV-negative gay men. AIDS Behav 2012; 16:2340-9. [PMID: 22790849 DOI: 10.1007/s10461-012-0252-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Little is known about the impact of HIV on the mental health of older gay men. In a nationwide online survey, 1,135 Australian gay men aged 40 years and older reported on their physical and mental health. Compared with HIV-negative men, those with HIV were more likely to report currently receiving treatment for a mental health condition (37 vs. 25 %, p = 0.001), but no more likely to report treatment for a major physical health condition other than HIV (39 % vs. 40 %). On a measure of psychological distress, more HIV-positive men were highly distressed (14 vs. 8 %, p = 0.01). There were no significant differences in mental health across age groups for either HIV-positive or HIV-negative men. Underlying factors for poorer mental health included lower income (p = 0.003), not working (p = 0.004), living alone (p = 0.03), treatment for a major physical health condition (p < 0.001), recent experiences of discrimination (p = 0.03), and regarding one's sexual orientation as an essential part of self-identity (p < 0.001). With disparities between older HIV-positive and HIV-negative gay men greater for mental than physical health, more attention may need to be given to the psychological well-being of those living with HIV, particularly by addressing underlying psychosocial factors.
Collapse
|
32
|
Pacella ML, Armelie A, Boarts J, Wagner G, Jones T, Feeny N, Delahanty DL. The impact of prolonged exposure on PTSD symptoms and associated psychopathology in people living with HIV: a randomized test of concept. AIDS Behav 2012; 16:1327-40. [PMID: 22012149 PMCID: PMC4391814 DOI: 10.1007/s10461-011-0076-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
People living with HIV (PLWH) report elevated levels of posttraumatic stress disorder symptoms (PTSS) and associated comorbidities. The present study tested the efficacy of prolonged exposure (PE) at reducing PTSS, depression, negative posttraumatic cognitions, and substance use in PLWH. Participants were randomly assigned to receive PE (n = 40) or to a weekly monitoring control group (n = 25). Assessments occurred at baseline, post-intervention and 3-months post-treatment. Following the 3-month assessment, controls were offered the intervention. All PE recipients (whether originally from the PE or control group) completed a 6-month assessment. Intent-to-treat mixed model repeated measures ANOVAs were conducted through 3-months post-treatment; within group analyses were conducted through 6-months. PE recipients reported fewer PTSS and negative posttraumatic cognitions and were more likely to achieve good end-state functioning; gains were maintained at 6-months. No between-group differences emerged for substance use. Overall, results support the efficacy of PE in PLWH.
Collapse
Affiliation(s)
| | - Aaron Armelie
- Kent State University, Department of Psychology, Kent, Ohio
| | - Jessica Boarts
- Kent State University, Department of Psychology, Kent, Ohio
| | | | - Tracy Jones
- The AIDS Taskforce of Greater Cleveland, Cleveland, Ohio
| | - Norah Feeny
- Case Western Reserve University, Cleveland, Ohio
| | - Douglas L. Delahanty
- Kent State University, Department of Psychology, Kent, Ohio
- Northeastern Ohio Universities College of Medicine (NEOUCOM), Department of Psychology in Psychiatry, Rootstown, Ohio
| |
Collapse
|
33
|
Kemppainen JK, Wantland D, Voss J, Nicholas P, Kirksey KM, Corless IB, Willard S, Holzemer WL, Robinson L, Hamilton MJ, Sefcik E, Eller LS, Huang E, Arudo J, Moezzi S, Rivero-Mendez M, Rosa M, Human S, Cuca Y, Lindgren T, Portillo CJ, Maryland M. Self-care behaviors and activities for managing HIV-related anxiety. J Assoc Nurses AIDS Care 2011; 23:111-23. [PMID: 21839652 DOI: 10.1016/j.jana.2011.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 05/13/2011] [Indexed: 11/25/2022]
Abstract
The goal of this study was to identify the baseline prevalence and effectiveness of anxiety self-management strategies in a convenience sample of persons living with HIV (PLWH; n = 343) in the United States, Puerto Rico, Kenya, and South Africa who reported HIV-related anxiety symptoms. Relationships between demographics and anxiety characteristics were determined, as was the effectiveness of self-care activities/behaviors to reduce anxiety. We found that the use of anxiety self-management strategies varied by gender and that ratings of effectiveness varied by country. Highest anxiety intensity scores were found in participants who were taking antiretroviral medications and who had undetectable viral loads. Forty-five percent of the persons with a diagnosis of AIDS reported anxiety symptoms. As HIV increases in areas of the world where self-care is the primary approach to managing HIV, additional research will be needed to address the effectiveness of cross-cultural differences in strategies for self-managing HIV-related anxiety.
Collapse
|
34
|
Thames AD, Becker BW, Marcotte TD, Hines LJ, Foley JM, Ramezani A, Singer EJ, Castellon SA, Heaton RK, Hinkin CH. Depression, cognition, and self-appraisal of functional abilities in HIV: an examination of subjective appraisal versus objective performance. Clin Neuropsychol 2011; 25:224-43. [PMID: 21331979 DOI: 10.1080/13854046.2010.539577] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Depression frequently co-occurs with HIV infection and can result in self-reported overestimates of cognitive deficits. Conversely, genuine cognitive dysfunction can lead to an under-appreciation of cognitive deficits. The degree to which depression and cognition influence self-report of capacity for instrumental activities of daily living (IADLs) requires further investigation. This study examined the effects of depression and cognitive deficits on self-appraisal of functional competence among 107 HIV-infected adults. As hypothesized, higher levels of depression were found among those who over-reported problems in medication management, driving, and cognition when compared to those who under-reported or provided accurate self-assessments. In contrast, genuine cognitive dysfunction was predictive of under-reporting of functional deficits. Together, these results suggest that over-reliance on self-reported functional status poses risk for error when diagnoses require documentation of both cognitive impairment and associated functional disability in everyday life.
Collapse
Affiliation(s)
- April D Thames
- Semel Institute for Neuroscience and Human Behavior, School of Medicine, University of California-Los Angeles, CA 90095, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Reif S, Mugavero M, Raper J, Thielman N, Leserman J, Whetten K, Pence BW. Highly stressed: stressful and traumatic experiences among individuals with HIV/AIDS in the Deep South. AIDS Care 2011; 23:152-62. [PMID: 21259127 PMCID: PMC3728698 DOI: 10.1080/09540121.2010.498872] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A history of traumatic and/or stressful experiences is prevalent among HIV-infected individuals and has been consistently associated with poorer health outcomes. However, little is known about incident stressful experiences and the factors that predict these experiences among HIV-infected individuals. Data from a longitudinal study of 611 HIV-infected individuals in the Southeastern USA were used to examine the frequency and types of incident stress reported in a 27-month period and to determine predictors associated with three incident stress measures (all stressful events, severe stressful events, and traumatic events such as physical assault). Incident stressful experiences frequently occurred among study participants, as 91% reported at least one stressful experience (median=3.5 experiences) and 10% of study participants reported traumatic stress in any given nine-month reporting period. Financial stressors were the most frequently reported by study participants. Greater emotional distress, substance use, and a higher number of baseline stressful experiences were significantly associated with reporting a greater number of incident stressful experiences and any traumatic experiences. Study results indicate that efforts are needed to identify individuals at risk for traumatic events and/or substantial stressors and to address the factors, including mental health and substance abuse, that contribute to these experiences.
Collapse
Affiliation(s)
- Susan Reif
- Center for Health Policy, Duke University, Durham, NC, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Depression symptoms and treatment among HIV infected and uninfected veterans. AIDS Behav 2010; 14:272-9. [PMID: 18648927 DOI: 10.1007/s10461-008-9428-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 06/25/2008] [Indexed: 10/21/2022]
Abstract
Depression is one of the most common comorbid conditions affecting persons with HIV. We compared depressive symptoms and depression treatment using data from the Veterans Aging Cohort Study (VACS), a prospective cohort of HIV-infected and uninfected subjects. We identified subjects with a Patient Health Questionnaire score of 10 or greater. Treatment was defined as prescription of a selective serotonin reuptake inhibitor (SSRI) or mental health counseling. Overall, 16% of 4,480 subjects had depressive symptoms, and HIV-infected patients were more likely to have had depressive symptoms (OR = 1.38, 95% CI = 1.18, 1.62). Geographic site of care and having a mental health provider at the clinic was associated with treatment. In multivariable models restricted to 732 patients with depressive symptoms, receipt of depression treatment did not differ by HIV status (Adjusted OR = 1.11, 95% CI = 0.80, 1.54). Non-Hispanic whites were more likely to receive treatment (Adjusted OR = 2.09, 95% CI 1.04, 4.24). Primary care and HIV providers were equally unlikely to treat active depressive symptoms. Treatment variation by race, site, and availability of a mental health provider, suggests targets for intervention.
Collapse
|
37
|
Functional consequences of HIV-associated neuropsychological impairment. Neuropsychol Rev 2009; 19:186-203. [PMID: 19472057 DOI: 10.1007/s11065-009-9095-0] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 04/29/2009] [Indexed: 11/26/2022]
Abstract
This review focuses on the "real world" implications of infection with HIV/AIDS from a neuropsychological perspective. Relevant literature is reviewed which examines the relationships between HIV-associated neuropsychological impairment and employment, driving, medication adherence, mood, fatigue, and interpersonal functioning. Specifically, the relative contributions of medical, cognitive, psychosocial, and psychiatric issues on whether someone with HIV/AIDS will be able to return to work, adhere to a complicated medication regimen, or safely drive a vehicle will be discussed. Methodological issues that arise in the context of measuring medication adherence or driving capacity are also explored. Finally, the impact of HIV/AIDS on mood state, fatigue, and interpersonal relationships are addressed, with particular emphasis on how these variables interact with cognition and independent functioning. The purpose of this review is to integrate neuropsychological findings with their real world correlates of functional behavior in the HIV/AIDS population.
Collapse
|
38
|
Schönnesson LN, Williams M, Atkinson J, Timpson S. Factors associated with depressive symptoms in African American crack cocaine smokers. JOURNAL OF SUBSTANCE USE 2009; 14:161-174. [PMID: 20428319 PMCID: PMC2860323 DOI: 10.1080/14659890802695857] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Few studies have examined factors associated with depressive symptoms in crack cocaine smokers, although cocaine use has been linked to depression. The purpose of this study was to identify correlates of depressive symptoms in a sample of 799 HIV-positive and HIV-seronegative African-American crack cocaine smokers. Multiple regression modelling revealed that anxiety was strongly and positively associated with depressive symptoms. In addition, being female and more frequent crack smoking were also found to be associated. Higher self-esteem and decision-making confidence were found to be associated with less often experiencing depressive symptoms. The model accounted for 64% of the variance in the data. It was noteworthy that HIV infection, as such, was not associated with depressive symptoms. The study has important implication for mental health and health promotion interventions targeting crack cocaine smokers.
Collapse
Affiliation(s)
- L Nilsson Schönnesson
- Venhälsan (Gay Men's Clinic), South General Hospital Karolinska Institute, Stockholm, Sweden
| | | | | | | |
Collapse
|
39
|
Lifson AR, Belloso WH, Carey C, Davey RT, Duprez D, El-Sadr WM, Gatell JM, Gey DC, Hoy JF, Krum EA, Nelson R, Nixon DE, Paton N, Pedersen C, Perez G, Price RW, Prineas RJ, Rhame FS, Sampson J, Worley J. Determination of the underlying cause of death in three multicenter international HIV clinical trials. HIV CLINICAL TRIALS 2008; 9:177-85. [PMID: 18547904 DOI: 10.1310/hct0903-177] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Describe processes and challenges for an Endpoint Review Committee (ERC) in determining and adjudicating underlying causes of death in HIV clinical trials. METHOD Three randomized HIV trials (two evaluating interleukin-2 and one treatment interruption) enrolled 11,593 persons from 36 countries during 1999-2008. Three ERC members independently reviewed each death report and supporting source documentation to assign underlying cause of death; differences of opinion were adjudicated. RESULTS Of 453 deaths reported through January 14, 2008, underlying causes were as follows: 10% AIDS-defining diseases, 21% non-AIDS malignancies, 9% cardiac diseases, 9% liver disease, 8% non-AIDS-defining infections, 5% suicides, 5% other traumatic events/accidents, 4% drug overdoses/acute intoxications, 11% other causes, and 18% unknown. Major reasons for unknown classification were inadequate clinical information or supporting documentation to determine cause of death. Half (51%) of deaths reviewed by the ERC required follow-up adjudication; consensus was eventually always reached. CONCLUSION ERCs can successfully provide blinded, independent, and systematic determinations of underlying cause of death in HIV clinical trials. Committees should include those familiar with AIDS and non-AIDS-defining diseases and have processes for adjudicating differences of opinion. Training for local investigators and procedure manuals should emphasize obtaining maximum possible documentation and follow-up information on all trial deaths.
Collapse
Affiliation(s)
- Alan R Lifson
- University of Minnesota, Minneapolis, Minnesota 55454-1015, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
van der Lee MJ, Blenke AAM, Rongen GA, Verwey-van Wissen CPWGM, Koopmans PP, Pharo C, Burger DM. Interaction study of the combined use of paroxetine and fosamprenavir-ritonavir in healthy subjects. Antimicrob Agents Chemother 2007; 51:4098-104. [PMID: 17846135 PMCID: PMC2151442 DOI: 10.1128/aac.01243-06] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Human immunodeficiency virus-infected patients have an increased risk for depression. Despite the high potential for drug-drug interactions, limited data on the combined use of antidepressants and antiretrovirals are available. Theoretically, ritonavir-boosted protease inhibitors may inhibit CYP2D6-mediated metabolism of paroxetine. We wanted to determine the effect of fosamprenavir-ritonavir on paroxetine pharmacokinetics and vice versa and to evaluate the safety of the combination. Group A started with 20 mg paroxetine every day for 10 days; after a wash-out period of 16 days, subjects received paroxetine (20 mg every day) plus fosamprenavir-ritonavir (700/100 mg twice a day) from days 28 to 37. Group B received the regimens in reverse order. On days 10 and 37, pharmacokinetic curves were recorded. Twenty-six healthy subjects (18 females, 8 males) were included. Median (range) age and weight were 44.4 (18.2 to 64.3) years and 68.8 (51.0 to 89.4) kg. Three subjects were excluded (two because of adverse events; one for nonadherence). Addition of fosamprenavir-ritonavir to paroxetine resulted in a significant decrease in paroxetine exposure: the geometric mean ratios (90% confidence intervals) of paroxetine plus fosamprenavir-ritonavir to paroxetine alone were 0.45 (0.41 to 0.49) for the area under the concentration-time curve from 0 to 24 h (AUC(0-24)), 0.49 (0.45 to 0.53) for the maximum concentration of the drug in plasma (C(max)), and 0.75 (0.71 to 0.80) for the apparent elimination half-life (t(1/2)). The free fraction of paroxetine showed a median (interquartile range) increase of 30% (18 to 42%) after the addition of fosamprenavir-ritonavir. The AUC(0-12), C(max), C(min), and t(1/2) of amprenavir and ritonavir were similar to those of historical controls. No serious adverse events occurred. Fosamprenavir-ritonavir reduced total paroxetine exposure by 55%. This is partly explained by protein displacement of paroxetine. We think that this interaction is clinically relevant and that titration to a higher dose of paroxetine may be necessary to accomplish the needed antidepressant effect.
Collapse
Affiliation(s)
- Manon J van der Lee
- Department of Clinical Pharmacy, Radboud University Medical Centre Nijmegen, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
41
|
Basu S, Bruce RD, Barry DT, Altice FL. Pharmacological pain control for human immunodeficiency virus-infected adults with a history of drug dependence. J Subst Abuse Treat 2007; 32:399-409. [PMID: 17481463 PMCID: PMC2128698 DOI: 10.1016/j.jsat.2006.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 10/09/2006] [Accepted: 10/24/2006] [Indexed: 12/01/2022]
Abstract
Clinicians treating human immunodeficiency virus (HIV)-infected patients with substance use disorders often face the challenge of managing patients' acute or chronic pain conditions while keeping in mind the potential dangers of prescription opiate dependence. In this clinical review, we critically appraise the existing data concerning barriers to appropriate treatment of pain among HIV-infected patients with substance use disorders. We then analyze published studies concerning the choice of pharmacological pain control regimens for acute and chronic pain conditions in HIV-infected patients, keeping in mind HIV-specific issues related to drug interactions and substance use disorders. We summarize this information in the form of flowcharts for physicians approaching HIV-infected patients who present with complaints of pain, providing evidence-based guidance for the structuring of pain management services and for addressing aberrant drug-taking behaviors.
Collapse
Affiliation(s)
- Sanjay Basu
- Yale University AIDS Program, Yale University School of Medicine, New Haven, CT 06511, USA
| | | | | | | |
Collapse
|
42
|
Abstract
HIV/AIDS and chemical dependency, the latter often intertwined with mental illness, are complex, overlapping spheres that adversely influence each other and the overall clinical outcomes of the affected individual. Each disorder individually impact tens of millions of people adversely, with explosive epidemics described worldwide. This article addresses the adverse consequences of HIV/AIDS, drug injection, the secondary comorbidities of both, and the impact of immunosuppression on presentation of disease as well as approaches to managing the HIV-infected drug user.
Collapse
Affiliation(s)
- R. Douglas Bruce
- Yale University AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510, USA
| | - Frederick L. Altice
- Yale University AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510, USA
| |
Collapse
|
43
|
Dalessandro M, Conti CM, Gambi F, Falasca K, Doyle R, Conti P, Caciagli F, Fulcheri M, Vecchiet J. Antidepressant therapy can improve adherence to antiretroviral regimens among HIV-infected and depressed patients. J Clin Psychopharmacol 2007; 27:58-61. [PMID: 17224714 DOI: 10.1097/jcp.0b013e31802f0dd1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several strategies have been introduced to manage nonadherence to highly active antiretroviral therapy (HAART). Treatment with antidepressants may improve self-reported adherence. In this brief report, a small sample of HIV-depressed patients (n = 9) were treated for a 6-month period with antidepressants improving self-reported adherence based on the HAART scale (poor, good, satisfactory, and optimal). Before the antidepressant treatment, adherence was reported as "good" by 3 patients and "satisfactory" by 6 patients. After antidepressant therapy, adherence to antiretroviral regimes was statistically higher in HIV-depressed on treatment than in HIV-depressed patients not treated with antidepressants (P < 0.0001). We used chi2 test with a significance level at P < 0.05. Treating depression in HIV-infected patients may serve to improve adherence to HAART.
Collapse
|