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Li X, Liu Y, Han J, Lin K, Bai X, Lu F. Trajectories of depressive symptoms in young and middle-aged men who have sex with men with new HIV-diagnosis: a 1-year prospective cohort study in Beijing, China. Front Public Health 2023; 11:1244624. [PMID: 37915822 PMCID: PMC10616961 DOI: 10.3389/fpubh.2023.1244624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Due to the sexual orientation and HIV diagnosis, young and middle-aged men who have sex with men (MSM) with new HIV-diagnosis may experience more depressive syndromes and face greater psychological stress. The study explored trajectories of depressive symptoms of young and middle-aged MSM within 1 year after new HIV-diagnosis and analyze the related factors. Methods From January 2021 to March 2021, 372 young and middle-aged MSM who were newly diagnosed as HIV-infection were recruited in two hospitals in Beijing. Self-rating Depression Scale was used to measure the participants' depressive symptom in 1st month, 3rd month, 6th month, 9th month and 12th month after HIV diagnosis. The latent class growth model was used to identify trajectories of the participants' depressive symptoms. Multinomial logistic regression was used to analyse factors related with the trajectories. Results Three hundred and twenty-eight young and middle-aged MSM with new HIV-diagnosis completed the research. Depressive symptom in 328 young and middle-aged MSM was divided into three latent categories: non-depression group (56.4%), chronic-mild depression group (28.1%), and persistent moderate-severe depression group (15.5%). The participants assessed as non-depression (non-depression group) or mild depression (chronic-mild depression group) at the baseline were in a non-depression state or had a downward trend within one-year, and the participants assessed as moderate and severe depression (persistent moderate-severe depression group) at the time of diagnosis were in a depression state continuously within 1-year. Multinomial logistic regression analysis showed that, compared with the non-depression group, monthly income of 5,000 ~ 10,000 RMB (equal to 690 ~ 1,380 USD) was the risk factor for the chronic-mild depression group, and self-rating status being fair/good and self-disclosure of HIV infection were protective factors for the persistent moderate-severe depression group while HIV-related symptoms was the risk factor. Conclusion Depressive symptoms in young and middle-aged MSM is divided into three latent categories. Extra care must be given to young and middle-aged MSM assessed as moderate or severe depression at the time of HIV-diagnosis, especially to those who had poor self-rating health status, did not tell others about their HIV-infection and experienced HIV-related symptoms.
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Affiliation(s)
- Xiao Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Yu Liu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Han
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Keke Lin
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoyan Bai
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Fengling Lu
- School of Medicine, Qingdao Huanghai University, Qingdao, China
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Marcus R, Tie Y, Dasgupta S, Beer L, Padilla M, Fagan J, Prejean J. Characteristics of Adults With Diagnosed HIV Who Experienced Housing Instability: Findings From the Centers for Disease Control and Prevention Medical Monitoring Project, United States, 2018. J Assoc Nurses AIDS Care 2022; 33:283-294. [PMID: 34812797 PMCID: PMC9124455 DOI: 10.1097/jnc.0000000000000314] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT People living with HIV (PLWH) who experience homelessness have poorer clinical outcomes than people with HIV who are not homeless; however, there is limited information on PLWH who experience other forms of housing instability. We used interviews and medical record abstraction data from the Medical Monitoring Project, collected 2018-2019 (N = 4,050), to describe sociodemographic characteristics and clinical outcomes of adults with HIV by whether people experienced unstable housing in the past 12 months. Overall, 21% were unstably housed, of which 55.2% were unstably housed but not homeless. People who were unstably housed were more likely to be younger, have lower educational attainment, be previously incarcerated, live at or below the poverty level, and have poorer mental health and clinical outcomes, independent of homelessness. Interventions to address housing instability, integrated with clinical care, could benefit not just PLWH who are homeless but also those who are unstably housed.
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Affiliation(s)
- Ruthanne Marcus
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, National Center for HIV/ AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yunfeng Tie
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, National Center for HIV/ AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharoda Dasgupta
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, National Center for HIV/ AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Linda Beer
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, National Center for HIV/ AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mabel Padilla
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, National Center for HIV/ AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Fagan
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, National Center for HIV/ AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joseph Prejean
- Behavioral and Clinical Surveillance Branch, Division of HIV Prevention, National Center for HIV/ AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Wise JM, Azuero A, Konkle-Parker D, Raper JL, Heaton K, Vance DE, Adimora AA, Wingood G, Golub E, Levin S, Wilson TE, Merenstein D, Yelin E, Weber KM, Fischl M, Kempf MC. Socioeconomic, Psychosocial, and Clinical Factors Associated With Employment in Women With HIV in the United States: A Correlational Study. J Assoc Nurses AIDS Care 2022; 33:33-44. [PMID: 34939986 PMCID: PMC8944186 DOI: 10.1097/jnc.0000000000000297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
ABSTRACT Employment is a social determinant of health, and women living with HIV (WLWH) are often underemployed. This correlational study examined the socioeconomic, psychosocial, and clinical factors associated with employment among WLWH (n = 1,357) and women at risk for HIV (n = 560). Descriptive and inferential statistics were used to evaluate factors associated with employment status. Employment was associated (p ≤ .05) with better socioeconomic status and quality of life (QOL), less tobacco and substance use, and better physical, psychological, and cognitive health. Among WLWH, employment was associated (p ≤ .05) with improved adherence to HIV care visits and HIV RNA viral suppression. Using multivariable regression modeling, differences were found between WLWH and women at risk for HIV. Among WLWH, household income, QOL, education, and time providing childcare remained associated with employment in adjusted multivariable analyses (R2 = .272, p < .001). A better understanding of the psychosocial and structural factors affecting employment is needed to reduce occupational disparities among WLWH.
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Affiliation(s)
- Jenni M. Wise
- Department of Family, Community, and Health Systems, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andres Azuero
- Department of Family, Community, and Health Systems, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Departments of Medicine and Infectious Diseases, School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - James L. Raper
- Department of Infectious Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Karen Heaton
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David E. Vance
- Acute, Chronic, and Continuing Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adaora A. Adimora
- Departments of Medicine and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gina Wingood
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia, USA
| | - Elizabeth Golub
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Susanna Levin
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University, Washington, DC, USA
| | - Ed Yelin
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Margaret Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mirjam-Colette Kempf
- Department of Family, Community and Health Systems, Health Behavior, Infectious Diseases, and Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ripamonti E, Clerici M. Living With Chronic HIV Disease in the Antiretroviral Era: The Impact of Neurocognitive Impairment on Everyday Life Functions. TOPICS IN ANTIVIRAL MEDICINE 2021; 29:386-396. [PMID: 34370420 PMCID: PMC8384087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
Although there is extensive literature around the biologic correlations of neurocognitive function in HIV/AIDS, less is known about the impact in everyday living. We conducted a systematic review of the association of neurocognitive impairment with everyday life functions in people with HIV on antiretroviral therapy. We specifically focused on attention, executive function, processing speed, and the central executive component of the working memory. We considered 3 domains of everyday functions: (1) autonomy, (2) decision making and adherence to treatment, and (3) quality of life and psychologic wellbeing. The relationship between neurocognitive impairment and mental health was examined, given its correlation with everyday life functions. Results indicate that people with HIV do experience problems with autonomy of daily living (especially if aged older than 50 years) and with decision making, and neurocognitive impairment plays a role in this regard. Psychologic wellbeing is associated with executive function and processing speed. These patients may also have a reduced quality of life, but the relationship between quality of life and cognition is uncertain or could be mediated by other factors. Neurocognitive impairment correlates with depression and anxiety; however, the relationship of cognitive performance with apathy is still controversial.
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Affiliation(s)
- Enrico Ripamonti
- Send correspondence to Enrico Ripamonti, Milan Center for Neuroscience NeuroMI, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milano, Italy, or email
| | - Mario Clerici
- Head of the Department of Pathophysiology and Transplantation at the University of Milan in Italy
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Ware D, Rueda S, Plankey M, Surkan P, Okafor CN, Teplin L, Friedman MR. The longitudinal impact of employment, retirement and disability status on depressive symptoms among men living with HIV in the Multicenter AIDS Cohort Study. PLoS One 2020; 15:e0239291. [PMID: 33007781 PMCID: PMC7532049 DOI: 10.1371/journal.pone.0239291] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/02/2020] [Indexed: 01/21/2023] Open
Abstract
Many persons living with HIV (PLWH) either reduced their employment capacity or stopped work completely due to disease progression. With the advent of effective antiretroviral therapy, some PLWH were able to return to the workforce and many are now transitioning into retirement. We examined the histories of employment, retirement and disability status on depression among 1,497 Participants living with HIV from 1997 to 2015 in the Multicenter AIDS Cohort Study. Data were collected on depressive symptoms, employment, retirement, disability status as well as HIV-related and sociodemographic characteristics. Employment, retirement and disability status were lagged 2 years to assess whether the risk of depression at a given observation were temporally predicted by each respective status, adjusting for prior depressive symptoms and covariates. Being employed (aOR: 0.76; 95% CI: 0.71-0.82) had lower odds of depression risk two years later compared to those unemployed. There were higher odds of depression risk associated with disability (aOR: 1.43; 95% CI: 1.32-1.54) versus those not on disability. Retirement status was not associated with the risk of depressive symptoms. These findings could help inform policies and employment programs to facilitate the return to work for PLWH who are willing and able to work.
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Affiliation(s)
- Deanna Ware
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, United States of America
| | - Sergio Rueda
- Department of Psychiatry, Institute of Medical Science, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Michael Plankey
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, United States of America
| | - Pamela Surkan
- Johns Hopkins Bloomberg School of Public Health, John Hopkins University, Baltimore, Maryland, United States of America
| | - Chukwuemeka N. Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, United States of America
| | - Linda Teplin
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - M. Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Abstract
Employment is a social determinant of health that is important for understanding health behaviors, health outcomes and HIV transmission among people living with HIV. This study is a scoping review of the literature that addresses (a) the relationship between employment and the HIV continuum of care, (b) determinants of employment among PLWH and (c) experiences with employment. We searched two databases, PubMed and Embase, and identified a total of 5622 articles that were subjected to title and abstract review. Of these, 5387 were excluded, leaving 235 articles for full-text review. A total of 66 articles met inclusion criteria and were included in the study. The literature suggests that employment status is positively associated with HIV testing, linkage to HIV care, retention in HIV care, and HIV medication adherence. Guided by a social-ecological framework, we identified determinants of employment at the individual, interpersonal, organizational, community, and policy levels that are amenable to public health intervention. Experiences with employment, including barriers, facilitators, advantages, disadvantages, and needs, provide additional insight for future research and programs.
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Affiliation(s)
- Catherine H Maulsby
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Rm. 904C, Baltimore, MD, 21205, USA.
| | - Aneeka Ratnayake
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Donna Hesson
- Welch Medical Library, Johns Hopkins University, Baltimore, MD, USA
| | | | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Vivre et travailler avec une maladie chronique : différences et condition commune. ARCH MAL PROF ENVIRO 2019. [DOI: 10.1016/j.admp.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kordovski VM, Woods SP, Verduzco M, Beltran J. The effects of aging and HIV disease on employment status and functioning. Rehabil Psychol 2018; 62:591-599. [PMID: 29265874 DOI: 10.1037/rep0000175] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE As the prevalence of older adults living with HIV disease increases, questions are emerging regarding the extent to which older age amplifies the adverse effects of HIV on employment status and functioning. This cross-sectional study sought to (1) investigate the combined effects of HIV and older age on employment status, (2) identify clinicodemographic correlates of employment status among older HIV+ persons, and (3) examine the combined effects of HIV and age on workplace performance among employed participants. METHOD The sample was 358 HIV+ (163 older, 195 younger) and 193 HIV- (94 older, 99 younger) adults, who completed a comprehensive neurocognitive research assessment that included measures of employment status and current workplace functioning. RESULTS We observed main effects of HIV and age on employment status, but no interaction. The older HIV+ sample demonstrated particularly high rates of disability, rather than elective retirement or unemployment. Among older HIV+ adults significant predictors of employment status included age, global neurocognitive functioning, combination antiretroviral therapy status, age at HIV infection, and hepatitis C coinfection. Finally, self-reported work functioning of older HIV+ adults differed only from the younger HIV- group. CONCLUSION Findings suggest that older age and HIV disease have additive adverse effects on employment status, but not work functioning, and that employment status is associated with both neurocognitive and medical risk factors among older HIV+ adults. Further longitudinal research is needed to elucidate specific disease and demographic characteristics that may operate as protective factors for retaining gainful employment among older HIV+ adults. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Jessica Beltran
- Department of Psychiatry, University of California, San Diego
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Peña Longobardo LM, Oliva-Moreno J. Differences in labour participation between people living with HIV and the general population: Results from Spain along the business cycle. PLoS One 2018; 13:e0195735. [PMID: 29684076 PMCID: PMC5912724 DOI: 10.1371/journal.pone.0195735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 03/28/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV/AIDS (Human immunodeficiency virus/Acquired immune deficiency syndrome) not only has a strong impact on the health of the worldwide population but also affects the labour status of HIV-positive people. The primary aim of this paper is to compare the labour participation of people living with HIV (PlwHIV) with the labour participation of the general population along the last business cycle in Spain. METHOD The data used are from the Hospital Survey on HIV-AIDS, with a total sample size of 4,651 PlwHIV and the Labour Force Survey from 2001 to 2010, with a total sample size of 660,674 individuals as general population. Propensity Score Matching method was used to analyse the differences between the labour participation of PlwHIV and the general population. Additionally, several specific models categorised into different subgroups (gender, education, source of infection and level of defences) were also performed. RESULTS We identified a convergence in labour participation across the period in the two populations considered: PlwHIV was 23% less likely to have a job than the general population during 2001-2002 and 14% less likely during 2009-2010. This convergence is mainly explained by two facts: first, the positive evolution of people infected by sex; second, the change in the PlwHIV population composition with a decreasing weight of people infected by drug use throughout the decade. Thereby, at the end of period, there was no statistical difference in the employment rate between PlwHIV infected through sex and the general population but there was strongly difference in PlwHIV infected through drugs. CONCLUSION Inmunological status, source of infection and level of education play a relevant role among the PlwHIV population when comparing their labour participation with the general population. In spite of this positive result, the likelihood of being employed in HIV-positive people continues to be different from that of non-carriers. Our study shows that institutional features of labour markets are relevant and should be considered in comparison between countries.
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Affiliation(s)
- Luz María Peña Longobardo
- Department of Economic Analysis and Finance, Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Juan Oliva-Moreno
- Department of Economic Analysis and Finance, Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain
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Verbooy K, Wagener M, Kaddouri M, Roelofs P, Miedema H, van Gorp E, Brouwer W, van Exel J. Are people living with HIV less productive at work? AIDS Care 2018. [PMID: 29517931 DOI: 10.1080/09540121.2018.1447076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Health problems may cause decreased productivity among working people. It is unclear if this also applies for people living with HIV (PLWH). This cross-sectional study compares data of PLWH of one of the main HIV treatment centres in the Netherlands (n = 298) to data of the general working population from a previously conducted study (n = 986). We investigate whether productivity at work differs between these groups. The questionnaires used in these studies contained a core of identical questions regarding productivity losses, in the form of absenteeism and presenteeism, over a four-week period and a variety of baseline characteristics, including health status measured with EQ-5D. For PLWH additional clinical data were collected from patient records. From the data, descriptive statistics were computed to characterize the samples. Pearson correlations were used to explore significant associations of productivity with baseline characteristics. A two-part model was used to evaluate both the occurrence and of size of productivity losses in working PLWH and an aggregated sample of PLWH and the general population. It was observed that, on average, total productivity losses do not differ significantly between working PWLH and the general working population, but that the occurrence and size of absenteeism and presenteeism were different. Furthermore, more health problems were associated with higher productivity losses. HIV status was not significantly associated with productivity losses. We conclude that among working people, health status was related to productivity losses but HIV status was not. However, further research is needed into the relation between HIV status and unemployment.
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Affiliation(s)
- Kaya Verbooy
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands
| | - Marlies Wagener
- b Centre of Expertise Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , the Netherlands.,c Department of Viroscience , Erasmus Medical Centre Rotterdam , Rotterdam , the Netherlands
| | - Meriam Kaddouri
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands
| | - Pepijn Roelofs
- b Centre of Expertise Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , the Netherlands
| | - Harald Miedema
- b Centre of Expertise Innovations in Care , Rotterdam University of Applied Sciences , Rotterdam , the Netherlands
| | - Eric van Gorp
- c Department of Viroscience , Erasmus Medical Centre Rotterdam , Rotterdam , the Netherlands.,d Department of Internal Medicine , Erasmus Medical Centre Rotterdam , Rotterdam , the Netherlands
| | - Werner Brouwer
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands
| | - Job van Exel
- a Institute of Health Policy and Management , Erasmus University Rotterdam , Rotterdam , the Netherlands.,e Erasmus School of Economics , Erasmus University Rotterdam , Rotterdam , the Netherlands
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Impact of protease inhibitors on circulating PCSK9 levels in HIV-infected antiretroviral-naive patients from an ongoing prospective cohort. AIDS 2017; 31:2367-2376. [PMID: 28857822 DOI: 10.1097/qad.0000000000001633] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The study aims to assess the association between proprotein convertase subtilisin/kexin type 9 (PCSK9), a major regulator of LDL cholesterol (LDL-C) homeostasis, and HIV-related dyslipidaemia in a cohort of HIV-positive (HIV+) patients under protease inhibitors. METHODS Plasma PCSK9 levels were measured in 103 HIV+ patients before and after initiating protease inhibitor-based antiretroviral therapy (ART), and in 90 HIV-negative controls matched for age and sex. PCSK9 was measured by ELISA. HIV+ patients who were not virologically suppressed at follow-up or were on lipid-lowering therapy were excluded. RESULTS In HIV+ (median age 36 years; 77.7% men), PCSK9 levels did not increase after protease inhibitor exposure (median 14 months) (279.5 ng/ml before, 289.6 ng/ml after; P = 0.49) and were significantly elevated versus controls at all timepoints (adjusted P value before and after: <0.05). After protease inhibitor initiation, total cholesterol, LDL-C and HDL cholesterol levels increased, but LDL-C remained lower versus controls. At baseline, PCSK9 levels were positively associated with immunodeficiency and the severity of HIV disease [HIV-1 viral load (P = 0.01), CD4 T-cell count <200/μl, P = 0.002], stage C HIV disease (P = 0.0002). In protease inhibitor-treated patients, PCSK9 levels were no longer associated with HIV-related factors but with total cholesterol (P = 0.0006), LDL-C (P = 0.01), HDL cholesterol (P = 0.01), triglycerides (P = 0.05) and glycaemia (P = 0.006). CONCLUSION PSCK9 levels are elevated in HIV+ patients. In ART-naive patients, the relationship between PCSK9 levels and infection severity suggests an effect of HIV disease. After initiating protease inhibitor-containing ART in virologically suppressed patients, PCSK9 levels were associated with dyslipidaemia similar to controls.
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Conyers LM, Richardson LA, Datti PA, Koch LC, Misrok M. A Critical Review of Health, Social, and Prevention Outcomes Associated With Employment for People Living With HIV. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:475-490. [PMID: 29068719 DOI: 10.1521/aeap.2017.29.5.475] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A growing need has emerged among HIV service providers, policymakers, and researchers to understand ways in which employment, as a key social determinant of health, can be leveraged toward improved health outcomes among people living with HIV (PLHIV) and the prevention of HIV transmission. This critical review summarizes and assesses current research related to (a) the employment needs and challenges among populations disproportionately impacted by HIV, (b) the relationship between employment and important health outcomes associated with the HIV Care Continuum, and (c) implications for policy, service provision, and future research. As a first step to deepening an understanding of these issues, this analysis identifies gaps in knowledge to underscore the need and direction for future research so that well-targeted interventions can be designed and evaluated and more responsive policies can be developed to address the public health implications of the vocational development and employment needs of PLHIV.
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Affiliation(s)
- Liza M Conyers
- Pennsylvania State University, University Park, Pennsylvania
| | | | | | | | - Mark Misrok
- National Working Positive Coalition, New York, New York
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Sub-Saharan African migrants have slower initial CD4+ cell recovery after combined antiretroviral treatment initiation than French natives. AIDS 2017; 31:1323-1332. [PMID: 28492394 DOI: 10.1097/qad.0000000000001482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Poorer immunologic responses to combined antiretroviral treatment (cART) have been reported among sub-Saharan African (SSA) migrants than among native Europeans. We studied whether differences in CD4 cell recovery between French natives and SSA migrants starting first-line cART could be explained by differences in socioeconomic conditions, inflammatory marker levels, and other established determinants. METHODS We compared 319 French natives and 175 SSA migrants (ANRS-COPANA cohort). Clinical, biological, and socioeconomic data (education, employment, income, and cohabiting partnership) were recorded at regular visits. A piecewise linear mixed-effects model was used to analyze CD4 cell count kinetics on cART. RESULTS Compared with French natives, SSA migrants were more frequently women, younger, less educated, living in more adverse conditions, and had more frequent symptoms of depression. The rate of CD4 cell recovery during the first 4 months on cART was significantly slower in SSA migrants, despite a similar virologic response, but did not differ significantly thereafter. The mean CD4 cell count rose from 251 cells/μl at baseline to 508 cells/μl at 36 months in migrants, and from 308 to 623 cells/μl in natives (additional mean gain of 58 cells/μl in natives). The difference persisted after adjustment for clinical, updated socioeconomic, and living conditions (-0.40√CD4 cells/month, P = 0.04); 25-hydroxyvitamin D, monocyte chemoattractant protein-1 and soluble tumor necrosis factor receptor 1 (sTNFR1) levels were lower in SSA migrants, but only sTNFR1 contributed to the difference in CD4 slope. CONCLUSION Initial CD4 cell recovery on cART was slower among SSA migrants than among French natives. This difference was not explained by established clinical and biological determinants or by socioeconomic status.
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Inequalities by educational level in response to combination antiretroviral treatment and survival in HIV-positive men and women in Europe. AIDS 2017; 31:253-262. [PMID: 27662557 DOI: 10.1097/qad.0000000000001270] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Socioeconomic inequality challenges population-level implementation of health interventions. We investigated differences by educational level in clinical, virological, and immunological responses to combined antiretroviral treatment (cART) in HIV-positive men and women in Collaboration of Observational HIV Epidemiological Research in Europe, a European collaboration. METHODS Data were pooled from 15 cohorts in eight countries of patients initiating cART in 1996-2013 with data on educational level categorized in UNESCO/ISCED classifications. Kaplan-Meier curves, Cox and piecewise linear mixed models were used. RESULTS Of 24 069 HIV-positive patients, 9% had not completed primary education, 32% had completed primary, 44% secondary, and 15% tertiary education. Overall, 21% were women, who were overrepresented in lower educational strata. During 132 507 person-years of follow-up, 1081 individuals died; cumulative mortality decreased with higher educational level (P < 0.001). Over 122 765 person-years, new AIDS events or death occurred in 2598 individuals; differences by education were more marked than for death alone (P < 0.001). Virological response was achieved by 67% of patients without completed basic education, 85% with completed primary education, 82% with secondary, and 87% with tertiary (P < 0.001). Patients with higher education had higher CD4 cell count at cART initiation and at each time after cART but rate of CD4 cell count recovery did not differ. Differences in mortality and clinical responses were similar for men and women and were not entirely explained by delayed HIV diagnosis and late cART initiation. CONCLUSION HIV-positive patients with lower educational level had worse responses to cART and survival in European countries with universal healthcare. To maximize the population impact of cART, Europe needs to decrease the socioeconomic divide.
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Annequin M, Lert F, Spire B, Dray-Spira R. Increase in Unemployment over the 2000's: Comparison between People Living with HIV and the French General Population. PLoS One 2016; 11:e0165634. [PMID: 27814374 PMCID: PMC5096670 DOI: 10.1371/journal.pone.0165634] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/14/2016] [Indexed: 12/13/2022] Open
Abstract
Background Despite improved health, unemployment has increased among people living with HIV (PlwHIV) over the last decade. However, since the economic recession of 2008, unemployment also increased in the French general population. This paper aimed to determine if the increase in the unemployment rate in the HIV population was higher than that in the French general population. Methods We used data from the ANRS-Vespa study, a repeated cross-sectional survey among two national representative samples of PlwHIV followed at hospitals in France in 2003 and 2011. We compared employment and unemployment rates between HIV-infected people (overall and according to period of HIV diagnosis) and the French general population in 2003 and 2011, using multivariate Poisson regressions adjusted for individual sociodemographic characteristics. Results The employment rate among PlwHIV was consistently lower than that in the general population in 2003 and 2011. In contrast, there was a trend of an increasing unemployment rate difference between PlwHIV and the general population: PlwHIV’s unemployment rate was 1.48 (95% confidence interval [CI]: 1.16–1.90) times higher than that of the general population in 2003, versus 1.62 (95% CI: 1.34–1.96) times higher in 2011. This unemployment rate difference was the highest for PlwHIV diagnosed in or after 2008 (adjusted prevalence rate ratio: 2.06; 95% CI: 1.59–2.67). Conclusions These results suggest that in time of economic recession, an increasing proportion of PlwHIV may be excluded from the labor market although they are willing to re-enter it. This constitutes a major issue relative to social consequences of chronic disease.
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Affiliation(s)
- Margot Annequin
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F75012, Paris, France
- * E-mail:
| | - France Lert
- INSERM, U1018, Center for Research in Epidemiology and Population Health, Villejuif, France
| | - Bruno Spire
- INSERM, UMR912, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Rosemary Dray-Spira
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, F75012, Paris, France
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Jacomet C, Berland P, Guiguet M, Simon A, Rey D, Arvieux C, Pugliese P, Gerbaud L. Impact of age on care pathways of people living with HIV followed up in hospital. AIDS Care 2016; 29:105-111. [PMID: 27334840 DOI: 10.1080/09540121.2016.1200712] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aging population of people living with human immunodeficiency virus (HIV) (PLWH) is exposed to a widening spectrum of non-AIDS-defining diseases. Thus, our objective was to compare the health care offered to PLWH according to age. We conducted a multicenter cross-sectional study on PLWH who consulted at one of 59 French HIV reference centers from 15th to 19th October 2012. Using our survey questionnaires, PLWH self-reported the medical care they received, whether or not tied to HIV infection monitoring, during the previous year. A total of 650 PLWH participated in the survey (median age 48 years, Interquartile range (IQR) 40-54), of which 95 were aged 60 years or over (14.5%). Compared to younger PLWH, 60-and-over PLWH were more often under complementary health insurance cover and less socially deprived based on the French EPICES (Evaluation of Precarity and Inequalities in Health Examination Centers) score. The elderly PLWH presented more comorbidities and less coinfections with hepatitis viruses. During health care, therapeutic education was less often offered to older PLWH (14% vs. 26%, p = .01), but this difference was mainly explained by sociodemographic factors and clinical status. Over the previous 6 months, 74% of PLWH who were followed up in hospital had also consulted another doctor, with a mean of 3.75 consultations (±4.18) without difference between age groups. After adjustment for sociodemographic factors and comorbidities, PLWH over 60 years were more likely to have consulted medical specialists as outpatients in the last 6 months (odds ratio [OR] = 2.63 [1.11-6.20]). Whatever their age, 13% of PLWH had been refused care on disclosure of their HIV status, and 27% of PLWH still did not disclose their HIV status to some caregivers. Coordinated health care throughout patients' lives is crucial, as health-care pathways evolve toward outpatient care as the patients get older.
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Affiliation(s)
- Christine Jacomet
- a Infectious Diseases Department , Clermont-Ferrand University Hospital , Clermont Ferrand , France
| | - Pauline Berland
- b Clermont-Ferrand University Hospital, EA 4681 PEPRADE, University of Auvergne , Clermont Ferrand , France
| | - Marguerite Guiguet
- c INSERM & Sorbonne Universities, UPMC , Univ. Paris 06, UMRS 1136, Paris , France
| | - Anne Simon
- d Internal Medicine Department , Pitié-Salpêtrière University Hospital , Paris , France
| | - David Rey
- e Center for HIV Care, Strasbourg University Hospital , Strasbourg , France
| | - Cédric Arvieux
- f Infectious Diseases and Emergency Unit , Rennes University Hospital , Rennes , France
| | - Pascal Pugliese
- g Infectious Diseases Unit , Nice University Hospital , Nice , France
| | - Laurent Gerbaud
- b Clermont-Ferrand University Hospital, EA 4681 PEPRADE, University of Auvergne , Clermont Ferrand , France
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Möller LM, Brands R, Sluiter JK, Schouten J, Wit FW, Reiss P, Prins M, Stolte IG. Prevalence and determinants of insufficient work ability in older HIV-positive and HIV-negative workers. Int Arch Occup Environ Health 2016; 89:699-709. [PMID: 26747456 PMCID: PMC4828476 DOI: 10.1007/s00420-015-1108-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 12/14/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE To explore whether the prevalence and determinants of insufficient work ability (WA) of older HIV-positive workers differ from a comparable group of HIV-negative workers. METHODS Cross-sectional data from 359 HIV-negative and 264 HIV-positive middle-aged individuals (45-65 years) participating in paid labor, collected within the AGEhIV Cohort Study between October 2010-September 2012, were selected. Data were collected by self-administered questionnaires and physical examination. Participants self-rated their current WA, ranging from 0 to 10. WA was dichotomized into insufficient (<6) and sufficient (≥6). Using univariable and multivariable logistic regression, we studied the independent effect of HIV status on insufficient WA and determinants of insufficient WA. RESULTS Overall, 8% of participants reported insufficient WA (HIV-positive 9 vs. HIV-negative 7%, P = 0.20). Twice as many HIV-positive as HIV-negative individuals were declared partly unfit for work (6 vs. 3%, P = 0.02). HIV status itself was not associated with WA in univariable and multivariable analyses. Multivariable analyses revealed that low educational level, working fewer hours, being partly unfit for work, experiencing a high need for recovery after work, staying home from work ≥2 times in the past 6 months, and reporting depressive symptoms were associated with insufficient WA, independent of HIV status. CONCLUSIONS HIV-positive individuals aged 45-65 years participating in paid labor seem to function as well at work as HIV-negative individuals. HIV-positive participants were more often formally declared partly unfit for work, but percentages were low in both groups. Knowledge of determinants of insufficient WA may help employers and professionals to optimize WA.
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Affiliation(s)
- Lisanne M Möller
- Cluster Infectious Diseases, Department of Research, Public Health Service, Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
| | - Ronald Brands
- Dutch HIV Association, Amsterdam, The Netherlands
- STI AIDS, Amsterdam, The Netherlands
| | - Judith K Sluiter
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Judith Schouten
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ferdinand W Wit
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands
| | - Peter Reiss
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands
- HIV Monitoring Foundation, Amsterdam, The Netherlands
| | - Maria Prins
- Cluster Infectious Diseases, Department of Research, Public Health Service, Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands.
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands.
| | - Ineke G Stolte
- Cluster Infectious Diseases, Department of Research, Public Health Service, Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands
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Abstract
This study documented the outcomes of 108 HIV-positive persons receiving vocational rehabilitation services. Over a 12-month follow-up, participants reported significantly decreased odds of any unstable housing [Adjusted Odds Ratio (AOR) = 0.21; 95 % CI 0.05-0.90; p < .05] and increased odds of being employed at least part-time (AOR = 10.19; 95 % CI 2.40-43.21; p < .01). However, reductions in perceived barriers to employment and increases in income were more pronounced among those not receiving disability benefits at baseline. This was consistent with findings from baseline qualitative interviews with 22 participants where those not on disability were subject to bureaucratic hurdles to rapidly accessing benefits and anticipated stigma of being on disability that propelled them to rejoin the workforce. Vocational rehabilitation could address key structural barriers to optimizing HIV treatment as prevention, and novel approaches are needed to improve outcomes among individuals receiving disability benefits.
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Elzi L, Conen A, Patzen A, Fehr J, Cavassini M, Calmy A, Schmid P, Bernasconi E, Furrer H, Battegay M. Ability to Work and Employment Rates in Human Immunodeficiency Virus (HIV)-1-Infected Individuals Receiving Combination Antiretroviral Therapy: The Swiss HIV Cohort Study. Open Forum Infect Dis 2016; 3:ofw022. [PMID: 26955645 PMCID: PMC4777901 DOI: 10.1093/ofid/ofw022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/28/2016] [Indexed: 11/13/2022] Open
Abstract
Background. Limited data exist on human immunodeficiency virus (HIV)-infected individuals' ability to work after receiving combination antiretroviral therapy (cART). We aimed to investigate predictors of regaining full ability to work at 1 year after starting cART. Methods. Antiretroviral-naive HIV-infected individuals <60 years who started cART from January 1998 through December 2012 within the framework of the Swiss HIV Cohort Study were analyzed. Inability to work was defined as a medical judgment of the patient's ability to work as 0%. Results. Of 5800 subjects, 4382 (75.6%) were fully able to work, 471 (8.1%) able to work part time, and 947 (16.3%) were unable to work at baseline. Of the 947 patients unable to work, 439 (46.3%) were able to work either full time or part time at 1 year of treatment. Predictors of recovering full ability to work were non-white ethnicity (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.20-3.54), higher education (OR, 4.03; 95% CI, 2.47-7.48), and achieving HIV-ribonucleic acid <50 copies/mL (OR, 1.83; 95% CI, 1.20-2.80). Older age (OR, 0.55; 95% CI, .42-.72, per 10 years older) and psychiatric disorders (OR, 0.24; 95% CI, .13-.47) were associated with lower odds of ability to work. Recovering full ability to work at 1 year increased from 24.0% in 1998-2001 to 41.2% in 2009-2012, but the employment rates did not increase. Conclusions. Regaining full ability to work depends primarily on achieving viral suppression, absence of psychiatric comorbidity, and favorable psychosocial factors. The discrepancy between patients' ability to work and employment rates indicates barriers to reintegration of persons infected with HIV.
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Affiliation(s)
- Luigia Elzi
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research , University Hospital Basel
| | - Anna Conen
- Division of Infectious Diseases , Cantonal Hospital Aarau
| | - Annalea Patzen
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research , University Hospital Basel
| | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology , University Hospital Zurich
| | - Matthias Cavassini
- Infectious Diseases Service, University Hospital and University of Lausanne
| | - Alexandra Calmy
- Division of Infectious Diseases , University Hospital Geneva
| | - Patrick Schmid
- Division of Infectious Diseases , Cantonal Hospital , St. Gallen
| | - Enos Bernasconi
- Division of Infectious Diseases , Regional Hospital , Lugano
| | - Hansjakob Furrer
- Department of Infectious Diseases , University Hospital Bern and University of Bern , Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research , University Hospital Basel
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Abstract
OBJECTIVES In a context marked by major changes in the field of HIV and in the general socioeconomic context, this study aimed at investigating changes in the employment situation of people living with HIV (PLWHIV) in France since the early 2000s. DESIGN Repeated cross-sectional survey among two nationally representative samples of PLWHIV followed at hospital in France in 2003 (N = 2932) and 2011 (N = 3022). METHODS Differences between 2003 and 2011 in (1) rates of employment, unemployment, and inactivity and (2) rates of work cessation and access to work following HIV diagnosis were measured using two-step multivariate Poisson regression models adjusted for individual sociodemographic determinants of position on the labor market, and then additionally for health status characteristics. RESULTS Overall, among working-age PLWHIV 60.9% in 2003 and 59.6% in 2011 were employed; 12.6 and 15.8%, respectively, were unemployed; and 26.5 and 24.6%, respectively, were inactive. Adjusting for sociodemographic determinants of position on the labor market, while employment rate was not different in 2011 compared with 2003, inactivity rate significantly decreased (adjusted prevalence rate ratio: 0.83, 95% confidence interval: [0.72-0.96]) and unemployment rate significantly increased (1.28 [1.04-1.57]). After additional adjustment for health status characteristics, the difference was no longer significant for inactivity (0.89 [0.77-1.03]) but remained significant for unemployment (1.55 [1.24-1.93]). Compared with 2003, in 2011 transitions to unemployment following HIV diagnosis tended to be more frequent (1.58 [0.92-2.68]) and access to work was significantly less frequent (0.57 [0.33-0.99]). CONCLUSION Improvements in HIV care have not translated into improvements in PLWHIV's situation regarding employment.
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Masten J. "A Shrinking Kind of Life": Gay Men's Experience of Aging With HIV. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2015; 58:319-337. [PMID: 25590461 DOI: 10.1080/01634372.2015.1005786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
More people are living with HIV into midlife and older age. Although increased longevity brings new hope, it also raises unanticipated challenges--especially for gay men who never thought they would live into middle and older age. Middle-aged and older people are more likely to face multiple comorbidities, yet many lack the necessary supports to help them adapt to the challenges of aging with HIV. This article presents the findings of a qualitative study developed to explore gay men's experience of aging with HIV. Multiple in-depth exploratory interviews were conducted with 15 gay-identified men living with HIV/AIDS over an 18-month period. A systematic strategy data analysis consistent with grounded theory revealed a pattern of subtle adjustments to living with HIV that resulted in diminishing circles of social support and social involvement. This dynamic is referred to as "a shrinking kind of life," an in-vivo code built from the participant's own words. Four themes from the research (physical challenges, a magnitude of loss, internal changes, & stigma) are discussed. Conclusions include recommendations for future research and implications for practice in the field. Practitioners knowledgeable of the factors that impact their social involvement can empower gay men through individual and group interventions to confront a shrinking kind of life and define for themselves what it means to optimally age with HIV.
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Affiliation(s)
- James Masten
- a Action for HIV and Aging (AHA Project) , New York , New York , USA
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Edmiston N, Passmore E, Smith DJ, Petoumenos K. Multimorbidity among people with HIV in regional New South Wales, Australia. Sex Health 2015; 12:425-32. [PMID: 26144504 DOI: 10.1071/sh14070] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/28/2015] [Indexed: 01/16/2023]
Abstract
UNLABELLED Background Multimorbidity is the co-occurrence of more than one chronic health condition in addition to HIV. Higher multimorbidity increases mortality, complexity of care and healthcare costs while decreasing quality of life. The prevalence of and factors associated with multimorbidity among HIV positive patients attending a regional sexual health service are described. METHODS A record review of all HIV positive patients attending the service between 1 July 2011 and 30 June 2012 was conducted. Two medical officers reviewed records for chronic health conditions and to rate multimorbidity using the Cumulative Illness Rating Scale (CIRS). Univariate and multivariate linear regression analyses were used to determine factors associated with a higher CIRS score. RESULTS One hundred and eighty-nine individuals were included in the study; the mean age was 51.8 years and 92.6% were men. One-quarter (25.4%) had ever been diagnosed with AIDS. Multimorbidity was extremely common, with 54.5% of individuals having two or more chronic health conditions in addition to HIV; the most common being a mental health diagnosis, followed by vascular disease. In multivariate analysis, older age, having ever been diagnosed with AIDS and being on an antiretroviral regimen other than two nucleosides and a non-nucleoside reverse transcriptase inhibitor or protease inhibitor were associated with a higher CIRS score. CONCLUSION To the best of our knowledge, this is the first study looking at associations with multimorbidity in the Australian setting. Care models for HIV positive patients should include assessing and managing multimorbidity, particularly in older people and those that have ever been diagnosed with AIDS.
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Affiliation(s)
- Natalie Edmiston
- Lismore Sexual Health Service, North Coast Public Health, 4 Shepherd Lane, Lismore, NSW 2480, Australia
| | - Erin Passmore
- NSW Ministry of Health, 73 Miller Street, North Sydney, NSW 2060, Australia
| | - David J Smith
- Lismore Sexual Health Service, North Coast Public Health, 4 Shepherd Lane, Lismore, NSW 2480, Australia
| | - Kathy Petoumenos
- Kirby Institute for Infection and Immunity in Society, UNSW Australia, Sydney, NSW 2052, Australia
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Quinlivan EB, Fletcher J, Eastwood EA, Blank AE, Verdecias N, Roytburd K. Health status of HIV-infected women entering care: baseline medical findings from the women of color initiative. AIDS Patient Care STDS 2015; 29 Suppl 1:S11-9. [PMID: 25561306 PMCID: PMC4283073 DOI: 10.1089/apc.2014.0277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The WOC Initiative is a prospective study of 921 women of color (WOC) entering HIV care at nine (three rural, six urban) sites across the US. A baseline interview was performed that included self-reported limitation(s) in activity, health conditions, and the CDC's health-related quality of life measures (Healthy Days). One-third of the WOC reported limiting an activity because of illness or a health condition and those with an activity limitation reported 13 physically and 14 mentally unhealthy days/month, compared with 5 physically and 9 mentally unhealthy days/month in the absence of an activity limitation. Age was associated with a three- to fourfold increased risk of an activity limitation but only for WOC in the urban sites. Diabetes was associated with a threefold increased risk of a limitation among women at rural sites. Cardiac disease was associated with a six- to sevenfold increased risk of an activity limitation for both urban and rural WOC. HIV+ WOC reported more physically and mentally unhealthy days than the general US female population even without an activity limitation. Prevention and treatment of diabetes and cardiovascular disease will need to be a standard part of HIV care to promote the long-term health and HRQOL for HIV-infected WOC.
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Affiliation(s)
- E Byrd Quinlivan
- 1 Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
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Tron L, Lert F, Spire B, Dray-Spira R. Tobacco smoking in HIV-infected versus general population in france: heterogeneity across the various groups of people living with HIV. PLoS One 2014; 9:e107451. [PMID: 25202968 PMCID: PMC4159331 DOI: 10.1371/journal.pone.0107451] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/12/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although the various groups of people living with HIV (PLWHIV) considerably differ regarding socioeconomic and behavioral characteristics, their specificities regarding tobacco smoking have been poorly investigated. We aimed to assess patterns of tobacco consumption across the various groups of PLWHIV and to compare them to the general population, accounting for the specific socioeconomic profile of PLWHIV. METHODS We used data of the ANRS-Vespa2 study, a national representative survey on PLWHIV conducted in France in 2011. Prevalence of past and current tobacco consumption, heavy smoking and strong nicotine dependence were assessed among the various groups of PLWHIV as defined by transmission category, gender and geographic origin, and compared to the French general population using direct standardization and multivariate Poisson regression models, accounting for gender, age, education and geographic origin. RESULTS Among the 3,019 participants aged 18-85 years (median time since HIV diagnosis: 12 years), 37.5% were current smokers and 22.1% were past smokers, with marked differences across the various groups of PLWHIV. Compared to the general population, the prevalence of regular smoking was increased among HIV-infected men who have sex with men (MSM) (adjusted prevalence rate ratio (aPRR): 1.19, 95% confidence interval (95% CI): 1.07-1.32), French-native women (aPRR: 1.32, 95% CI: 1.10-1.57), and heterosexual French-native men (although not significantly, aPRR: 1.19, 95% CI: 0.98-1.45). Additionally, HIV-infected MSM were significantly less likely to be ex-smokers (aPRR: 0.73, 95% CI: 0.64-0.82) than the general population and similar trends were observed among heterosexual French-native men (aPRR: 0.89, 95% CI: 0.78-1.02) and women (aPRR: 0.84, 95% CI: 0.70-1.01). HIV-infected sub-Saharan African migrants were less likely to be regular smokers than the general population. CONCLUSIONS Smoking constitutes a major concern in various groups of PLWHIV in France including MSM and heterosexual French-natives, probably resulting from PLWHIV being less likely to quit smoking than their counterparts in the general population.
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Affiliation(s)
- Laure Tron
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, Paris, France
- * E-mail:
| | - France Lert
- INSERM, U1018, Center for Research in Epidemiology and Population Health, Department of epidemiology of Occupational and Social Determinants of Health, Villejuif, France
- Versailles Saint-Quentin-en-Yvelines University, Villejuif, France
| | - Bruno Spire
- INSERM, UMR912, Economics and Social Sciences Applied to Health and Analysis of Medical Information (SESSTIM), Marseille, France
- Aix Marseille University, UMR_S912, IRD, Marseille, France
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Rosemary Dray-Spira
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, Paris, France
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Hadigan C, Kattakuzhy S. Diabetes mellitus type 2 and abnormal glucose metabolism in the setting of human immunodeficiency virus. Endocrinol Metab Clin North Am 2014; 43:685-96. [PMID: 25169561 PMCID: PMC4159723 DOI: 10.1016/j.ecl.2014.05.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
As the modern era of combination antiretroviral therapy has increased life expectancy for individuals infected with the human immunodeficiency virus (HIV), type 2 diabetes mellitus and disorders of glucose metabolism have emerged as an important issue in the care of this population. Multiple mechanisms, both specific and nonspecific to HIV, underlie a significant prevalence. Although best-practice diagnostic testing remains unclear, the risks associated with diabetes in the setting of HIV are well characterized, ranging from organ-specific damage to socioeconomic decline. As population-specific treatment data are limited, current guidelines serve as a basis for ongoing management.
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Affiliation(s)
- Colleen Hadigan
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, 10 Center Drive, Bethesda, MD 20892, Telephone (301) 594-5754, Fax (301) 402-4097
| | - Sarah Kattakuzhy
- Laboratory of Immunoregulation, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland 21702, Telephone (301) 594-7807, Fax (301) 402-1137
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Abstract
OBJECTIVE To estimate annual employment rates and disability retirement rates (DRRs) among HIV-infected individuals and population controls during the period 1996-2011. DESIGN A population-based cohort study including all HIV-infected individuals born in Denmark and not reporting intravenous (i.v.) drug abuse as a route of HIV infection or diagnosed with hepatitis C infection (n = 2799) and 22,369 individually matched persons from the background population. Study inclusion was 1 January 1996 or HIV diagnosis, which ever came last. METHODS Data on employment status and disability pension were extracted from Danish national registries. Employment rate and DRR were estimated in each calendar year after study inclusion for the cohorts included before 1996 (pre-1996), 1996-1999 and 2000-2011. RESULTS Employment rate in the year of study inclusion increased from 54.8% [95% confidence interval (CI) 50.5-59.6] in the pre-1996 cohort to 74.6% (66.9-83.2) and 77.4% (72.8-82.2) in the 1996-1999 and 2000-2011 cohorts, respectively, compared with 85.9-87.2% in the comparison cohorts. Five years from study inclusion, employment rates were 56.1 (51.4-61.1), 66.2 (58.7-74.6) and 70.9% (65.0-77.3) in the pre-1996, 1996-1999 and 2000-2011 cohorts, respectively, compared with 82.5-85.6% in the comparison cohorts. Five years from study inclusion, DRRs were 32.3 (28.9-36.3) in the pre-1996 cohort and decreased to 17.8 (14.1-22.4) and 11.6% (9.4-14.4) in the 1996-1999 and 2000-2011 cohorts, respectively, compared with 5.1-7.2% in the comparison cohorts. CONCLUSION After the introduction of HAART, employment rates have increased profoundly among HIV-infected individuals, but have remained lower than in the background population. During the same period, DRRs decreased among HIV-infected individuals, but still remained higher than in the background population.
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Douab T, Marcellin F, Vilotitch A, Protopopescu C, Préau M, Suzan-Monti M, Sagaon-Teyssier L, Lert F, Carrieri MP, Dray-Spira R, Spire B. Health-related quality of life of people living with HIV followed up in hospitals in France: comparing trends and correlates between 2003 and 2011 (ANRS-VESPA and VESPA2 national surveys). AIDS Care 2014; 26 Suppl 1:S29-40. [DOI: 10.1080/09540121.2014.906553] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Taoufiq Douab
- INSERM, UMR912 (SESSTIM), 13006, Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13006, Marseille, France
| | - Fabienne Marcellin
- INSERM, UMR912 (SESSTIM), 13006, Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13006, Marseille, France
| | - Antoine Vilotitch
- INSERM, UMR912 (SESSTIM), 13006, Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13006, Marseille, France
| | - Camelia Protopopescu
- INSERM, UMR912 (SESSTIM), 13006, Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13006, Marseille, France
| | - Marie Préau
- INSERM, UMR912 (SESSTIM), 13006, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13006, Marseille, France
- Groupe de Recherche en Psychologie Sociale, Institut de Psychologie, Université Lyon 2, Bron, France
| | - Marie Suzan-Monti
- INSERM, UMR912 (SESSTIM), 13006, Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13006, Marseille, France
| | - Luis Sagaon-Teyssier
- INSERM, UMR912 (SESSTIM), 13006, Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13006, Marseille, France
| | - France Lert
- Centre de recherche en épidémiologie et santé des populations, Hôpital Paul Brousse, Inserm U1018, Villejuif, France
- Université de Versailles Saint-Quentin-en-Yvelines, UMRS 1018, Villejuif, France
| | - Maria Patrizia Carrieri
- INSERM, UMR912 (SESSTIM), 13006, Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13006, Marseille, France
| | - Rosemary Dray-Spira
- Centre de recherche en épidémiologie et santé des populations, Hôpital Paul Brousse, Inserm U1018, Villejuif, France
- Université de Versailles Saint-Quentin-en-Yvelines, UMRS 1018, Villejuif, France
| | - Bruno Spire
- INSERM, UMR912 (SESSTIM), 13006, Marseille, France
- Aix Marseille Université, UMR_S912, IRD, 13006, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, 13006, Marseille, France
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Richardson LA, Milloy MJS, Kerr TH, Parashar S, Montaner JSG, Wood E. Employment predicts decreased mortality among HIV-seropositive illicit drug users in a setting of universal HIV care. J Epidemiol Community Health 2013; 68:93-6. [PMID: 24153247 DOI: 10.1136/jech-2013-202918] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Given the link between employment and mortality in the general population, we sought to assess this relationship among HIV-positive people who use illicit drugs in Vancouver, Canada. METHODS Data were derived from a prospective cohort study of HIV seropositive people who use illicit drugs (n=666) during the period of May 1996-June 2010 linked to comprehensive clinical data in Vancouver, Canada, a setting where HIV care is delivered without charge. We estimated the relationship between employment and mortality using proportional hazards survival analysis, adjusting for relevant behavioural, clinical, social and socioeconomic factors. RESULTS In a multivariate survival model, a time-updated measure of full time, temporary or self-employment compared with no employment was significantly associated with a lower risk of death (adjusted HR=0.44, 95% CI 0.22 to 0.91). Results were robust to adjustment for relevant confounders, including age, injection and non-injection drug use, plasma viral load and baseline CD4 T-cell count. CONCLUSIONS These findings suggest that employment may be an important dimension of mortality risk of HIV-seropositive illicit drug users. The potentially health-promoting impacts of labour market involvement warrant further exploration given the widespread barriers to employment and persistently elevated levels of preventable mortality among this highly marginalised population.
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Affiliation(s)
- Lindsey A Richardson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, , Vancouver, Canada
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Emlet CA, Fredriksen-Goldsen KI, Kim HJ. Risk and protective factors associated with health-related quality of life among older gay and bisexual men living with HIV disease. THE GERONTOLOGIST 2013; 53:963-72. [PMID: 23355449 DOI: 10.1093/geront/gns191] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To identify risk and protective factors associated with mental and physical health-related quality of life, after controlling for key background characteristics, in a population of older gay and bisexual men living with HIV disease. Previous research examining quality of life among persons living with HIV rarely includes older adults. DESIGN AND METHODS Survey responses from 226 gay and bisexual men aged 50 and older, and living with HIV disease, which were part of the Caring and Aging with Pride study, were analyzed using multivariate linear regression models. RESULTS Findings reveal that comorbidity, limitations in activities, and victimization are significant risk factors for decreased physical and mental health-related quality of life. Stigma and HIV progression did not contribute to the overall outcome variables in multivariate models. Social support and self-efficacy serve as protective factors although social support was only significant with mental health-related quality of life. IMPLICATIONS Comorbidity, functional limitations, and lifetime victimization are risks to quality of life among older gay and bisexual men with HIV disease. Self-efficacy and social support represent intrapersonal and interpersonal resources that can be enhanced through interventions to improve health-related quality of life.
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Affiliation(s)
- Charles A Emlet
- *Address correspondence to Charles A. Emlet, MSW, Social Work Program, University of Washington Tacoma, 1900 Commerce St. Campus Box 358425, Tacoma, WA 98402. E-mail:
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