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Konkle-Parker D, Cleveland JD, Long D, Nair V, Fischl M, Wingood G, Edmonds A. Population Density and Health Outcomes in Women with HIV in the Southern United States: A Retrospective Longitudinal Analysis. J Womens Health (Larchmt) 2024; 33:1111-1119. [PMID: 38864119 DOI: 10.1089/jwh.2023.0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Purpose: Published studies have revealed challenges for people with human immunodeficiency virus (HIV) living in rural areas compared to those in urban areas, such as poor access to HIV care, insufficient transportation, and isolation. The purpose of this study was to examine associations between population density and multiple psychosocial and clinical outcomes in the largest cohort of women with HIV (WWH) in the United States. Methods: Women's Interagency HIV Study (WIHS) participants from Southern sites (n = 561) in 2013-2018 were categorized and compared by population density quartiles. The most urban quartile was compared with the most rural quartile in several psychosocial and clinical variables, including HIV viral load suppression, HIV medication adherence, HIV care attendance, depression, internalized HIV stigma, and perceived discrimination in healthcare settings. Results: Although women in the lowest density quartile were unexpectedly more highly resourced, women in that quartile had greater odds of not attending an HIV care visit in the last six months (odds ratio [OR] = 0.64, 95% confidence interval [CI] [0.43-0.95]), yet higher odds for having fully suppressed HIV when compared to women in the highest density quartile (OR = 1.64, 95% CI [1.13-2.38]). Highly urban WWH had greater likelihood of unsuppressed HIV, even after controlling for income, employment, and health insurance, despite reporting greater HIV care adherence and similar medication adherence. Discussion: Further investigation into the reasons for these disparities by population density is needed, and particular clinical attention should be focused on individuals from high population density areas to help maximize their health outcomes.
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Affiliation(s)
- D Konkle-Parker
- Schools of Medicine, Nursing, Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - J D Cleveland
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - V Nair
- School of Population Health, Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - M Fischl
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miami, FL, USA
| | - G Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - A Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Liang X, Aouizerat BE, So‐Armah K, Cohen MH, Marconi VC, Xu K, Justice AC. DNA methylation-based telomere length is associated with HIV infection, physical frailty, cancer, and all-cause mortality. Aging Cell 2024; 23:e14174. [PMID: 38629454 PMCID: PMC11258465 DOI: 10.1111/acel.14174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 07/21/2024] Open
Abstract
Telomere length (TL) is an important indicator of cellular aging. Shorter TL is associated with several age-related diseases including coronary heart disease, heart failure, diabetes, osteoporosis, and cancer. Recently, a DNA methylation-based TL (DNAmTL) estimator has been developed as an alternative method for directly measuring TL. In this study, we examined the association of DNAmTL with cancer prevalence and mortality risk among people with and without HIV in the Veterans Aging Cohort Study Biomarker Cohort (VACS, N = 1917) and Women's Interagency HIV Study Cohort (WIHS, N = 481). We profiled DNAm in whole blood (VACS) or in peripheral blood mononuclear cells (WIHS) using an array-based method. Cancer prevalence was estimated from electronic medical records and cancer registry data. The VACS Index was used as a measure of physiologic frailty. Models were adjusted for self-reported race and ethnicity, batch, smoking status, alcohol consumption, and five cell types (CD4, CD8, NK, B cell, and monocyte). We found that people with HIV had shorter average DNAmTL than those without HIV infection [beta = -0.25, 95% confidence interval (-0.32, -0.18), p = 1.48E-12]. Greater value of VACS Index [beta = -0.002 (-0.003, -0.001), p = 2.82E-05] and higher cancer prevalence [beta = -0.07 (-0.10, -0.03), p = 1.37E-04 without adjusting age] were associated with shortened DNAmTL. In addition, one kilobase decrease in DNAmTL was associated with a 40% increase in mortality risk [hazard ratio: 0.60 (0.44, 0.82), p = 1.42E-03]. In summary, HIV infection, physiologic frailty, and cancer are associated with shortening DNAmTL, contributing to an increased risk of all-cause mortality.
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Affiliation(s)
- Xiaoyu Liang
- Department of Epidemiology and BiostatisticsMichigan State UniversityEast LansingMichiganUSA
| | - Bradley E. Aouizerat
- Translational Research Center, College of DentistryNew York UniversityNew YorkNew YorkUSA
- Department of Oral and Maxillofacial Surgery, College of DentistryNew York UniversityNew YorkNew YorkUSA
| | - Kaku So‐Armah
- Boston University School of MedicineBostonMassachusettsUSA
| | - Mardge H. Cohen
- Department of MedicineStroger Hospital of Cook CountyChicagoIllinoisUSA
| | - Vincent C. Marconi
- Emory University School of Medicine and Rollins School of Public HealthThe Atlanta Veterans Affairs Medical CenterAtlantaGeorgiaUSA
| | - Ke Xu
- Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | - Amy C. Justice
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
- Yale School of Public HealthNew HavenConnecticutUSA
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3
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Rubtsova AA, Taylor TN, Wingood G, Ofotokun I, Gustafson D, Vance DE, Holstad M. "As I Grew Older, My Life Got Better": Conceptions of Successful Aging among Older Women Living with or at Risk of HIV. AIDS Behav 2024; 28:1581-1593. [PMID: 38231362 DOI: 10.1007/s10461-024-04270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 01/18/2024]
Abstract
Successful aging (SA) is an important target for HIV care. However, we have insufficient understanding of how older women living with HIV (OWLH) in the US define SA. We explored conceptions of SA by OWLH and older women at risk of HIV and examined whether SA conceptions differed by (1) HIV serostatus, and (2) participation in the Women's Interagency HIV Study (WIHS). These analyses were part of a larger mixed-methods study with a sequential design. Participants were recruited at two clinical WIHS sites. We enrolled both WIHS participants and non-WIHS clinic patients. Our sample was 84% Black and included 29 OWLH and 15 older women at risk of HIV. We conducted 21 semi-structured interviews and four focus groups. The dataset was analyzed using descriptive, comparative, and relational analysis. We found four interlinked themes: life course perspective, accepting and celebrating aging, taking care of yourself, and looking good. The life course perspective was a core theme: participants assessed their aging in comparison to their earlier life hardships. These themes were similarly present among OWLH and older women at risk of HIV, although OWLH emphasized taking care of HIV. SA conceptualizations by OWLH did not differ whether or not they participated in the WIHS. Women living with or at risk of HIV may experience severe hardships throughout their lives. Overcoming these hardships may be linked to SA. Assessing the needs and connecting women to resources and programs are critical for SA promotion.
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Affiliation(s)
- Anna A Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Tonya N Taylor
- College of Medicine, Division of Infectious Diseases, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ighovwerha Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - David E Vance
- The University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Marcia Holstad
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
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4
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Ramakrishnan A, Fujita AW, Mehta CC, Wilson TE, Shoptaw S, Carrico A, Adimora AA, Eaton EF, Jones DL, Chandran A, Sheth AN. Brief Report: Substance Use Care Continuum in Women With and Without HIV in the Southern United States. J Acquir Immune Defic Syndr 2024; 95:424-430. [PMID: 38133580 PMCID: PMC10927302 DOI: 10.1097/qai.0000000000003373] [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: 07/26/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Substance use (SU) contributes to poor outcomes among persons living with HIV. Women living with HIV (WWH) in the United States are disproportionately affected in the South, and examining SU patterns, treatment, and HIV outcomes in this population is integral to addressing HIV and SU disparities. METHODS WWH and comparable women without HIV (WWOH) who enrolled 2013-2015 in the Women's Interagency HIV Study Southern sites (Atlanta, Birmingham/Jackson, Chapel Hill, and Miami) and reported SU (self-reported nonmedical use of drugs) in the past year were included. SU and treatment were described annually from enrollment to the end of follow-up. HIV outcomes were compared by SU treatment engagement. RESULTS At enrollment, among 840 women (608 WWH, 232 WWOH), 18% (n = 155) reported SU in the past year (16% WWH, 24% WWOH); 25% (n = 38) of whom reported SU treatment. Over time, 30%, 21%, and 18% reported SU treatment at 1, 2, and 3 years, respectively, which did not significantly differ by HIV status. Retention in HIV care did not differ by SU treatment. Viral suppression was significantly higher in women who reported SU treatment only at enrollment ( P = 0.03). CONCLUSIONS We identified a substantial gap in SU treatment engagement, with only a quarter reporting treatment utilization, which persisted over time. SU treatment engagement was associated with viral suppression at enrollment but not at other time points or with retention in HIV care. These findings can identify gaps and guide future strategies for integrating HIV and SU care for WWH.
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Affiliation(s)
- Aditi Ramakrishnan
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Ayako W. Fujita
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - C. Christina Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Tracey E. Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Adam Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ellen F. Eaton
- Division of Infectious Diseases, Department of Medicine, University of Alabama School of Medicine, Birmingham, AL
| | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL; and
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anandi N. Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
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5
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Giron LB, Liu Q, Adeniji OS, Yin X, Kannan T, Ding J, Lu DY, Langan S, Zhang J, Azevedo JLLC, Li SH, Shalygin S, Azadi P, Hanna DB, Ofotokun I, Lazar J, Fischl MA, Haberlen S, Macatangay B, Adimora AA, Jamieson BD, Rinaldo C, Merenstein D, Roan NR, Kutsch O, Gange S, Wolinsky SM, Witt MD, Post WS, Kossenkov A, Landay AL, Frank I, Tien PC, Gross R, Brown TT, Abdel-Mohsen M. Immunoglobulin G N-glycan markers of accelerated biological aging during chronic HIV infection. Nat Commun 2024; 15:3035. [PMID: 38600088 PMCID: PMC11006954 DOI: 10.1038/s41467-024-47279-4] [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: 09/01/2023] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
People living with HIV (PLWH) experience increased vulnerability to premature aging and inflammation-associated comorbidities, even when HIV replication is suppressed by antiretroviral therapy (ART). However, the factors associated with this vulnerability remain uncertain. In the general population, alterations in the N-glycans on IgGs trigger inflammation and precede the onset of aging-associated diseases. Here, we investigate the IgG N-glycans in cross-sectional and longitudinal samples from 1214 women and men, living with and without HIV. PLWH exhibit an accelerated accumulation of pro-aging-associated glycan alterations and heightened expression of senescence-associated glycan-degrading enzymes compared to controls. These alterations correlate with elevated markers of inflammation and the severity of comorbidities, potentially preceding the development of such comorbidities. Mechanistically, HIV-specific antibodies glycoengineered with these alterations exhibit a reduced ability to elicit anti-HIV Fc-mediated immune activities. These findings hold potential for the development of biomarkers and tools to identify and prevent premature aging and comorbidities in PLWH.
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Affiliation(s)
| | - Qin Liu
- The Wistar Institute, Philadelphia, PA, USA
| | | | | | | | | | - David Y Lu
- The Wistar Institute, Philadelphia, PA, USA
- Cornell University, New York, NY, USA
| | | | | | | | - Shuk Hang Li
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | | | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jason Lazar
- SUNY Downstate Health Sciences University, New York, NY, USA
| | - Margaret A Fischl
- Division of Infectious Disease, Department of Medicine, University of Miami, Miami, FL, USA
| | | | | | | | | | | | | | - Nadia R Roan
- Gladstone Institutes, San Francisco, CA, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Olaf Kutsch
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Mallory D Witt
- Lundquist Institute of Biomedical Research at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | | | | | - Ian Frank
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Phyllis C Tien
- University of California San Francisco, San Francisco, CA, USA
| | - Robert Gross
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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6
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Shorer EF, Rubin LH, French AL, Weber KM, Daubert E, Yohannes T, Morack R, Clish C, Bullock K, Gustafson D, Sharma A, Rogando AC, Qi Q, Burgess HJ, Dastgheyb RM. Tryptophan-kynurenine metabolic pathway and daytime dysfunction in women with HIV. J Neurovirol 2024; 30:122-130. [PMID: 38472641 DOI: 10.1007/s13365-024-01195-x] [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: 12/15/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024]
Abstract
Sleep disturbances are prevalent in women with HIV (WWH). Tryptophan-kynurenine (T-K) pathway metabolites are associated with alterations in actigraphy derived sleep measures in WWH, although may not always correlate with functional impairment. We investigated the relationship between T-K pathway metabolites and self-reported daytime dysfunction in WWH and women without HIV (WWoH). 141 WWH on stable antiretroviral therapy and 140 demographically similar WWoH enrolled in the IDOze Study had targeted plasma T-K metabolites measured using liquid chromatography-tandem mass spectrometry. We utilized the daytime dysfunction component of the Pittsburgh Sleep Quality Index (PSQI) to assess functional impairment across HIV-serostatus. Lower levels of 5-hydroxytryptophan and serotonin were associated with greater daytime dysfunction in all women. In WWH, daytime dysfunction was associated with increased kynurenic acid (R = 0.26, p < 0.05), and kynurenic acid-tryptophan (KA-T) ratio (R = 0.28, p < 0.01). WWH with daytime dysfunction had a 0.7 log fold increase in kynurenic acid compared to WWH without daytime dysfunction. Kynurenic acid levels and the KA-T ratio were associated with daytime dysfunction in WWH but not in WWoH. Longitudinal studies are needed to establish a causal relationship and directionality between T-K metabolic changes and sleep impairment in WWH.
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Affiliation(s)
- Eran Frank Shorer
- Department of Neurology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Room 490, Carnegie Building, 600 North Wolfe Street, Baltimore, MD, USA.
| | - Leah H Rubin
- Department of Neurology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Room 490, Carnegie Building, 600 North Wolfe Street, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Audrey L French
- Department of Medicine, Stroger Hospital of Cook County, Chicago, IL, USA
| | | | | | | | | | - Clary Clish
- Metabolomics Platform, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Kevin Bullock
- Metabolomics Platform, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrea C Rogando
- Hektoen Institute of Medicine, Chicago, IL, USA
- College of Science and Health at Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Raha M Dastgheyb
- Department of Neurology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Room 490, Carnegie Building, 600 North Wolfe Street, Baltimore, MD, USA
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7
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Daubert EM, Dionne J, Atrio J, Knittel AK, Kassaye SG, Seidman D, Long A, Brockmann S, Ofotokun I, Fischl MA, Massad LS, Weber KM. Declining Prevalence of Trichomonas vaginalis Diagnosed by Wet Mount in a Cohort of U.S. Women With and Without HIV. J Womens Health (Larchmt) 2024; 33:388-395. [PMID: 38215275 PMCID: PMC10924113 DOI: 10.1089/jwh.2023.0263] [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: 01/14/2024] Open
Abstract
Background: Women living with HIV (WLWH) are often coinfected with Trichomonas vaginalis (TV), and annual screening is recommended. Our goal was to assess differences in TV prevalence at study entry and over time in enrollment cohorts of the Women's Interagency HIV Study. Methods: In a multisite study, TV was diagnosed by wet mount microscopy. Prevalence was determined across four enrollment waves: 1994-1995, 2001-2002, 2011-2012, and 2013-2015. Generalized estimating equation multivariable logistic regression models assessed changes in visit prevalence across waves after controlling for HIV disease severity and other risks. Results: At 63,824 person-visits (3,508 WLWH and 1,262 women without HIV), TV was diagnosed by wet mount at 1979 visits (3.1%). After multivariable adjustment, HIV status was not associated with TV detection, which was more common among younger women, women with multiple partners, and irregular condom use. All enrollment waves showed a decline in TV detection over time, although p-value for trend did not reach significance for most recent waves. To explore the potential utility of screening among WLWH, we assessed rates of TV detection among women without appreciable vaginal discharge on examination. Initial TV prevalence among asymptomatic women was 3.5%, and prevalence decreased to 0.5%-1% in the most recent wave (2013-2015) (p-trend <0.0001). Conclusions: In this cohort, TV rates are low among WLWH, and HIV does not increase TV risk. Screening may benefit newly diagnosed WLWH, women with risk factors, or those receiving care sporadically but is unlikely to further reduce the low rate of TV among women in care, especially older women without multiple partners. The clinical trials registration number for WIHS is NCT00000797.
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Affiliation(s)
| | - Jodie Dionne
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jessica Atrio
- Montefiore Hospital & Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Seble G. Kassaye
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Dominika Seidman
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Amanda Long
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan Brockmann
- State University of New York (SUNY) Health Sciences University, Brooklyn, New York, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Margaret A. Fischl
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - L. Stewart Massad
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kathleen M. Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois, USA
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8
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Shahid A, MacLennan S, Jones BR, Sudderuddin H, Dang Z, Cobarrubias K, Duncan MC, Kinloch NN, Dapp MJ, Archin NM, Fischl MA, Ofotokun I, Adimora A, Gange S, Aouizerat B, Kuniholm MH, Kassaye S, Mullins JI, Goldstein H, Joy JB, Anastos K, Brumme ZL. The replication-competent HIV reservoir is a genetically restricted, younger subset of the overall pool of HIV proviruses persisting during therapy, which is highly genetically stable over time. J Virol 2024; 98:e0165523. [PMID: 38214547 PMCID: PMC10878278 DOI: 10.1128/jvi.01655-23] [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: 10/24/2023] [Accepted: 12/07/2023] [Indexed: 01/13/2024] Open
Abstract
Within-host HIV populations continually diversify during untreated infection, and this diversity persists within infected cell reservoirs during antiretroviral therapy (ART). Achieving a better understanding of on-ART proviral evolutionary dynamics, and a better appreciation of how the overall persisting pool of (largely genetically defective) proviruses differs from the much smaller replication-competent HIV reservoir, is critical to HIV cure efforts. We reconstructed within-host HIV evolutionary histories in blood from seven participants of the Women's Interagency HIV Study who experienced HIV seroconversion, and used these data to characterize the diversity, lineage origins, and ages of proviral env-gp120 sequences sampled longitudinally up to 12 years on ART. We also studied HIV sequences emerging from the reservoir in two participants. We observed that proviral clonality generally increased over time on ART, with clones frequently persisting long term. While on-ART proviral integration dates generally spanned the duration of untreated infection, HIV emerging in plasma was exclusively younger (i.e., dated to the years immediately pre-ART). The genetic and age distributions of distinct proviral sequences remained stable during ART in all but one participant, in whom there was evidence that younger proviruses had been preferentially eliminated after 12 years on ART. Analysis of the gag region in three participants corroborated our env-gp120-based observations, indicating that our observations are not influenced by the HIV region studied. Our results underscore the remarkable genetic stability of the distinct proviral sequences that persist in blood during ART. Our results also suggest that the replication-competent HIV reservoir is a genetically restricted, younger subset of this overall proviral pool.IMPORTANCECharacterizing the genetically diverse HIV sequences that persist in the reservoir despite antiretroviral therapy (ART) is critical to cure efforts. Our observations confirm that proviruses persisting in blood on ART, which are largely genetically defective, broadly reflect the extent of within-host HIV evolution pre-ART. Moreover, on-ART clonal expansion is not appreciably accompanied by the loss of distinct proviral lineages. In fact, on-ART proviral genetic composition remained stable in all but one participant, in whom, after 12 years on ART, proviruses dating to around near ART initiation had been preferentially eliminated. We also identified recombinant proviruses between parental sequence fragments of different ages. Though rare, such sequences suggest that reservoir cells can be superinfected with HIV from another infection era. Overall, our finding that the replication-competent reservoir in blood is a genetically restricted, younger subset of all persisting proviruses suggests that HIV cure strategies will need to eliminate a reservoir that differs in key respects from the overall proviral pool.
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Affiliation(s)
- Aniqa Shahid
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Signe MacLennan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Bradley R. Jones
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Bioinformatics Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hanwei Sudderuddin
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Zhong Dang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kyle Cobarrubias
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Maggie C. Duncan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Natalie N. Kinloch
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Michael J. Dapp
- Department of Microbiology, University of Washington, School of Medicine, Seattle, Washington, USA
| | - Nancie M. Archin
- UNC HIV Cure Center, Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Margaret A. Fischl
- Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Adaora Adimora
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Mark H. Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, New York, USA
| | - Seble Kassaye
- Division of Infectious Diseases and Tropical Medicine, Georgetown University, Washington, DC, USA
| | - James I. Mullins
- Department of Microbiology, University of Washington, School of Medicine, Seattle, Washington, USA
- Department of Global Health, University of Washington, School of Medicine, Seattle, Washington, USA
- Department of Medicine, University of Washington, School of Medicine, Seattle, Washington, USA
| | - Harris Goldstein
- Departments of Microbiology and Immunology and Pediatrics, Albert Einstein College of Medicine, Bronx, New York, New York, USA
| | - Jeffrey B. Joy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Bioinformatics Program, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
| | - Zabrina L. Brumme
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - the MACS/WIHS combined cohort study (MWCSS)OfotokunIghovwerha1ShethAnandi1WingoodGina1BrownTodd2MargolickJoseph2AnastosKathryn3HannaDavid3SharmaAnjali3GustafsonDeborah4WilsonTracey4D’SouzaGypsyamber5GangeStephen5TopperElizabeth5CohenMardge6FrenchAudrey6WolinskySteven7PalellaFrank7StosorValentina7AouizeratBradley8PriceJennifer8TienPhyllis8DetelsRoger9MimiagaMatthew9KassayeSeble10MerensteinDaniel10AlcaideMaria11FischlMargaret11JonesDeborah11MartinsonJeremy12RinaldoCharles12KempfMirjam-Colette13Dionne-OdomJodie13Konkle-ParkerDeborah13BrockJames B.13AdimoraAdaora14Floris-MooreMichelle14Emory University, Atlanta, Georgia, USAJohns Hopkins University, Baltimore, Maryland, USAAlbert Einstein College of Medicine, Bronx, New York, USASuny Downstate Medical Center, Brooklyn, New York, USAJohns Hopkins University, Baltimore, Maryland, USAHektoen Institute for Medical Research, Chicago, Illinois, USANorthwestern University at Chicago, Chicago, Illinois, USAUniversity of California San Francisco, San Francisco, California, USAUniversity of California Los Angeles, Los Angeles, California, USAGeorgetown University, Washington, DC, USAUniversity of Miami School of Medicine, Coral Gables, Florida, USAUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USAUniversity of Alabama Birmingham, Birmingham, Alabama, USAUniversity of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Bioinformatics Program, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Microbiology, University of Washington, School of Medicine, Seattle, Washington, USA
- UNC HIV Cure Center, Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, University of Miami School of Medicine, Miami, Florida, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- College of Dentistry, New York University, New York, New York, USA
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, New York, USA
- Division of Infectious Diseases and Tropical Medicine, Georgetown University, Washington, DC, USA
- Department of Global Health, University of Washington, School of Medicine, Seattle, Washington, USA
- Department of Medicine, University of Washington, School of Medicine, Seattle, Washington, USA
- Departments of Microbiology and Immunology and Pediatrics, Albert Einstein College of Medicine, Bronx, New York, New York, USA
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
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9
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Freedman ME, Weber KM, Yohannes T, Cohen MH, Moskowitz JT. A web-based positive-affect intervention to reduce stress and improve well-being in women living with HIV - feasibility and acceptability of a single-arm, pilot study. AIDS Care 2024; 36:115-121. [PMID: 37311108 PMCID: PMC10716357 DOI: 10.1080/09540121.2023.2221423] [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: 04/27/2022] [Accepted: 05/30/2023] [Indexed: 06/15/2023]
Abstract
Women living with HIV (WLWH) experience high rates of depression but are underrepresented in mental health research. Positive emotions are associated with beneficial health outcomes in WLWH and should be a targeted component of psychological interventions in this population. Positive psychological interventions aim to increase positive emotions through the use of simple exercises, such as keeping a gratitude journal. We conducted a single-arm feasibility/acceptability study of a five-week, self-guided, web-based positive affect skills intervention in a sample of WLWH (N = 23) who also participate in a longitudinal observational study, the Women's Interagency HIV Study. The intervention was feasible as measured by home practice and post-intervention assessment completion, and acceptable as measured by exit interview feedback regarding recommendation of the program to friends or others living with HIV. On average, participants completed home practice for about 8 out of 9 skills. The mean response for recommendation of the program to a friend was 9.26/10 (SD = 1.63) and the mean response for recommendation of the program to others living with HIV was 9.68/10 (SD = 0.82). Participant feedback will be used to adapt and enhance the delivery of this intervention. Further studies are needed to assess efficacy and impact on psychological outcomes.
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Affiliation(s)
- Melanie E. Freedman
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Kathleen M. Weber
- Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - Tsion Yohannes
- Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital of Cook County Health System, Chicago IL, USA
| | - Judith T. Moskowitz
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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10
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Wang Y, Sharma A, Weber KM, Topper E, Appleton AA, Gustafson D, Clish CB, Kaplan RC, Burk RD, Qi Q, Peters BA. The menopause-related gut microbiome: associations with metabolomics, inflammatory protein markers, and cardiometabolic health in women with HIV. Menopause 2024; 31:52-64. [PMID: 38086007 PMCID: PMC10841550 DOI: 10.1097/gme.0000000000002287] [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: 12/17/2023]
Abstract
OBJECTIVE This study aimed to identify menopause-related gut microbial features, as well as their related metabolites and inflammatory protein markers, and link with cardiometabolic risk factors in women with and without HIV. METHODS In the Women's Interagency HIV Study, we performed shotgun metagenomic sequencing on 696 stool samples from 446 participants (67% women with HIV), and quantified plasma metabolomics and serum proteomics in a subset (~86%). We examined the associations of menopause (postmenopausal vs premenopausal) with gut microbial features in a cross-sectional repeated-measures design and further evaluated those features in relation to metabolites, proteins, and cardiometabolic risk factors. RESULTS Different overall gut microbial composition was observed by menopausal status in women with HIV only. We identified a range of gut microbial features that differed between postmenopausal and premenopausal women with HIV (but none in women without HIV), including abundance of 32 species and functional potentials involving 24 enzymatic reactions and lower β-glucuronidase bacterial gene ortholog. Specifically, highly abundant species Faecalibacterium prausnitzii , Bacteroides species CAG:98 , and Bifidobacterium adolescentis were depleted in postmenopausal versus premenopausal women with HIV. Menopause-depleted species (mainly Clostridia ) in women with HIV were positively associated with several glycerophospholipids, while negatively associated with imidazolepropionic acid and fibroblast growth factor 21. Mediation analysis suggested that menopause may decrease plasma phosphatidylcholine plasmalogen C36:1 and C36:2 levels via reducing abundance of species F. prausnitzii and Acetanaerobacterium elongatum in women with HIV. Furthermore, waist-to-hip ratio was associated with menopause-related microbes, metabolites, and fibroblast growth factor 21 in women with HIV. CONCLUSIONS Menopause was associated with a differential gut microbiome in women with HIV, related to metabolite and protein profiles that potentially contribute to elevated cardiometabolic risk.
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Affiliation(s)
- Yi Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Elizabeth Topper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, NY, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | | | - Robert C. Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Robert D. Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brandilyn A. Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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11
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Giron LB, Liu Q, Adeniji OS, Yin X, Kannan T, Ding J, Lu DY, Langan S, Zhang J, Azevedo JLLC, Li SH, Shalygin S, Azadi P, Hanna DB, Ofotokun I, Lazar J, Fischl MA, Haberlen S, Macatangay B, Adimora AA, Jamieson BD, Rinaldo C, Merenstein D, Roan NR, Kutsch O, Gange S, Wolinsky S, Witt M, Post WS, Kossenkov A, Landay A, Frank I, Tien PC, Gross R, Brown TT, Abdel-Mohsen M. Plasma Glycomic Markers of Accelerated Biological Aging During Chronic HIV Infection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.09.551369. [PMID: 37609144 PMCID: PMC10441429 DOI: 10.1101/2023.08.09.551369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
People with HIV (PWH) experience an increased vulnerability to premature aging and inflammation-associated comorbidities, even when HIV replication is suppressed by antiretroviral therapy (ART). However, the factors that contribute to or are associated with this vulnerability remain uncertain. In the general population, alterations in the glycomes of circulating IgGs trigger inflammation and precede the onset of aging-associated diseases. Here, we investigate the IgG glycomes of cross-sectional and longitudinal samples from 1,216 women and men, both living with virally suppressed HIV and those without HIV. Our glycan-based machine learning models indicate that living with chronic HIV significantly accelerates the accumulation of pro-aging-associated glycomic alterations. Consistently, PWH exhibit heightened expression of senescence-associated glycan-degrading enzymes compared to their controls. These glycomic alterations correlate with elevated markers of inflammatory aging and the severity of comorbidities, potentially preceding the development of such comorbidities. Mechanistically, HIV-specific antibodies glycoengineered with these alterations exhibit reduced anti-HIV IgG-mediated innate immune functions. These findings hold significant potential for the development of glycomic-based biomarkers and tools to identify and prevent premature aging and comorbidities in people living with chronic viral infections.
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Affiliation(s)
| | - Qin Liu
- The Wistar Institute, Philadelphia, PA, USA
| | | | | | | | | | - David Y. Lu
- The Wistar Institute, Philadelphia, PA, USA
- Cornell University, New York, NY, USA
| | | | | | | | - Shuk Hang Li
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | | | | | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jason Lazar
- SUNY Downstate Health Sciences University, New York, NY, USA
| | | | | | | | | | | | | | | | - Nadia R. Roan
- Gladstone Institutes, San Francisco, CA, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Olaf Kutsch
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | - Mallory Witt
- Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | | | - Ian Frank
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Phyllis C. Tien
- University of California San Francisco, San Francisco, CA, USA
| | - Robert Gross
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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12
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Banerjee T, Frongillo EA, Turan JM, Sheira LA, Adedimeji A, Wilson T, Merenstein D, Cohen M, Adimora AA, Ofotokun I, Metsch L, D’Souza G, Fischl MA, Fisher M, Tien PC, Weiser SD. Association of Higher Intake of Plant-Based Foods and Protein With Slower Kidney Function Decline in Women With HIV. J Acquir Immune Defic Syndr 2023; 94:203-210. [PMID: 37850979 PMCID: PMC10593493 DOI: 10.1097/qai.0000000000003269] [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: 03/10/2023] [Accepted: 06/26/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND We investigated whether there exists an association between dietary acid load and kidney function decline in women living with HIV (WLWH) receiving antiretroviral therapy (ART). SETTING One thousand six hundred eight WLWH receiving ART in the WIHS cohort with available diet data and a baseline estimated glomerular filtration rate (eGFR) ≥15 mL/minute/1.73 m2. METHODS A brief dietary instrument conducted from 2013 to 2016 under the Food Insecurity Sub-Study was used for assessing fruits and vegetables (FV) and protein intake. A mixed-effects model with random intercept and slope was used to estimate subjects' annual decline rate in eGFR and the association between FV intake and eGFR decline, adjusting for sociodemographics, serum albumin, comorbidities, time on ART, ART drugs, HIV markers, and baseline eGFR. We evaluated whether markers of inflammation mediated the effect of FV intake on decline in eGFR, using causal mediation analysis. RESULTS We found a dose-response relationship for the association of FV intake and eGFR decline, with lesser annual decline in eGFR in the middle and highest tertiles of FV intake. An increase of 5 servings of FV intake per day was associated with a lower annual eGFR decline (-1.18 [-1.43, -0.94]). On average, 39% of the association between higher FV intake and slower eGFR decline was explained by decreased levels of inflammation. CONCLUSIONS Plant-rich diet was associated with slower decline in kidney function. Inflammation is a potential path through which diet may affect kidney function. The findings support an emerging body of literature on the potential benefits of plant-rich diets for prevention of chronic kidney disease.
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Affiliation(s)
- Tanushree Banerjee
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco CA
| | - Edward A. Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina
| | - Janet M. Turan
- School of Public Health, University of Alabama at Birmingham
| | - Lila A. Sheira
- School of Nursing, University of California, San Francisco
| | - Adebola Adedimeji
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine
| | - Tracey Wilson
- School of Public Health, SUNY Downstate Health Sciences University
| | | | | | - Adaora A. Adimora
- School of Public Health, University of North Carolina at Chapel Hill
| | | | - Lisa Metsch
- School of Public Health, Columbia University
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | | | - Molly Fisher
- Department of Medicine, Albert Einstein College of Medicine
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13
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Shahid A, MacLennan S, Jones BR, Sudderuddin H, Dang Z, Cobamibias K, Duncan MC, Kinloch NN, Dapp MJ, Archin NM, Fischl MA, Ofotokun I, Adimora A, Gange S, Aouizerat B, Kuniholm MH, Kassaye S, Mullins JI, Goldstein H, Joy JB, Anastos K, Brumme ZL. The replication-competent HIV reservoir is a genetically restricted, younger subset of the overall pool of HIV proviruses persisting during therapy, which is highly genetically stable over time. RESEARCH SQUARE 2023:rs.3.rs-3259040. [PMID: 37645749 PMCID: PMC10462229 DOI: 10.21203/rs.3.rs-3259040/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Within-host HIV populations continually diversify during untreated infection, and members of these diverse forms persist within infected cell reservoirs, even during antiretroviral therapy (ART). Characterizing the diverse viral sequences that persist during ART is critical to HIV cure efforts, but our knowledge of on-ART proviral evolutionary dynamics remains incomplete, as does our understanding of the differences between the overall pool of persisting proviral DNA (which is largely genetically defective) and the subset of intact HIV sequences capable of reactivating. Here, we reconstructed within-host HIV evolutionary histories in blood from seven participants of the Women's Interagency HIV Study (WIHS) who experienced HIV seroconversion. We measured diversity, lineage origins and ages of proviral sequences (env-gp120) sampled up to four times, up to 12 years on ART. We used the same techniques to study HIV sequences emerging from the reservoir in two participants. Proviral clonality generally increased over time on ART, with clones frequently persisting across multiple time points. The integration dates of proviruses persisting on ART generally spanned the duration of untreated infection (though were often skewed towards years immediately pre-ART), while in contrast, reservoir-origin viremia emerging in plasma was exclusively "younger" (i.e., dated to the years immediately pre-ART). The genetic and age distributions of distinct proviral sequences remained highly stable during ART in all but one participant in whom, after 12 years, there was evidence that "younger" proviruses had been preferentially eliminated. Analysis of within-host recombinant proviral sequences also suggested that HIV reservoirs can be superinfected with virus reactivated from an older era, yielding infectious viral progeny with mosaic genomes of sequences with different ages. Overall, results underscore the remarkable genetic stability of distinct proviral sequences that persist on ART, yet suggest that replication-competent HIV reservoir represents a genetically-restricted and overall "younger" subset of the overall persisting proviral pool in blood.
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Affiliation(s)
- Aniqa Shahid
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Signe MacLennan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Bradley R Jones
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Hanwei Sudderuddin
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Zhong Dang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Kyle Cobamibias
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Maggie C Duncan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Natalie N Kinloch
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Michael J Dapp
- Department of Microbiology, University of Washington, School of Medicine, Seattle, WA, USA
| | - Nande M Archin
- UNC HIV Cure Center, Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, NC, USA
| | - Margaret A Fischl
- Department of Medicine, University of Miami School of Medicine, Miami, FL, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Adaora Adimora
- Departments of Medicine and Epidemiology, University of North Carolina School of Medicine, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Stephen Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, NY, USA
| | - Seble Kassaye
- Division of Infectious Diseases and Tropical Medicine, Georgetown University, Washington, DC, USA
| | - James I Mullins
- Department of Microbiology, University of Washington, School of Medicine, Seattle, WA, USA
| | - Harris Goldstein
- Departments of Microbiology and Immunology and Pediatrics, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Jeffrey B Joy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | - Zabrina L Brumme
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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14
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Garimella PS, Scherzer R, Kestenbaum BR, Hoofnagle AN, Jotwani V, Gustafson D, Karim R, Sharma A, Cohen M, Dumond J, Abraham A, Estrella M, Shlipak MG, Ix JH. Tubular Secretory Solute Clearance and HIV Infection. J Acquir Immune Defic Syndr 2023; 93:319-326. [PMID: 36988544 PMCID: PMC10313730 DOI: 10.1097/qai.0000000000003200] [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: 02/17/2022] [Accepted: 12/05/2022] [Indexed: 03/30/2023]
Abstract
BACKGROUND Tubular secretion is an important kidney function responsible for the clearance of numerous medications, including antibiotics and antivirals. It is unknown whether persons living with HIV have lower secretion compared with HIV-uninfected persons, which might predispose them to the risk of progressive kidney disease or adverse drug events. SETTING AND METHODS We evaluated a panel of 6 endogenous secretory solutes in 199 women living with HIV (WLWH) and 100 women without HIV enrolled in the Women's Interagency HIV Study. Secretory clearance was estimated as the urine-to-plasma ratio of each solute, with adjustment for urine tonicity. Using multivariable linear regression analysis, we compared differences in levels of secretory solute clearance between women with and without HIV and evaluated characteristics associated with secretion. RESULTS WLWH were older (median 40 vs. 38 years) but had similar estimated glomerular filtration rate (eGFR, 96 vs. 100 mL/minute/1.73 m 2 ) compared with those without HIV. African American and Latino race, diabetes, diastolic blood pressure, smoking, hepatitis C, peak HIV viral load, and current and nadir CD4 count were associated with differences in clearance of at least 1 marker after multivariable adjustment. The secretory clearance of 3 solutes (cinnamoylglycine, kynurenic acid, and pyridoxic acid) were on average 10%-15% lower among WLWH compared with those without HIV independent of eGFR, albuminuria and chronic kidney disease risk factors, including HCV, and injection drug use. CONCLUSIONS HIV is associated with reduced secretion among women with preserved eGFR. The implications of these findings for drug dosing and adverse events need to be evaluated.
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Affiliation(s)
- Pranav S. Garimella
- Kidney Research Innovation Hub of San Diego and Division of Nephrology and Hypertension, University of California San Diego, San Diego, USA
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, USA
| | | | - Andrew N. Hoofnagle
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Vasantha Jotwani
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, USA
- Department of Medicine, San Francisco VA Medical Health Care System, San Francisco, USA
| | - Deborah Gustafson
- Department of Neurology, SUNY Downstate Medical Center, New York, NY, USA
| | - Roksana Karim
- Department of Clinical Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mardge Cohen
- Stroger Hospital of Cook County Health and Human Services, Chicago, IL, USA
| | - Julie Dumond
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Alison Abraham
- Department of Epidemiology, University of Colorado School of Public Health, Denver, CO, USA
| | - Michelle Estrella
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, USA
- Department of Medicine, San Francisco VA Medical Health Care System, San Francisco, USA
| | - Michael G. Shlipak
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, San Francisco, USA
- Department of Medicine, San Francisco VA Medical Health Care System, San Francisco, USA
| | - Joachim H. Ix
- Kidney Research Innovation Hub of San Diego and Division of Nephrology and Hypertension, University of California San Diego, San Diego, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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15
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Vásquez E, Kuniholm MH, Appleton AA, Rubin LH, Adimora AA, Fischl MA, Fox E, Mack WJ, Holman S, Moran CA, Minkoff H, Plankey MW, Sharma A, Tien PC, Weber KM, Gustafson DR. Midlife body mass index, central adiposity and neuropsychological performance over 10 years in women living with and without HIV. Front Endocrinol (Lausanne) 2023; 14:1108313. [PMID: 37484940 PMCID: PMC10361616 DOI: 10.3389/fendo.2023.1108313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Background and objective Observations of overweight and obesity in association with neuropsychological performance (NP) vary over the adult life course depending on baseline levels, biological sex, age, race, temporality of measurements, and other factors. Therefore, similar published analyses across cohorts are inconsistent. In our sample of women living with HIV (WLWH) and women without HIV (WWOH), we conducted comparable analyses as those published in men with and without HIV. We examined cross-sectional and longitudinal associations between body mass index (BMI) and waist circumference (WC) and NP. Methods Four hundred thirty two 432 virologically-suppressed WLWH and 367 WWOH, ≥40 years in the Women's Interagency HIV Study (WIHS) with anthropometry and NP assessments every two years from 2009-2019 were included in the study. Demographically-adjusted T-scores were calculated for six NP domains: learning, memory, executive function, processing speed, attention and working memory, and motor function. Multivariable linear regression models stratified by HIV status were used to examine cross-sectional associations of BMI and WC by NP domain; repeated measures analyses assessed baseline BMI and WC in association with longitudinal change in NP. Covariates included sociodemographic, behavioral, and HIV-related characteristics. Results At baseline among all women, the median age was 45 years, 65% were Non-Latinx Black women, and 45% were obese women. Obese WLWH (BMI≥30.0 kg/m2) had poorer executive function (β=-2.27, 95%CI [-4.46, -0.07]) versus WLWH with healthy BMI (18.5-24.9 kg/m2). Longitudinally over ~8 years, obese versus overweight WWOH improved on memory (β=2.19, 95%CI [0.13, 4.26]), however overweight versus healthy WWOH experienced declining memory (β= -2.67, 95%CI [-5.40, -0.07]). Increasing WC was associated with declining executive, processing speed, and motor function (p's<0.05); an at-risk WC was associated with improved memory (β=1.81, 95%CI [0.19, 3.44]) among WWOH. Among WLWH, increasing BMI was associated with improved learning (β=0.07, 95%CI [0.00, 0.15]. Conclusion Our cross-sectional and longitudinal analyses evaluating the associations of BMI and WC and NP were mixed compared to previous reports. This illustrates the importance of sociodemographic characteristics, baseline levels of exposures and outcomes, HIV status, temporality of measurements, and other factors when evaluating aging HIV epidemiology study results.
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Affiliation(s)
- Elizabeth Vásquez
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health State University of New York, Rensselaer, NY, United States
| | - Mark H. Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health State University of New York, Rensselaer, NY, United States
| | - Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health State University of New York, Rensselaer, NY, United States
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
- Department of Psychology, Johns Hopkins University, Baltimore, MD, United States
- Department Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Ada A. Adimora
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Margaret A. Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ervin Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Wendy J. Mack
- Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Susan Holman
- Department of Medicine/STAR Program, State University of New York Health Sciences University, Brooklyn, NY, United States
| | - Caitlin Anne Moran
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Grady Healthcare System, Infectious Diseases Program, Atlanta, United States
| | - Howard Minkoff
- Department of Neurology, State of New York Downstate Health Sciences University, Brooklyn, NY, United States
| | - Michael W. Plankey
- Department of Medicine, Georgetown University, Washington, DC, United States
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco, CA, United States
- Department of Veterans Affairs, San Francisco, CA, United States
| | - Kathleen M. Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, IL, United States
| | - Deborah R. Gustafson
- Department of Neurology, State of New York Downstate Health Sciences University, Brooklyn, NY, United States
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Elbur AI, Ghebremichael M, Konkle-Parker D, Jones DL, Collins S, Adimora AA, Schneider MF, Cohen MH, Tamraz B, Plankey M, Wilson T, Adedimeji A, Haberer J, Jacobson DL. Trajectories of Antiretroviral Therapy Adherence and Virologic Failure in Women With HIV in the United States. J Acquir Immune Defic Syndr 2023; 93:162-170. [PMID: 36804871 PMCID: PMC10180014 DOI: 10.1097/qai.0000000000003174] [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: 10/13/2022] [Accepted: 12/28/2022] [Indexed: 02/22/2023]
Abstract
BACKGROUND Women with HIV (WHIV) in the United States face many challenges with adherence to antiretroviral therapy (ART), and suboptimal adherence often leads to virologic failure. This study aimed to determine the association between ART adherence trajectories and the risk of virologic failure. METHODS We included WHIV (aged 18 years or older) enrolled in the Women's Interagency HIV Study in the United States from April 2014 to September 2019 who had at least 2 consecutive measurements of HIV RNA and ≥3 measurements of self-reported adherence. Group-based trajectory modeling was used to identify adherence trajectories. Cox proportional hazard ratios were used to measure the association. MAIN OUTCOME MEASURE Virologic failure was defined as HIV RNA ≥200 copies/mL at 2 consecutive visits. RESULTS We included 1437 WHIV (median age 49 years). Of all women, 173 (12.0%) experienced virologic failure. Four adherence trajectories were identified, namely "consistently high" (26.3%), "moderate increasing" (9.5%), "moderate decreasing" (30.6%), and "consistently low" (33.5%). Women in the consistently low adherence group consumed alcohol and experienced depression more than other groups. Compared with the "consistently high" trajectory, the risk of virologic failure was higher among women with "consistently low" [adjusted hazard ratio (aHR) 2.8; 95% confidence interval (CI): 1.6 to 4.9; P < 0.001] and "moderate decreasing" adherence trajectories (aHR 1.8; 95% CI: 1.0 to 3.2; P = 0.04), but it was similar to those with "moderate increasing" adherence trajectory (aHR 1.0; 95% CI: 0.4 to 2.5; P = 0.94). CONCLUSIONS Adherence to ART remains a challenge among WHIV. Multilevel behavioral interventions to address poor adherence, alcohol consumption, and depression are needed.
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Affiliation(s)
| | | | - Deborah Konkle-Parker
- Schools of Nursing, Medicine and Population Health, University of Mississippi Medical Center, Jackson, MS
| | - Deborah L. Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Shelby Collins
- Emory University School of Medicine, Division of Infectious Disease, Atlanta, GA
| | - Adaora A. Adimora
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael F. Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago IL
| | - Bani Tamraz
- University of California, San Francisco, School of Pharmacy, San Francisco, CA, MA
| | - Michael Plankey
- Georgetown University Medical Center, Department of Medicine, Division of General Internal Medicine, Washington DC
| | - Tracey Wilson
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Jessica Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA; and
| | - Denise L. Jacobson
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
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17
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Rubin LH, O'Halloran JA, Williams DW, Li Y, Fitzgerald KC, Dastgheyb R, Damron AL, Maki PM, Spence AB, Sharma A, Gustafson DR, Milam J, Weber KM, Adimora AA, Ofotokun I, Fischl MA, Konkle-Parker D, Xu Y. Integrase Inhibitors are Associated with Neuropsychiatric Symptoms in Women with HIV. J Neuroimmune Pharmacol 2023; 18:1-8. [PMID: 35178611 PMCID: PMC9381649 DOI: 10.1007/s11481-021-10042-3] [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: 10/11/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Women with HIV(WWH) are more likely to discontinue/change antiretroviral therapy(ART) due to side effects including neuropsychiatric symptoms. Efavirenz and integrase strand transfer inhibitors(INSTIs) are particularly concerning. We focused on these ART agents and neuropsychiatric symptoms in previously developed subgroups of WWH that differed on key sociodemographic factors as well as longitudinal behavioral and clinical profiles. WWH from the Women's Interagency HIV Study were included if they had ART data available, completed the Perceived Stress Scale-10 and PTSD Checklist-Civilian. Questionnaires were completed biannually beginning in 2008 through 2016. To examine ART-symptom associations, constrained continuation ratio model via penalized maximum likelihood were fit within 5 subgroups of WWH. Data from 1882 WWH contributed a total of 4598 observations. 353 women were previously defined as primarily having well-controlled HIV with vascular comorbidities, 463 with legacy effects(CD4 nadir < 250cells/mL), 274 aged ≤ 45 with hepatitis, 453 between 35-55 years, and 339 with poorly-controlled HIV/substance users. INSTIs, but not efavirenz, were associated with symptoms among key subgroups of WWH. Among those with HIV legacy effects, dolutegravir and elvitegravir were associated with greater stress/anxiety and avoidance symptoms(P's < 0.01); dolutegravir was also associated with greater re-experiencing symptoms(P = 0.005). Elvitegravir related to greater re-experiencing and hyperarousal among women with well-controlled HIV with vascular comorbidities(P's < 0.022). Raltegravir was associated with less hyperarousal, but only among women aged ≤ 45 years(P = 0.001). The adverse neuropsychiatric effects of INSTIs do not appear to be consistent across all WWH. Key characteristics (e.g., age, hepatitis positivity) may need consideration to fully weight the risk-benefit ratio of dolutegravir and elvitegravir in WWH.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MDD, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MDD, USA.
| | - Jane A O'Halloran
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Dionna W Williams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MDD, USA
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MDD, USA
| | - Yuliang Li
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MDD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexandra L Damron
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pauline M Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, ILD, USA
| | - Amanda B Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DCD, USA
| | | | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, New York City, , USA
| | - Joel Milam
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, CA, USA
| | - Kathleen M Weber
- CORE Center, Cook County Health and Hektoen Institute of Medicine, Chicago, IL, USA
| | - Adaora A Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Igho Ofotokun
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA
| | | | - Deborah Konkle-Parker
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MDD, USA
- Division of Biostatistics and Bioinformatics at The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MDD, USA
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18
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Wang Z, Peters BA, Bryant M, Hanna DB, Schwartz T, Wang T, Sollecito CC, Usyk M, Grassi E, Wiek F, Peter LS, Post WS, Landay AL, Hodis HN, Weber KM, French A, Golub ET, Lazar J, Gustafson D, Sharma A, Anastos K, Clish CB, Burk RD, Kaplan RC, Knight R, Qi Q. Gut microbiota, circulating inflammatory markers and metabolites, and carotid artery atherosclerosis in HIV infection. MICROBIOME 2023; 11:119. [PMID: 37237391 PMCID: PMC10224225 DOI: 10.1186/s40168-023-01566-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Alterations in gut microbiota have been implicated in HIV infection and cardiovascular disease. However, how gut microbial alterations relate to host inflammation and metabolite profiles, and their relationships with atherosclerosis, have not been well-studied, especially in the context of HIV infection. Here, we examined associations of gut microbial species and functional components measured by shotgun metagenomics with carotid artery plaque assessed by B-mode carotid artery ultrasound in 320 women with or at high risk of HIV (65% HIV +) from the Women's Interagency HIV Study. We further integrated plaque-associated microbial features with serum proteomics (74 inflammatory markers measured by the proximity extension assay) and plasma metabolomics (378 metabolites measured by liquid chromatography tandem mass spectrometry) in relation to carotid artery plaque in up to 433 women. RESULTS Fusobacterium nucleatum, a potentially pathogenic bacteria, was positively associated with carotid artery plaque, while five microbial species (Roseburia hominis, Roseburia inulinivorans, Johnsonella ignava, Odoribacter splanchnicus, Clostridium saccharolyticum) were inversely associated with plaque. Results were consistent between women with and without HIV. Fusobacterium nucleatum was positively associated with several serum proteomic inflammatory markers (e.g., CXCL9), and the other plaque-related species were inversely associated with proteomic inflammatory markers (e.g., CX3CL1). These microbial-associated proteomic inflammatory markers were also positively associated with plaque. Associations between bacterial species (especially Fusobacterium nucleatum) and plaque were attenuated after further adjustment for proteomic inflammatory markers. Plaque-associated species were correlated with several plasma metabolites, including the microbial metabolite imidazole-propionate (ImP), which was positively associated with plaque and several pro-inflammatory markers. Further analysis identified additional bacterial species and bacterial hutH gene (encoding enzyme histidine ammonia-lyase in ImP production) associated with plasma ImP levels. A gut microbiota score based on these ImP-associated species was positively associated with plaque and several pro-inflammatory markers. CONCLUSION Among women living with or at risk of HIV, we identified several gut bacterial species and a microbial metabolite ImP associated with carotid artery atherosclerosis, which might be related to host immune activation and inflammation. Video Abstract.
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Affiliation(s)
- Zheng Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - MacKenzie Bryant
- Department of Pediatrics, University of California, La Jolla, San Diego, CA, USA
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tara Schwartz
- Department of Pediatrics, University of California, La Jolla, San Diego, CA, USA
| | - Tao Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Mykhaylo Usyk
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Evan Grassi
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Fanua Wiek
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lauren St Peter
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Howard N Hodis
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Audrey French
- Department of Internal Medicine, Stroger Hospital of Cook County, Chicago, IL, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jason Lazar
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Robert D Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rob Knight
- Department of Pediatrics, University of California, La Jolla, San Diego, CA, USA
- Department of Bioengineering, University of California, La Jolla, San Diego, CA, USA
- Department of Computer Science and Engineering, University of California, La Jolla, San Diego, CA, USA
- Center for Microbiome Innovation, University of California, La Jolla, San Diego, CA, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Elbur AI, Ghebremichael M, Konkle-Parker D, Jones DL, Collins S, Adimora AA, Schneider MF, Cohen MH, Tamraz B, Plankey M, Wilson T, Adedimeji A, Haberer JE, Jacobson DL. Dual trajectories of antiretroviral therapy adherence and polypharmacy in women with HIV in the United States. AIDS Res Ther 2023; 20:29. [PMID: 37179294 PMCID: PMC10182649 DOI: 10.1186/s12981-023-00520-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Polypharmacy, using five or more medications, may increase the risk of nonadherence to prescribed treatment. We aimed to identify the interrelationship between trajectories of adherence to antiretroviral therapy (ART) and polypharmacy. METHODS We included women with HIV (aged ≥ 18) enrolled in the Women's Interagency HIV Study in the United States from 2014 to 2019. We used group-based trajectory modeling (GBTM) to identify trajectories of adherence to ART and polypharmacy and the dual GBTM to identify the interrelationship between adherence and polypharmacy. RESULTS Overall, 1,538 were eligible (median age of 49 years). GBTM analysis revealed five latent trajectories of adherence with 42% of women grouped in the consistently moderate trajectory. GBTM identified four polypharmacy trajectories with 45% categorized in the consistently low group. CONCLUSIONS The joint model did not reveal any interrelationship between ART adherence and polypharmacy trajectories. Future research should consider examining the interrelationship between both variables using objective measures of adherence.
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Affiliation(s)
| | | | - Deborah Konkle-Parker
- Schools of Nursing, Medicine and Population Health, University of Mississippi Medical Center, Jackson, MS USA
| | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL USA
| | - Shelby Collins
- Division of Infectious Disease, Emory University School of Medicine, Atlanta, GA USA
| | - Adaora A. Adimora
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Michael F. Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, IL USA
| | - Bani Tamraz
- School of Pharmacy, University of California, San Francisco, San Francisco, CA USA
| | - Michael Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC USA
| | - Tracey Wilson
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY USA
| | - Adebola Adedimeji
- Dept of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Jessica E. Haberer
- Center for Global Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Denise L. Jacobson
- Center for Biostatistics in AIDS Research, Department of Biostatistics , Harvard T. H. Chan School of Public Health, Boston, MA USA
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20
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Mei Z, Yin MT, Sharma A, Wang Z, Peters BA, Chandran A, Weber KM, Ross RD, Gustafson D, Zheng Y, Kaplan RC, Burk RD, Qi Q. Gut microbiota and plasma metabolites associated with bone mineral density in women with or at risk of HIV infection. AIDS 2023; 37:149-159. [PMID: 36205320 PMCID: PMC9742192 DOI: 10.1097/qad.0000000000003400] [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: 01/25/2023]
Abstract
OBJECTIVE To evaluate gut microbiota (GMB) alterations and metabolite profile perturbations associated with bone mineral density (BMD) in the context of HIV infection. DESIGN Cross-sectional studies of 58 women with chronic HIV infection receiving antiretroviral therapy and 33 women without HIV infection. METHODS We examined associations of GMB and metabolites with BMD among 91 women. BMD was measured by dual-energy X-ray absorptiometry (DXA), and T -scores of lumbar spine or total hip less than -1 defined low BMD. GMB was measured by 16S rRNA V4 region sequencing on fecal samples, and plasma metabolites were measured by liquid chromatography-tandem mass spectrometry. Associations of GMB with plasma metabolites were assessed in a larger sample (418 women; 280 HIV+ and 138 HIV-). RESULTS Relative abundances of five predominant bacterial genera ( Dorea , Megasphaera , unclassified Lachnospiraceae, Ruminococcus , and Mitsuokella ) were higher in women with low BMD compared with those with normal BMD (all linear discriminant analysis (LDA) scores >2.0). A distinct plasma metabolite profile was identified in women with low BMD, featuring lower levels of several metabolites belonging to amino acids, carnitines, caffeine, fatty acids, pyridines, and retinoids, compared with those with normal BMD. BMD-associated bacterial genera, especially Megasphaera , were inversely associated with several BMD-related metabolites (e.g. 4-pyridoxic acid, C4 carnitine, creatinine, and dimethylglycine). The inverse association of Megasphaera with dimethylglycine was more pronounced in women with HIV infection compared with those without HIV infection ( P for interaction = 0.016). CONCLUSION Among women with and at risk of HIV infection, we identified altered GMB and plasma metabolite profiles associated with low BMD.
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Affiliation(s)
- Zhendong Mei
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx
| | - Michael T Yin
- Department of Medicine, College of Physicians and Surgeons, Columbia University Irving Medical Center, New York
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Zheng Wang
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx
| | - Brandilyn A Peters
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Ryan D Ross
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, Illinois
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York
| | - Yan Zheng
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Robert D Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx
- Department of Pediatrics, Albert Einstein College of Medicine
- Department of Microbiology and Immunology, and Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx
- Department of Nutrition and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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21
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Drummond MB, Edmonds A, Ramirez C, Stosor V, Barjaktarevic I, Morris A, McCormack MC, Bhatt SP, Alcaide ML, Cribbs SK, D’Souza G, Bhandari N, Kunisaki KM, Huang L, Kassaye SG, Foronjy R, Sharma A, Westreich DJ, Adimora AA. Association Between HIV and Prevalence and Manifestations of Asthma: Analysis of the Multicenter AIDS Cohort Study and Women's Interagency HIV Study. J Acquir Immune Defic Syndr 2022; 91:419-428. [PMID: 36083508 PMCID: PMC9649933 DOI: 10.1097/qai.0000000000003088] [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: 04/25/2022] [Accepted: 08/17/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The association between HIV and asthma prevalence and manifestations remains unclear, with few studies including women. SETTING A retrospective observational cohort study from the Multicenter AIDS Cohort Study and Women's Interagency HIV Study. METHODS Asthma was defined in 2 ways: (1) self-report and (2) robust criteria requiring all the following: lack of fixed airflow obstruction, presence of wheeze on the St. George's Respiratory Questionnaire (SGRQ), and report of asthma therapies. Estimates of asthma prevalence and asthma-related manifestations were compared by HIV serostatus. RESULTS A total of 1815 men and 2122 women were included. Asthma prevalence did not differ between people with HIV (PWH) and people without HIV regardless of definition: self-report (men, 12.0% vs. 11.2%; women, 24.3% vs. 27.5%) and robust criteria (men, 5.0% vs. 3.4%; women, 12.8% vs. 13.2%). Among men with asthma, worse respiratory symptom burden was reported among those with HIV, regardless of asthma definition. Among women with self-reported asthma, those with HIV had less respiratory symptom burden. Regardless of serostatus, women with robust-defined asthma had similar respiratory symptoms across SGRQ domains and similar frequencies of phlegm, shortness of breath, and wheezing. CONCLUSIONS Among PWH and people without HIV, asthma prevalence was 2-fold to 3-fold higher using self-reported definition rather than robust definition. In men and women, HIV was not associated with increased asthma prevalence. In men, HIV was associated with more respiratory symptoms when asthma was self-reported; the relationship was attenuated with the robust criteria. Further studies are needed to explore asthma phenotypes among PWH.
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Affiliation(s)
- M. Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Edmonds
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Catalina Ramirez
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Valentina Stosor
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Chicago, IL
| | - Igor Barjaktarevic
- Division of Pulmonary Medicine, Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Alison Morris
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Meredith C. McCormack
- Division of Pulmonary Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Surya P. Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Maria L. Alcaide
- Department of Medicine, OB/GYN, and Public Health, University of Miami Miller School of Medicine, Miami, FL
| | - Sushma K. Cribbs
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA, USA; Atlanta Veterans Affairs Medical Center, Atlanta, GA
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Neha Bhandari
- Division of Pulmonary and Critical Care Medicine, Cook County Health, Chicago, IL
| | - Ken M. Kunisaki
- Pulmonary, Allergy, Critical Care and Sleep Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
| | - Laurence Huang
- Divisions of Pulmonary and Critical Care Medicine and HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, CA
| | - Seble G. Kassaye
- Department of Medicine, Georgetown University Medical Center, Georgetown University, Washington, DC
| | - Robert Foronjy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Anjali Sharma
- Divisions of General Internal Medicine and Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY
| | - Daniel J. Westreich
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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22
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Rubin LH, Bekhbat M, Turkson S, Mehta CC, Maki PM, Anastos K, Gustafson D, Spence AB, Milam J, Chow FC, Weber K, Springer G, Gange SJ, Neigh GN. Glucocorticoid Receptor Function and Cognitive Performance in Women With HIV. Psychosom Med 2022; 84:893-903. [PMID: 36044614 PMCID: PMC9553273 DOI: 10.1097/psy.0000000000001126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/18/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Alterations in glucocorticoid receptor (GCR) function may be a risk factor for cognitive complications among older people with human immunodeficiency virus (HIV). We evaluated whether HIV serostatus and age modify the GCR function-cognition association among women. METHODS Eighty women with HIV ( n = 40, <40 years of age [younger]; n = 40, >50 years of age [older]) and 80 HIV-uninfected women ( n = 40 older, n = 40 younger) enrolled in the Women's Interagency HIV Study completed a comprehensive neuropsychological test battery. Peripheral blood mononuclear cells collected concurrent with neuropsychological testing were assessed for GCR function. Multivariable linear regression analyses were conducted to examine whether a) HIV serostatus and age were associated with GCR function, and b) GCR function-cognition associations are moderated by HIV serostatus and age adjusting for relevant covariates. RESULTS Among older women, higher baseline FKBP5 expression level was associated with lower attention/working memory performance among women with HIV ( B = 6.4, standard error = 1.7, p = .0003) but not in women without HIV infection ( B = -1.7, standard error = 1.9, p = .37). There were no significant HIV serostatus by age interactions on dexamethasone (DEX)-stimulated expression of the genes regulated by the GCR or lipopolysaccharide-stimulated tumor necrosis factor α levels (with or without DEX stimulation; p values > .13). HIV serostatus was associated with GC target genes PER1 ( p = .006) and DUSP1 ( p = .02), but not TSC22D3 ( p = .32), after DEX stimulation. CONCLUSIONS Collectively, these data suggest that HIV serostatus and age may modify the influence of the GCR, such that the receptor is likely engaged to a similar extent, but the downstream influence of the receptor is altered, potentially through epigenetic modification of target genes.
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23
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Jin W, Ni Y, Rubin LH, Spence AB, Xu Y. A Bayesian nonparametric approach for inferring drug combination effects on mental health in people with HIV. Biometrics 2022; 78:988-1000. [PMID: 34145900 PMCID: PMC10515268 DOI: 10.1111/biom.13508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 05/11/2021] [Accepted: 05/19/2021] [Indexed: 11/27/2022]
Abstract
Although combination antiretroviral therapy (ART) with three or more drugs is highly effective in suppressing viral load for people with HIV (human immunodeficiency virus), many ART agents may exacerbate mental health-related adverse effects including depression. Therefore, understanding the effects of combination ART on mental health can help clinicians personalize medicine with less adverse effects to avoid undesirable health outcomes. The emergence of electronic health records offers researchers' unprecedented access to HIV data including individuals' mental health records, drug prescriptions, and clinical information over time. However, modeling such data is challenging due to high dimensionality of the drug combination space, the individual heterogeneity, and sparseness of the observed drug combinations. To address these challenges, we develop a Bayesian nonparametric approach to learn drug combination effect on mental health in people with HIV adjusting for sociodemographic, behavioral, and clinical factors. The proposed method is built upon the subset-tree kernel that represents drug combinations in a way that synthesizes known regimen structure into a single mathematical representation. It also utilizes a distance-dependent Chinese restaurant process to cluster heterogeneous populations while considering individuals' treatment histories. We evaluate the proposed approach through simulation studies, and apply the method to a dataset from the Women's Interagency HIV Study, showing the clinical utility of our model in guiding clinicians to prescribe informed and effective personalized treatment based on individuals' treatment histories and clinical characteristics.
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Affiliation(s)
- Wei Jin
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD 21218
| | - Yang Ni
- Department of Statistics, Texas A&M University, College Station, TX 77843
| | - Leah H. Rubin
- Departments of Neurology and Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Amanda B. Spence
- Department of Medicine, Georgetown University, Washington, DC 20057
| | - Yanxun Xu
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD 21218
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24
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Thompson EC, Muhammad JN, Adimora AA, Chandran A, Cohen MH, Crockett KB, Goparaju L, Henderson E, Kempf MC, Konkle-Parker D, Kwait J, Mimiaga M, Ofotokun I, Rubin L, Sharma A, Teplin LA, Vance DE, Weiser SD, Weiss DJ, Wilson TE, Turan JM, Turan B. Internalized HIV-Related Stigma and Neurocognitive Functioning Among Women Living with HIV. AIDS Patient Care STDS 2022; 36:336-342. [PMID: 36099481 PMCID: PMC9810353 DOI: 10.1089/apc.2022.0041] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The prevalence of HIV-associated neurocognitive impairment persists despite highly effective antiretroviral therapy (ART). In this study we explore the role of internalized stigma, acceptance of negative societal characterizations, and perceptions about people living with HIV (PLWH) on neurocognitive functioning (executive function, learning, memory, attention/working memory, psychomotor speed, fluency, motor skills) in a national cohort of women living with HIV (WLWH) in the United States. We utilized observational data from a multicenter study of WLWH who are mostly African American living in low-resource settings. Neurocognitive function was measured using an eight-test battery. A multiple linear regression model was constructed to investigate the relationship between internalized stigma and overall neurocognitive functioning (mean of all neurocognitive domain standardized T-scores), adjusting for age, education, race, previous neuropsychological battery scores, illicit drug use, viral load, and years on ART. Our analysis revealed that internalized HIV-related stigma is significantly associated with worse performance on individual domain tests and overall neurocognitive performance (B = 0.27, t = 2.50, p = 0.01). This suggests HIV-related internalized stigma may be negatively associated with neurocognitive functioning for WLWH. This finding highlights a specific psychosocial factor associated with poor neurocognitive function that may be targeted to better promote the health of PLWH. Future research on the longitudinal relationship between these variables and the effects of other stigma dimensions on poor neurocognitive function would provide further insights into the pathways explaining the relationship between internalized stigma and neurocognition.
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Affiliation(s)
- Emma C. Thompson
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Josh N. Muhammad
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adoara A. Adimora
- School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Aruna Chandran
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mardge H. Cohen
- Chicago Women's Interagency HIV Study, Chicago, Illinois, USA
| | - Kaylee B. Crockett
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lakshmi Goparaju
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Emmett Henderson
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mirjam-Colette Kempf
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jennafer Kwait
- Whitman-Walker Institute, Washington, District of Columbia, USA
| | - Matthew Mimiaga
- School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Igho Ofotokun
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Leah Rubin
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anjala Sharma
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Linda A. Teplin
- School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David E. Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sheri D. Weiser
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Deborah J. Weiss
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tracey E. Wilson
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Janet M. Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
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25
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Warren-Jeanpiere L, Goparaju L, Spence AB, Michel K, Wang C, Kikkisetti A, Kassaye S. "I Haven't Been Ill, I Know It's There": a Case Study Examination of the Social, Behavioral, Clinical, and Structural Factors that Contribute to Sustained Viremia Among Women Living with HIV. J Racial Ethn Health Disparities 2022; 9:1192-1205. [PMID: 34075566 PMCID: PMC8633077 DOI: 10.1007/s40615-021-01060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/24/2021] [Accepted: 05/13/2021] [Indexed: 01/21/2023]
Abstract
Compared to their HIV-seropositive male counterparts, HIV-seropositive women are less likely to achieve and retain viral suppression (VS). Data regarding the social, behavioral, clinical, and structural factors that facilitate or impede viral suppression among HIV-seropositive women is needed. This study aims to examine HIV-seropositive women's perceptions regarding factors that contribute to their HIV treatment decisions. Two case studies describe the HIV treatment decision-making of two never suppressed, HIV-seropositive women aged 65 and 54. The framework method of analysis was employed to obtain a descriptive overview of three interrelated areas of inquiry: (1) the meanings women give to VS; (2) social, behavioral, clinical, and structural obstacles related to HIV medication adherence; and (3) women's perceptions of what they need to achieve and sustain (VS). The meaning of VS for both women is influenced by how they currently feel. Women's general feeling of wellness detracts from any sense of urgency that may be associated with engaging in HIV treatment. Mistrust of medical providers and unstable housing/unemployment pose as obstacles to medication adherence. Finally, women's accounts of what they need to achieve and remain virally suppressed are influenced by a gap in understanding related to HIV treatment. HIV clinicians should routinely measure their patients' HIV health literacy to ensure patients understand when to begin and why they should continue an HIV treatment regimen. To increase their capacity to provide appropriate HIV care, providers should take into consideration how patients' life experiences and social locations influence their HIV treatment decision-making.
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Affiliation(s)
- Lari Warren-Jeanpiere
- Georgetown University Medical Center, 2115 Wisconsin Ave, NW, Suite 130, Washington DC 20007,Corresponding author – Lari Warren-Jeanpiere , (202) 687-1975
| | - Lakshmi Goparaju
- Georgetown University Medical Center, 2115 Wisconsin Ave, NW, Suite 130, Washington DC 20007
| | - Amanda Blair Spence
- Georgetown University Medical Center, 2115 Wisconsin Ave, NW, Suite 130, Washington DC 20007,Department of Medicine/Division of Infectious Diseases, 3800 Reservoir Road, NW, Georgetown University, Washington DC, 20007
| | - Kate Michel
- Georgetown University Medical Center, 2115 Wisconsin Ave, NW, Suite 130, Washington DC 20007
| | - Cuiwei Wang
- Georgetown University Medical Center, 2115 Wisconsin Ave, NW, Suite 130, Washington DC 20007
| | - Anjali Kikkisetti
- Georgetown University Medical Center, 2115 Wisconsin Ave, NW, Suite 130, Washington DC 20007
| | - Seble Kassaye
- Georgetown University Medical Center, 2115 Wisconsin Ave, NW, Suite 130, Washington DC 20007,Department of Medicine/Division of Infectious Diseases, 3800 Reservoir Road, NW, Georgetown University, Washington DC, 20007
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26
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Cohen MH, Benning L, Weber KM, Sharma A, Plankey M, Kempf MC, Wilson TE, Aouizerat B, Milam J, Adimora AA, Wingood G, Carrico AW. Predictors and Consequences of Prescription Opioid Use in Women Living With and Without HIV: 20-Year Follow-Up. J Womens Health (Larchmt) 2022; 31:1188-1196. [PMID: 35230165 PMCID: PMC9419927 DOI: 10.1089/jwh.2021.0231] [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: 02/02/2023] Open
Abstract
Objective: To examine predictors and consequences of prescription opioid use among a cohort of women living with HIV (WLWH) and women without HIV from 2000 to 2019. Materials and Methods: The Women's Interagency HIV Study is a multisite, prospective cohort study. Cumulative proportion of visits with prescription opioid use was categorized as follows: minimal (0%-9%), intermediate (10%-39%), and chronic (>40%). Logistic regression examined independent predictors, and proportional hazards regression estimated unadjusted and adjusted hazards of all-cause mortality, comparing intermediate and chronic prescription opioid use with minimal use. Results: Annual prevalence of prescription opioid use significantly increased from 12.6% to 19.3% from 2000 to 2019 (p < 0.0001). Prescription opioid use was minimal in 75%, intermediate in 16%, and chronic in 9% of women. WLWH had 56% higher odds of chronic prescription opioid use compared with women without HIV. Even after adjusting for quality-of-life scores including ratings of pain, women with intermediate and chronic prescription opioid use had greater odds of being sexual minorities (lesbian or bisexual), unemployed, and were more likely to report benzodiazepine and nonprescription substance use compared with those with minimal use. Intermediate and chronic prescription opioid use were each associated with an almost 1.5-fold increased risk of all-cause mortality. Conclusions: Despite federally mandated opioid prescribing guidelines, prescription opioid use and related mortality significantly increased in women experiencing physical and psychosocial vulnerabilities. The higher mortality rate found among prescription opioid users may reflect the many underlying chronic medical and psychosocial conditions for which these opioids were prescribed, as well as complications of opioids themselves. Findings underscore the need for non-opioid and nonpharmacological interventions for chronic pain, particularly in sexual minorities and WLWH. Avoiding concurrent use of opioids with benzodiazepines and nonprescription drugs might reduce mortality. Clinical Trial Registration Number: NCT00000797.
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Affiliation(s)
- Mardge H. Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, USA.,Address correspondence to: Mardge H. Cohen, MD, WIHS, 2225 W. Harrison, Chicago, IL 60612, USA
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kathleen M. Weber
- Hektoen Institute of Medicine, Cook County Health and Hospitals System, Chicago, Illinois, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Plankey
- Division of General Medicine, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Mirjam-Colette Kempf
- Department of Family, Community and Health Systems, Health Behavior, Epidemiology and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Brad Aouizerat
- Department of Oral and Maxillofacial Surgery, Bluestone Center for Clinical Research, College of Dentistry, New York University, New York, New York, USA
| | - Joel Milam
- Department of Epidemiology, School of Population Health, University of California at Irvine, Irvine, California, USA
| | - Adaora A. Adimora
- Department of Medicine, University of North Carolina School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gina Wingood
- Department of Sociomedical Sciences, Mailman School of Public Health, Lerner Center for Public Health Promotion, New York, New York, USA.,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Adam W. Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
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27
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Wang Z, Peters BA, Usyk M, Xing J, Hanna DB, Wang T, Post WS, Landay AL, Hodis HN, Weber K, French A, Golub ET, Lazar J, Gustafson D, Kassaye S, Aouizerat B, Haberlen S, Malvestutto C, Budoff M, Wolinsky SM, Sharma A, Anastos K, Clish CB, Kaplan RC, Burk RD, Qi Q. Gut Microbiota, Plasma Metabolomic Profiles, and Carotid Artery Atherosclerosis in HIV Infection. Arterioscler Thromb Vasc Biol 2022; 42:1081-1093. [PMID: 35678187 PMCID: PMC9339474 DOI: 10.1161/atvbaha.121.317276] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Alterations in gut microbiota and blood metabolomic profiles have been implicated in HIV infection and cardiovascular disease. However, it remains unclear whether alterations in gut microbiota may contribute to disrupted host blood metabolomic profiles in relation to atherosclerosis, especially in the context of HIV infection. METHODS We analyzed cross-sectional associations between gut microbiota features and carotid artery plaque in 361 women with or at high risk of HIV (67% HIV+), and further integrated plaque-associated microbial features with plasma lipidomic/metabolomic profiles. Furthermore, in 737 women and men, we examined prospective associations of baseline gut bacteria-associated lipidomic and metabolomic profiles with incident carotid artery plaque over 7-year follow-up. RESULTS We found 2 potentially pathogenic bacteria, Fusobacterium and Proteus, were associated with carotid artery plaque; while the beneficial butyrate producer Odoribacter was inversely associated with plaque. Fusobacterium and Proteus were associated with multiple lipids/metabolites which were clustered into 8 modules in network. A module comprised of 9 lysophosphatidylcholines and lysophosphatidylethanolamines and a module comprised of 9 diglycerides were associated with increased risk of carotid artery plaque (risk ratio [95% CI], 1.34 [1.09-1.64] and 1.24 [1.02-1.51] per SD increment, respectively). Functional analyses identified bacterial enzymes in lipid metabolism associated with these plasma lipids. In particular, phospholipase A1 and A2 are the key enzymes in the reactions producing lysophosphatidylcholines and lysophosphatidylethanolamines. CONCLUSIONS Among individuals with or at high risk of HIV infection, we identified altered gut microbiota and related functional capacities in the lipid metabolism associated with disrupted plasma lipidomic profiles and carotid artery atherosclerosis.
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Affiliation(s)
- Zheng Wang
- Department of Epidemiology and Population Health (Z.W., B.A.P., J.X., D.B.H., T.W., K.A., R.C.K., R.D.B., Q.Q.), Albert Einstein College of Medicine, Bronx, New York
| | - Brandilyn A Peters
- Department of Epidemiology and Population Health (Z.W., B.A.P., J.X., D.B.H., T.W., K.A., R.C.K., R.D.B., Q.Q.), Albert Einstein College of Medicine, Bronx, New York
| | - Mykhaylo Usyk
- Department of Pediatrics (M.U., R.D.B.), Albert Einstein College of Medicine, Bronx, New York
| | - Jiaqian Xing
- Department of Epidemiology and Population Health (Z.W., B.A.P., J.X., D.B.H., T.W., K.A., R.C.K., R.D.B., Q.Q.), Albert Einstein College of Medicine, Bronx, New York
| | - David B Hanna
- Department of Epidemiology and Population Health (Z.W., B.A.P., J.X., D.B.H., T.W., K.A., R.C.K., R.D.B., Q.Q.), Albert Einstein College of Medicine, Bronx, New York
| | - Tao Wang
- Department of Epidemiology and Population Health (Z.W., B.A.P., J.X., D.B.H., T.W., K.A., R.C.K., R.D.B., Q.Q.), Albert Einstein College of Medicine, Bronx, New York
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University, Baltimore, MD (W.S.P.)
| | - Alan L Landay
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL (A.L.L)
| | - Howard N Hodis
- Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles (H.N.H.)
| | | | - Audrey French
- Department of Internal Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL (A.F.)
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.T.G., S.H.)
| | - Jason Lazar
- Department of Medicine (J.L.), State University of New York Downstate Medical Center, Brooklyn
| | - Deborah Gustafson
- Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington DC (S.K.)
| | | | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (E.T.G., S.H.)
| | | | - Matthew Budoff
- David Geffen School of Medicine, University of California, Los Angeles (M.B.)
| | - Steven M Wolinsky
- Department of Medicine, Feinberg School of Medicine, Northwestern University Chicago, IL (S.M.W.)
| | - Anjali Sharma
- Department of Medicine (A.S., K.A.), Albert Einstein College of Medicine, Bronx, New York
| | - Kathryn Anastos
- Department of Epidemiology and Population Health (Z.W., B.A.P., J.X., D.B.H., T.W., K.A., R.C.K., R.D.B., Q.Q.), Albert Einstein College of Medicine, Bronx, New York.,Department of Medicine (A.S., K.A.), Albert Einstein College of Medicine, Bronx, New York
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA (C.B.C.)
| | - Robert C Kaplan
- Department of Epidemiology and Population Health (Z.W., B.A.P., J.X., D.B.H., T.W., K.A., R.C.K., R.D.B., Q.Q.), Albert Einstein College of Medicine, Bronx, New York.,Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (R.C.K.)
| | - Robert D Burk
- Department of Epidemiology and Population Health (Z.W., B.A.P., J.X., D.B.H., T.W., K.A., R.C.K., R.D.B., Q.Q.), Albert Einstein College of Medicine, Bronx, New York.,Department of Pediatrics (M.U., R.D.B.), Albert Einstein College of Medicine, Bronx, New York.,Department of Microbiology & Immunology (R.D.B.), Albert Einstein College of Medicine, Bronx, New York
| | - Qibin Qi
- Department of Epidemiology and Population Health (Z.W., B.A.P., J.X., D.B.H., T.W., K.A., R.C.K., R.D.B., Q.Q.), Albert Einstein College of Medicine, Bronx, New York.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (Q.Q.)
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28
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Mehta CC, Hagen KS, Collins LF, Moore RH, Ofotokun I. Nested and multipart prospective observational studies, flaming fiasco or efficiently economical?: The Brain, Bone, Heart case study. BMC Med Res Methodol 2022; 22:203. [PMID: 35879677 PMCID: PMC9310359 DOI: 10.1186/s12874-022-01675-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 07/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Collecting new data from cross-sectional/survey and cohort observational study designs can be expensive and time-consuming. Nested (hierarchically cocooned within an existing parent study) and/or Multipart (≥ 2 integrally interlinked projects) study designs can expand the scope of a prospective observational research program beyond what might otherwise be possible with available funding and personnel. The Brain, Bone, Heart (BBH) study provides an exemplary case to describe the real-world advantages, challenges, considerations, and insights from these complex designs. MAIN: BBH is a Nested, Multipart study conducted by the Specialized Center for Research Excellence (SCORE) on Sex Differences at Emory University. BBH is designed to examine whether estrogen insufficiency-induced inflammation compounds HIV-induced inflammation, leading to end-organ damage and aging-related co-morbidities affecting the neuro-hypothalamic-pituitary-adrenal axis (brain), musculoskeletal (bone), and cardiovascular (heart) organ systems. Using BBH as a real-world case study, we describe the advantages and challenges of Nested and Multipart prospective cohort study design in practice. While excessive dependence on its parent study can pose challenges in a Nested study, there are significant advantages to the study design as well. These include the ability to leverage a parent study's resources and personnel; more comprehensive data collection and data sharing options; a broadened community of researchers for collaboration; dedicated longitudinal research participants; and, access to historical data. Multipart, interlinked studies that share a common cohort of participants and pool of resources have the advantage of dedicated key personnel and the challenge of increased organizational complexity. Important considerations for each study design include the stability and administration of the parent study (Nested) and the cohesiveness of linkage elements and staff organizational capacity (Multipart). CONCLUSION Using the experience of BBH as an example, Nested and/or Multipart study designs have both distinct advantages and potential vulnerabilities that warrant consideration and require strong biostatistics and data management leadership to optimize programmatic success and impact.
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Affiliation(s)
- C Christina Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA.
| | - Kimberly S Hagen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Lauren F Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
- Grady Infectious Diseases Program, Grady Health System, 341 Ponce De Leon Ave NE, Atlanta, GA, 30308, USA
| | - Renee' H Moore
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
- Grady Infectious Diseases Program, Grady Health System, 341 Ponce De Leon Ave NE, Atlanta, GA, 30308, USA
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29
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Xue X, Hua S, Weber K, Qi Q, Kaplan R, Gustafson DR, Sharma A, French A, Burgess HJ. Jointly modeling of sleep variables that are objectively measured by wrist actigraphy. Stat Med 2022; 41:2804-2821. [PMID: 35417078 PMCID: PMC9942772 DOI: 10.1002/sim.9385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/27/2022] [Accepted: 03/07/2022] [Indexed: 02/01/2023]
Abstract
Recently developed actigraphy devices have made it possible for continuous and objective monitoring of sleep over multiple nights. Sleep variables captured by wrist actigraphy devices include sleep onset, sleep end, total sleep time, wake time after sleep onset, number of awakenings, etc. Currently available statistical methods to analyze such actigraphy data have limitations. First, averages over multiple nights are used to summarize sleep activities, ignoring variability over multiple nights from the same subject. Second, sleep variables are often analyzed independently. However, sleep variables tend to be correlated with each other. For example, how long a subject sleeps at night can be correlated with how long and how frequent he/she wakes up during that night. It is important to understand these inter-relationships. We therefore propose a joint mixed effect model on total sleep time, number of awakenings, and wake time. We develop an estimating procedure based upon a sequence of generalized linear mixed effects models, which can be implemented using existing software. The use of these models not only avoids computational intensity and instability that may occur by directly applying a numerical algorithm on a complicated joint likelihood function, but also provides additional insights on sleep activities. We demonstrated in simulation studies that the proposed estimating procedure performed well in estimating both fixed and random effects' parameters. We applied the proposed model to data from the Women's Interagency HIV Sleep Study to examine the association of employment status and age with overall sleep quality assessed by several actigraphy measured sleep variables.
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Affiliation(s)
- Xiaonan Xue
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Simin Hua
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kathleen Weber
- Core Center of Cook County Health, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Qibin Qi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Robert Kaplan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Deborah R. Gustafson
- Department of Neurology, Section for Neuro Epidemiology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Audrey French
- Core Center of Cook County Health, Stroger Hospital of Cook County, Chicago, Illinois, USA,Division of Infectious Diseases, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Helen J. Burgess
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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30
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Rubin LH, Neijna AG, Shi Q, Hoover DR, Tamraz B, Anastos K, Edmonds A, Fischl MA, Gustafson D, Maki PM, Merenstein D, Sheth AN, Springer G, Vance D, Weber KM, Sharma A. Degree of Polypharmacy and Cognitive Function in Older Women with HIV. AIDS Res Hum Retroviruses 2022; 38:571-579. [PMID: 35357949 PMCID: PMC9297323 DOI: 10.1089/aid.2021.0231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The number of people with HIV (PWH) experiencing age-associated comorbidities including those treated with medications and cognitive impairment is increasing. We examined associations between polypharmacy and cognition in older women with HIV (WWH) given their vulnerability to this comorbidity. Cross-sectional analysis capitalizing on Women's Interagency HIV Study data collected between 2014 and 2017. WWH meeting the following criteria were analyzed: age ≥50 years; availability of self-reported non-antiretroviral therapy (ART) medications data; and neuropsychological data. The number of non-ART medications used regularly in the prior 6 months was summed. Polypharmacy was categorized as none/low (0-4), moderate (5-9), or severe (≥10). Multivariable linear regression analyses examined polypharmacy-cognition (T-score) associations in the total sample and among virally suppressed (VS; < 20 copies/mL)-WWH after covariate adjustment for enrollment site, income, depressive symptoms, substance use (smoking, heavy alcohol, marijuana, crack, cocaine, and/or heroin), the Veterans Aging Cohort Study index (indicators of HIV disease and organ system function, hepatitis C virus serostatus), ART use, nadir CD4 count, and specific ART drugs (efavirenz, integrase inhibitors). We included 637 women (median age = 55 years; 72% Black). Ninety-four percent reported ART use in the past 6 months and 75% had HIV RNA <20 copies/mL. Comorbidity prevalence was high (61% hypertension; 26% diabetes). Moderate and severe polypharmacy in WWH were 34% and 24%. In WWH, severe polypharmacy was associated with poorer executive function (p = .007) and processing speed (p = .01). The same pattern of findings remained among VS-WWH. Moderate polypharmacy was not associated with cognition. Moderate and severe polypharmacy were common and associated with poorer executive function and processing speed in WWH. Severe polypharmacy may be a major contributor to the persistence of domain-specific cognitive complications in older WWH above and beyond the conditions that these medications are used to treat.
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Affiliation(s)
- Leah H. Rubin
- Department of Neurology and Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ava G. Neijna
- Department of Neurology and Baltimore, Maryland, USA
| | - Qiuhu Shi
- New York Medical College, Valhalla, New York, USA
| | | | - Bani Tamraz
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, California, USA
| | | | - Andrew Edmonds
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Deborah Gustafson
- Department of Neurology, SUNY-Downstate Medical Center, Brooklyn, New York, USA
| | - Pauline M. Maki
- Department of Psychology and Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | | | - Gayle Springer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David Vance
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA
| | - Kathleen M. Weber
- Cook County Health & Hospital System/Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Anjali Sharma
- Albert Einstein College of Medicine, Bronx, New York, USA
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Psomas CK, Hoover DR, Shi Q, Brown TT, Vance DE, Holman S, Plankey MW, Tien PC, Weber KM, Floris-Moore M, Bolivar HH, Golub ET, McDonnell Holstad M, Radtke KK, Tamraz B, Erlandson KM, Rubin LH, Sharma A. Polypharmacy Is Associated With Falls in Women With and Without HIV. J Acquir Immune Defic Syndr 2022; 90:351-359. [PMID: 35333216 PMCID: PMC9203977 DOI: 10.1097/qai.0000000000002955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aging in people with HIV is associated with increased risk of developing synergistic conditions such as neurocognitive impairment, polypharmacy, and falls. We assessed associations between polypharmacy (use of 5 or more non-ART medications), use of neurocognitive adverse effects (NCAE) medications, and odds of falls in women with HIV (WWH) and without HIV (HIV-). METHODS Self-reported falls and medication use data were contributed semiannually by 1872 (1315 WWH and 557 HIV-) Women's Interagency HIV Study participants between 2014 and 2016. Polypharmacy and NCAE medication use were evaluated separately and jointly in multivariable models to assess their independent contributions to single and multiple falls risk. RESULTS The proportion of women who reported any fall was similar by HIV status (19%). WWH reported both greater polypharmacy (51% vs. 41%; P < 0.001) and NCAE medication use (44% vs. 37%; P = 0.01) than HIV- women. Polypharmacy conferred elevated odds of single fall [adjusted odds ratio (aOR) 1.67, 95% CI: 1.36 to 2.06; P < 0.001] and multiple falls (aOR 2.31, 95% CI: 1.83 to 2.93; P < 0.001); the results for NCAE medications and falls were similar. Both polypharmacy and number of NCAE medications remained strongly and independently associated with falls in multivariable models adjusted for HIV serostatus, study site, sociodemographics, clinical characteristics, and substance use. CONCLUSIONS Polypharmacy and NCAE medication use were greater among WWH compared with HIV-, and both were independently and incrementally related to falls. Deprescribing and avoidance of medications with NCAEs may be an important consideration for reducing fall risk among WWH and sociodemographically similar women without HIV.
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Affiliation(s)
- Christina K Psomas
- Department of Infectious Diseases and Internal Medicine, European Hospital Marseille, Marseille, France
| | - Donald R Hoover
- Department of Statistics and Biostatistics and Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, NJ
| | - Qiuhu Shi
- Department of Epidemiology and Community Health, New York Medical College, Valhalla, NY
| | - Todd T Brown
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University, School of Medicine, Baltimore, MD
| | - David E Vance
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL
| | - Susan Holman
- Department of Medicine/STAR Program, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Phyllis C Tien
- Department of VA Medical Center, San Fransisco, CA
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Kathleen M Weber
- Department of Medicine, Cook County Health/CORE Center and Hektoen Institute of Medicine, Chicago, IL
| | | | - Hector H Bolivar
- Department of Medicine, University of Miami Health System, Miami, FL
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Kendra K Radtke
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco School of Pharmacy, San Francisco, CA
| | - Bani Tamraz
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
| | - Leah H Rubin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; and
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
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Spence AB, Liu C, Rubin L, Aouizerat B, Vance DE, Bolivar H, Lahiri CD, Adimora AA, Weber K, Gustafson D, Sosanya O, Turner RS, Kassaye S. Class-Based Antiretroviral Exposure and Cognition Among Women Living with HIV. AIDS Res Hum Retroviruses 2022; 38:561-570. [PMID: 35109713 PMCID: PMC9297324 DOI: 10.1089/aid.2021.0097] [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: 02/02/2023] Open
Abstract
Neurologic complications of the human immunodeficiency virus (HIV) are common in treated individuals, and toxicity of certain antiretroviral therapies (ART) may contribute to cognitive impairment. We investigated exposures to specific ART and cognition among women living with HIV (WLWH). Virologically suppressed (viral load <200 copies/mL during at least two semi-annual visits) WLWH and age/race matched HIV-seronegative controls enrolled in the Women's Interagency HIV Study who completed at least two biennial cognitive assessments were included. Analysis of WLWH was restricted to those with exposure to the drug class of interest and a nucleoside reverse transcriptase inhibitor (NRTI) backbone. Generalized estimating equations were used to evaluate repeated measures of cognition over time in association with ART class exposure. Among 1,242 eligible WLWH, 20% (n = 247) had isolated drug exposure to non-nucleoside reverse transcriptase inhibitors (NNRTI), 18% (n = 219) to protease inhibitors (PIs), and 6% (n = 79) to integrase inhibitors with a NRTI backbone. Cognitive assessments were performed at a median of 3 biennial visits {IQR 2-4 visits}. At the index assessment, 21% of WLWH demonstrated global cognitive impairment versus 29% at their last cognitive assessment. In multivariable analyses adjusted for hypertension, depression, diabetes mellitus, history of AIDS-defining illness, alcohol use, number of medications, and time on ART, WLWH exposed to NNRTIs demonstrated verbal learning improvements (mean T-score change 1.3, p = .020) compared to other treated women. Compared to HIV-seronegative women, WLWH exposed to PIs had worse verbal learning (mean T-score difference -2.62, p = .002) and verbal memory performance (mean T-score difference -1.74, p = .032) at baseline. Compared to HIV-seronegative women, WLWH exposed to PIs had improvements in verbal learning (mean T-score slope difference 0.36, p = .025) and verbal memory (mean T-score slope difference 0.32, p = .042). The index T-score and slope of change in the T-score were similar among other treated groups and the HIV-seronegative group. We noted emerging trends in cognition in WLWH exposed to specific drug classes. Ongoing study of this relatively young group is important to characterize long-term cognitive outcomes and effect of antiretrovirals as treatment guidelines evolve.
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Affiliation(s)
- Amanda Blair Spence
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA.,Address correspondence to: Amanda Blair Spence, Division of Infectious Diseases, Georgetown University Medical Center, 3800 Reservoir Road NW, 5th Floor PHC, Washington, DC 20007, USA
| | - Chenglong Liu
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Leah Rubin
- Department of Neurology and John Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, and John Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Psychiatry, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bradley Aouizerat
- Department of Oral and Maxillofacial Surgery, College of Dentistry, New York University, New York, New York, USA.,Bluestone Center for Clinical Research, College of Dentistry, New York University, New York, New York, USA
| | - David Eugene Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hector Bolivar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Cecile Delille Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine and Grady Healthcare System, Atlanta, Georgia, USA
| | - Adaora A. Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathleen Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York-Downstate Health Sciences University, Brooklyn, New York, USA
| | - Oluwakemi Sosanya
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Raymond Scott Turner
- Department of Neurology, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Seble Kassaye
- Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia, USA
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Li F, Buchanan AL, Cole SR. Generalizing trial evidence to target populations in non-nested designs: Applications to AIDS clinical trials. J R Stat Soc Ser C Appl Stat 2022; 71:669-697. [PMID: 35968541 PMCID: PMC9367209 DOI: 10.1111/rssc.12550] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Comparative effectiveness evidence from randomized trials may not be directly generalizable to a target population of substantive interest when, as in most cases, trial participants are not randomly sampled from the target population. Motivated by the need to generalize evidence from two trials conducted in the AIDS Clinical Trials Group (ACTG), we consider weighting, regression and doubly robust estimators to estimate the causal effects of HIV interventions in a specified population of people living with HIV in the USA. We focus on a non-nested trial design and discuss strategies for both point and variance estimation of the target population average treatment effect. Specifically in the generalizability context, we demonstrate both analytically and empirically that estimating the known propensity score in trials does not increase the variance for each of the weighting, regression and doubly robust estimators. We apply these methods to generalize the average treatment effects from two ACTG trials to specified target populations and operationalize key practical considerations. Finally, we report on a simulation study that investigates the finite-sample operating characteristics of the generalizability estimators and their sandwich variance estimators.
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Affiliation(s)
- Fan Li
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
- Center for Methods in Implementation and Prevention Science, Yale University, New Haven, Connecticut, USA
| | - Ashley L. Buchanan
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Stephen R. Cole
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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34
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Daniels J, Aldous A, Pyra M, Xia Y, Juzumaite M, Jais M, Simmens S, Murphy K, Taylor TN, Kassaye S, Benning L, Cohen MH, Weber KM, Ghosh M. Lifetime sexual violence exposure in women compromises systemic innate immune mediators associated with HIV pathogenesis: A cross-sectional analysis. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221099486. [PMID: 35579000 PMCID: PMC9118419 DOI: 10.1177/17455057221099486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Violence and HIV/AIDS syndemic highly prevalent among women impairs HIV prevention efforts. Prolonged exposure to violence results in physical trauma and psychological distress. Building on previous findings regarding genital immune dysregulation following sexual abuse exposure, we investigate here whether systemic changes occur as well. METHODS Using the Women's Interagency HIV Study repository, 77 women were stratified by HIV serostatus and categorized into four subgroups: (1) no sexual abuse history and lower depression score (Control); (2) no sexual abuse history but higher depression score (Depression); (3) high sexual abuse exposure and lower depression score (Abuse); (4) high sexual abuse exposure and higher depression score (Abuse + Depression). Inflammation-associated immune biomarkers (TNF-α, IL-6, IL-1α, IL-1β, TGF-β, MIP-3α, IP-10, MCP-1, and Cathepsin-B) and anti-inflammatory/anti-HIV biomarkers (Secretory leukocyte protease inhibitor, Elafin, human beta-defensin-2 (HBD-2), alpha-defensins 1-3, Thrombospondin, Serpin-A1, and Cystatin-C) were measured in plasma using enzyme-linked immunosorbent assay. Within each HIV serostatus, differences in biomarker levels between subgroups were evaluated with Kruskal-Wallis and Dunn's test with Bonferroni correction. Spearman correlations between biomarkers were assessed for each subgroup. RESULTS Compared to the Control and Depression groups, Abuse + Depression was associated with significantly higher levels of chemokines MIP-3α and IP-10 (p < 0.01) and lower levels of inflammatory cytokine IL-1β (p < 0.01) in the HIV-uninfected population. Human beta-defensin-2 was lowest in the Abuse + Depression group (p < 0.05 versus Depression). By contrast, among HIV-infected, Abuse and Abuse + Depression were associated with lower levels of MIP-3α (p < 0.05 versus Control) and IP-10 (p < 0.05, Abuse versus Control). Inflammatory cytokine IL-6 was higher in both Abuse groups (p < 0.05 versus Control), while Elafin was lowest in the Abuse + Depression group (p < 0.01 versus Depression). CONCLUSION We report compromised plasma immune responses that parallel previous findings in the genital mucosa, based on sexual abuse and HIV status. Systemic biomarkers may indicate trauma exposure and impact risk of HIV acquisition/transmission.
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Affiliation(s)
- Jason Daniels
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Annette Aldous
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Maria Pyra
- The Chicago Center for HIV Elimination, The University of Chicago, Chicago, IL, USA
| | - Yu Xia
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Monika Juzumaite
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Mariel Jais
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Samuel Simmens
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Kerry Murphy
- Albert Einstein College of Medicine—Montefiore Medical Center, Bronx, NY, USA
| | - Tonya N Taylor
- SUNY Downstate Medical Center, The State University of New York, Brooklyn, NY, USA
| | - Seble Kassaye
- Georgetown University Medical Center, Washington, DC, USA
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mardge H Cohen
- Cook County Health and Hospitals System, Hektoen Institute of Medicine, Chicago, IL, USA
| | - Kathleen M Weber
- Cook County Health and Hospitals System, Hektoen Institute of Medicine, Chicago, IL, USA
| | - Mimi Ghosh
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA,Mimi Ghosh, Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA.
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35
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Saigusa R, Roy P, Freuchet A, Gulati R, Ghosheh Y, Suthahar SSA, Durant CP, Hanna DB, Kiosses WB, Orecchioni M, Wen L, Wu R, Kuniholm MH, Landay AL, Anastos K, Tien PC, Gange SJ, Kassaye S, Vallejo J, Hedrick CC, Kwok WW, Sette A, Hodis HN, Kaplan RC, Ley K. Single cell transcriptomics and TCR reconstruction reveal CD4 T cell response to MHC-II-restricted APOB epitope in human cardiovascular disease. NATURE CARDIOVASCULAR RESEARCH 2022; 1:462-475. [PMID: 35990517 PMCID: PMC9383695 DOI: 10.1038/s44161-022-00063-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/04/2022] [Indexed: 02/02/2023]
Abstract
Atherosclerosis is accompanied by a CD4 T cell response to apolipoprotein B (APOB). Major Histocompatibility Complex (MHC)-II tetramers can be used to isolate antigen-specific CD4 T cells by flow sorting. Here, we produce, validate and use an MHC-II tetramer, DRB1*07:01 APOB-p18, to sort APOB-p18-specific cells from peripheral blood mononuclear cell samples from 8 DRB1*07:01+ women with and without subclinical cardiovascular disease (sCVD). Single cell RNA sequencing showed that transcriptomes of tetramer+ cells were between regulatory and memory T cells in healthy women and moved closer to memory T cells in women with sCVD. TCR sequencing of tetramer+ cells showed clonal expansion and V and J segment usage similar to those found in regulatory T cells. These findings suggest that APOB-specific regulatory T cells may switch to a more memory-like phenotype in women with atherosclerosis. Mouse studies showed that such switched cells promote atherosclerosis.
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Affiliation(s)
| | - Payel Roy
- La Jolla Institute for Immunology, La Jolla, CA, USA
| | | | - Rishab Gulati
- La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Yanal Ghosheh
- La Jolla Institute for Immunology, La Jolla, CA, USA
| | | | | | - David B. Hanna
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY, USA
| | | | | | - Lai Wen
- La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Runpei Wu
- La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Mark H. Kuniholm
- University at Albany, Department of Epidemiology and Biostatistics, Rensselaer, NY, USA
| | - Alan L. Landay
- Rush University Medical Center, Department of Internal Medicine, Chicago, IL, USA
| | - Kathryn Anastos
- Albert Einstein College of Medicine, Departments of Medicine and Epidemiology & Population Health, Bronx NY, USA
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Stephen J. Gange
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore MD, USA
| | - Seble Kassaye
- Georgetown University, Georgetown University Medical Center, Washington, DC, USA
| | | | | | - William W. Kwok
- Benaroya Research Institute at Virginia Mason, Tetramer Core Laboratory, Seattle, WA, USA
| | | | - Howard N. Hodis
- Keck School of Medicine, University of Southern California Departments of Medicine and Population and Public Health Sciences, Los Angeles, CA, USA
- Atherosclerosis Research Unit, University of Southern California, Los Angeles, CA, USA
| | - Robert C. Kaplan
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY, USA
- Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, WA, USA
| | - Klaus Ley
- La Jolla Institute for Immunology, La Jolla, CA, USA
- University of California San Diego, San Diego, CA, USA
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36
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Liang X, Sinha R, Justice AC, Cohen MH, Aouizerat BE, Xu K. A new monocyte epigenetic clock reveals nonlinear effects of alcohol consumption on biological aging in three independent cohorts (N = 2242). Alcohol Clin Exp Res 2022; 46:736-748. [PMID: 35257385 PMCID: PMC9117474 DOI: 10.1111/acer.14803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Assessing the effect of alcohol consumption on biological age is essential for understanding alcohol use-related comorbidities and mortality. Previously developed epigenetic clocks are mainly based on DNA methylation in heterogeneous cell types, which provide limited knowledge on the impacts of alcohol consumption at the individual cellular level. Evidence shows that monocytes play an important role in both alcohol-induced pathophysiology and the aging process. In this study, we developed a novel monocyte-based DNA methylation clock (MonoDNAmAge) to assess the impact of alcohol consumption on monocyte age. METHODS A machine learning method was applied to select a set of chronological age-associated DNA methylation CpG sites from 1202 monocyte methylomes. Pearson correlation was tested between MonoDNAmAge and chronological age in three independent cohorts (Ntotal = 2242). Using the MonoDNAmAge clock and four established clocks (i.e., HorvathDNAmAge, HannumDNAmAge, PhenoDNAmAge, GrimDNAmAge), we then evaluated the effect of alcohol consumption on epigenetic aging in the three cohorts [i.e., Yale Stress Center Community Study (YSCCS), Veteran Aging Cohort Study (VACS), Women's Interagency HIV Study (WIHS)] using linear and quadratic models. RESULTS The MonoDNAmAge, comprised of 186 CpG sites, was moderately to strongly correlated with chronological age in the three cohorts (r = 0.90, p = 3.12E-181 in YSCCS; r = 0.54, p = 1.75E-96 in VACS; r = 0.66, p = 1.50E-60 in WIHS). More importantly, we found a nonlinear association between MonoDNAmAge and alcohol consumption (pmodel = 4.55E-08, px2 = 7.80E-08 in YSCCS; pmodel = 1.85E-02, px2 = 3.46E-02 in VACS). Heavy alcohol consumption increased EAAMonoDNAmAge up to 1.60 years while light alcohol consumption decreased EAAMonoDNAmAge up to 2.66 years. These results were corroborated by the four established epigenetic clocks (i.e., HorvathDNAmAge, HannumDNAmAge, PhenoDNAmAge, GrimDNAmAge). CONCLUSIONS The results suggest a nonlinear relationship between alcohol consumption and its effects on epigenetic age. Considering adverse effects of alcohol consumption on health, nonlinear effects of alcohol use should be interpreted with caution. The findings, for the first time, highlight the complex effects of alcohol consumption on biological aging.
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Affiliation(s)
- Xiaoyu Liang
- Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA,VA Connecticut Healthcare SystemWest HavenConnecticutUSA,Department of Preventive MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | - Rajita Sinha
- Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA,Child Study CenterYale School of MedicineNew HavenConnecticutUSA,Department of NeuroscienceYale School of MedicineNew HavenConnecticutUSA
| | - Amy C. Justice
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA,Yale University School of MedicineNew Haven Veterans Affairs Connecticut Healthcare SystemNew HavenConnecticutUSA
| | - Mardge H. Cohen
- Department of MedicineStroger Hospital of Cook CountyChicagoIllinoisUSA
| | - Bradley E. Aouizerat
- Bluestone Center for Clinical ResearchCollege of DentistryNew York UniversityNew YorkNew YorkUSA,Department of Oral and Maxillofacial SurgeryCollege of DentistryNew York UniversityNew YorkNew YorkUSA
| | - Ke Xu
- Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA,VA Connecticut Healthcare SystemWest HavenConnecticutUSA
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37
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Massad LS, Daubert EM, Evans CT, Minkoff H, Kassaye S, Dionne-Odom J, Seidman D, Murphy K, Alcaide ML, Adimora AA, Sheth AN, Golub ET, French AL, Weber KM. Trends in Bacterial Vaginosis Prevalence in a Cohort of U.S. Women with and at Risk for HIV. J Womens Health (Larchmt) 2022; 31:726-732. [PMID: 34449258 PMCID: PMC9133967 DOI: 10.1089/jwh.2021.0102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Women with human immunodeficiency virus (HIV) often have bacterial vaginosis (BV). The goal of this analysis was to assess how BV prevalence changed over time and across U.S. regions in enrollment cohorts of the Women's Interagency HIV Study. Methods: In a multisite study, BV was diagnosed retrospectively when pH and two of three other Amsel criteria were met. Prevalence was determined across four recruitment waves: 1994-5, 2001-2, 2011-2, and 2013-5. Generalized estimating equation multivariable logistic regression models assessed changes in visit prevalence across waves after controlling for HIV disease severity and other risks. Results: Among 4,790 women (3,539 with HIV and 1,251 without HIV), BV was diagnosed at 7,870 (12%) of 64,444 visits. Baseline prevalence across enrollment waves was 15.0%-19.2%, but declined in all cohorts, with prevalence in the initial cohort falling to 3.9% in the 1994-5 cohort after up to 21 years of continuous observation. Prevalence varied within U.S. regions. HIV status was not associated with BV. Conclusion: BV prevalence decreased with time in study. Prevalence varied across sites, but was not uniformly increased or decreased in any U.S. region. Clinical Trials.gov identifier: NCT00000797.
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Affiliation(s)
- L Stewart Massad
- Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Charlesnika T Evans
- Department of Preventive Medicine, Center for Health Services and Outcomes Research, Northwestern University, Chicago, Illinois, USA.,VA Center of Innovation for Complex Chronic Healthcare, Hines, Illinois, USA
| | - Howard Minkoff
- Department of Obstetrics & Gynecology, Maimonides Medical Center, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Jodie Dionne-Odom
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dominika Seidman
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, USA
| | - Kerry Murphy
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Maria L Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Adaora A Adimora
- Department of Medicine, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anandi N Sheth
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Audrey L French
- Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Kathleen M Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois, USA
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Wells J, Chandler R, Flowers L, Paul S, Sharma A, Kalifa N, Holstad M. Perceptions of Anal Cancer Risk Among HIV-Positive and High-Risk HIV-Negative Women. J Low Genit Tract Dis 2022; 26:181-185. [PMID: 35019899 PMCID: PMC8940637 DOI: 10.1097/lgt.0000000000000652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Women living with HIV (WLWH) have a greater risk of anal cancer than women without HIV; however, there are limited studies that examine awareness of anal cancer risk among WLWH and "high-risk" HIV-negative women. This study examines risk factors for anal cancer, perceptions of risk for anal cancer, and perceptions of anal cancer screening among a cohort of WLWH and high-risk HIV-negative women. MATERIALS AND METHODS From the Atlanta, GA, and Bronx, NY, sites of the Women's Interagency HIV Study, 155 WLWH and HIV-negative women were enrolled and the Champion Health Belief Model Scale questionnaire measuring risk perceptions to anal cancer was administered to each participant. RESULTS The WLWH perceived anal cancer to be less serious and perceived facing fewer barriers to anal cancer screening than HIV-negative women (both p = .01). Older women (≥50 years) felt that they had less barriers to anal cancer screening (p = .047). Moreover, women who had less than a high school education felt more susceptible to anal cancer (p = .001), as did women who reported a history of anal intercourse (p = .017). CONCLUSIONS Despite being at an increased risk for anal cancer, perceptions of susceptibility to anal cancer and seriousness of anal cancer were low among WLWH. These findings highlight opportunities for provider and patient educational interventions to improve awareness of anal cancer risk among WLWH.
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Affiliation(s)
- Jessica Wells
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | | | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Nia Kalifa
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Marcia Holstad
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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Wells J, Bai J, Tsementzi D, Jhaney CI, Foster A, Watkins Bruner D, Gillespie T, Li Y, Hu YJ. Exploring the Anal Microbiome in HIV Positive and High-Risk HIV Negative Women. AIDS Res Hum Retroviruses 2022; 38:228-236. [PMID: 35044233 PMCID: PMC8968844 DOI: 10.1089/aid.2020.0245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This exploratory study sought to characterize the anal microbiome and explore associations among the anal microbiome, risk factors for anal cancer, and clinical factors. A pilot sample of 50 HIV infected and high-risk HIV negative women were recruited from the former Women's Interagency HIV Study. Microbiome characterization by 16S rRNA gene sequencing and datasets were analyzed using QIIME 2™. Composition of the anal microbiome and its associations with anal cancer risk factors and clinical factors were analyzed using linear decomposition model and permutational multivariate analysis of variance. Composition of the anal microbiome among HIV positive and high-risk negative women was dominated by Bacteroides, Prevotella, and Campylobacter. The overall taxonomic composition and microbial diversity of the anal microbiome did not significantly differ by HIV status. However, the abundance of Ruminococcus 1 belonging to the Rumincoccaceae family was associated with HIV status (q = .05). No anal cancer risk factors were associated with the anal microbiome composition. Clinical factors marginally associated with the anal microbiome composition included body mass index (BMI; p = .05) and hepatitis C virus (HCV; p = .05). Although HIV and risk factors for anal cancer were not associated with the composition of the anal microbiome in this pilot sample, other clinical factors such as BMI and HCV, may be worth further investigation in a larger study. Future research can build on these findings to explore the role of the microbiome and HIV comorbidities in women.
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Affiliation(s)
- Jessica Wells
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.,Address correspondence to: Jessica Wells, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Room 230, Atlanta, GA 30322-1007, USA
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Despina Tsementzi
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Camber Ileen Jhaney
- Department of Surgery and Department of Hematology & Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Antonina Foster
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Deborah Watkins Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.,Department of Surgery and Department of Hematology & Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Theresa Gillespie
- Department of Surgery and Department of Hematology & Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Yunxiao Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Yi-Juan Hu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Kuniholm MH, Vásquez E, Appleton AA, Kingsley L, Palella FJ, Budoff M, Michos ED, Fox E, Jones D, Adimora AA, Ofotokun I, D'souza G, Weber KM, Tien PC, Plankey M, Sharma A, Gustafson DR. Cardiovascular risk score associations with frailty in men and women with or at risk for HIV. AIDS 2022; 36:237-347. [PMID: 34934019 PMCID: PMC8711611 DOI: 10.1097/qad.0000000000003107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand the relationship between cardiovascular disease (CVD) risk and frailty among men (MWH) and women living with HIV (WWH), or at risk for HIV. DESIGN We considered 10-year coronary heart disease and atherosclerotic CVD risk by Framingham risk score (FRS, 2001 National Cholesterol Education Program Adult Treatment Program III) and Pooled Cohort Equations (PCE, 2013 American College of Cardiology/American Heart Association) in relation to the Fried Frailty Phenotype (FFP) in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). METHODS FFP was ascertained in MACS from 2004 to 2019 and in WIHS from 2005 to 2006 and 2011-2019. FFP score at least three of five components defined frailty. Repeated measures logistic regression (both cohorts) and Cox proportional hazards regression (MACS) were performed, controlled for education, income, cholesterol medication and hepatitis C virus serostatus, and among MWH and WWH, CD4+ cell count/μl, antiretroviral therapy, and HIV viral load. RESULTS There were 5554 participants (1265 HIV seronegative/1396 MWH; 768 seronegative/1924 WWH) included. Among men, high-risk FRS was associated with increased risk of incident frailty among seronegative [adjusted hazard ratio (aHR)) = 2.12, 95% confidence interval (CI):1.22-3.69] and MWH (aHR = 2.19, 95% CI: 1.33-3.61). Similar associations were seen with high-risk PCE and incident frailty among SN (aHR = 1.88, 95% CI: 1.48-2.39) and MWH (aHR = 1.59, 95% CI: 1.26-2.00). Among women, high-risk PCE was associated with frailty in SN [adjusted odds ratio (aOR) = 1.43, 95% CI: 1.02-2.00] and WWH (aOR = 1.36, 95% CI: 1.08-1.71); however, high-risk FRS was not (seronegative: aOR = 1.03, 95% CI: 0.30-3.49; WWH: aOR = 0.86, 95% CI: 0.23-3.20). CONCLUSION Higher CVD risk was associated with increased frailty regardless of HIV serostatus among men and women. These findings may inform clinical practices of screening for frailty.
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Affiliation(s)
- Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Elizabeth Vásquez
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York
| | - Lawrence Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Frank J Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew Budoff
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | | | - Ervin Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Deborah Jones
- Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Adaora A Adimora
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Igho Ofotokun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Gypsyamber D'souza
- Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Kathleen M Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, and Department of Veterans Affairs, San Francisco, California
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx
| | - Deborah R Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
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Aaron KJ, Brill I, Causey-Pruitt Z, Murphy K, Augenbraun M, Kassaye S, Milam JE, Seidman D, French AL, Gange SJ, Adimora AA, Sheth AN, Fischl MA, Van Der Pol B, Marrazzo J, Kempf MC, Dionne-Odom J. Factors associated with syphilis seroprevalence in women with and at-risk for HIV infection in the Women's Interagency HIV Study (1994-2015). Sex Transm Infect 2022; 98:4-10. [PMID: 33408096 PMCID: PMC9099234 DOI: 10.1136/sextrans-2020-054674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Syphilis rates among women in the USA more than doubled between 2014 and 2018. We sought to identify correlates of syphilis among women enrolled in the Women's Interagency HIV Study (WIHS) to inform targeted interventions. METHODS The retrospective cross-sectional analysis of secondary data included women with HIV or at-risk of HIV who enrolled in the multisite US WIHS cohort between 1994 and 2015. Syphilis screening was performed at baseline. Infection was defined serologically by a positive rapid plasma reagin test with confirmatory treponemal antibodies. Sociodemographic and behavioural characteristics stratified by baseline syphilis status were compared for women enrolled during early (1994-2002) and recent (2011-2015) years. Multivariable binomial modelling with backward selection (p>0.2 for removal) was used to model correlates of syphilis. RESULTS The study included 3692 women in the early cohort and 1182 women in the recent cohort. Syphilis prevalence at enrolment was 7.5% and 3.7% in each cohort, respectively (p<0.01). In adjusted models for the early cohort, factors associated with syphilis included age, black race, low income, hepatitis C seropositivity, drug use, HIV infection and >100 lifetime sex partners (all p<0.05). In the recent cohort, age (adjusted prevalence OR (aPOR) 0.2, 95% CI 0.1 to 0.6 for 30-39 years; aPOR 0.5, 95% CI 0.2 to 1.0 for 40-49 years vs ≥50 years), hepatitis C seropositivity (aPOR 2.1, 95% CI 1.0 to 4.1) and problem alcohol use (aPOR 2.2, 95% CI 1.1 to 4.4) were associated with infection. CONCLUSIONS Syphilis screening is critical for women with HIV and at-risk of HIV. Targeted prevention efforts should focus on women with hepatitis C and problem alcohol use.
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Affiliation(s)
- Kristal J Aaron
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ilene Brill
- Department of Epidemiology, The University of Alabama at Birmingham, Ryals School of Public Health, Birmingham, Alabama, USA
| | - Zenoria Causey-Pruitt
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kerry Murphy
- Department of Medicine/Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Augenbraun
- Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, New York, USA
| | - Seble Kassaye
- Department of Medicine/Division of Infectious Diseases, Georgetown University, Washington, DC, USA
| | - Joel E Milam
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Dominika Seidman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Zuckerberg San Francisco General Hospital, and Bixby Center for Global Reproductive Health, San Francisco, California, USA
| | - Audrey L French
- Division of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County and Ruth M. Rothstein CORE Center, Chicago, Illinois, USA
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adaora A Adimora
- School of Medicine and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anandi N Sheth
- Department of Medicine/Division of Infectious Diseases, Emory University, Atlanta, Georgia, USA
| | - Margaret A Fischl
- Department of Medicine/Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Barbara Van Der Pol
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeanne Marrazzo
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mirjam-Colette Kempf
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA,Department of Epidemiology, The University of Alabama at Birmingham, Ryals School of Public Health, Birmingham, Alabama, USA,Department of Family, Community & Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jodie Dionne-Odom
- Department of Medicine/Division of Infectious Diseases, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Levy ME, Waters A, Sen S, Castel AD, Plankey M, Molock S, Asch F, Goparaju L, Kassaye S. Psychosocial stress and neuroendocrine biomarker concentrations among women living with or without HIV. PLoS One 2021; 16:e0261746. [PMID: 34941922 PMCID: PMC8699620 DOI: 10.1371/journal.pone.0261746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/09/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Women living with HIV (WLWH) experience psychosocial stress related to social-structural vulnerabilities. To investigate neuroendocrine pathways linking stress and increased cardiovascular disease risk among WLWH, we evaluated associations between psychosocial stress (i.e., perceived stress, posttraumatic stress, and experiences of race- and gender-based harassment) and a composite neuroendocrine biomarker index among WLWH and women without HIV. METHODS In 2019-2020, Women's Interagency HIV Study participants in Washington, DC completed a questionnaire and provided blood and 12-hour overnight urine samples for testing of serum dehydroepiandrosterone sulfate (DHEA-S) and urinary free cortisol, epinephrine, and norepinephrine. Psychosocial stress was measured using the Perceived Stress Scale, PTSD Checklist-Civilian Version, and Racialized Sexual Harassment Scale. Latent profile analysis was used to classify participants into low (38%), moderate (44%), and high (18%) stress groups. Composite biomarker index scores between 0-4 were assigned based on participants' number of neuroendocrine biomarkers in high-risk quartiles (≥75th percentile for cortisol, epinephrine, and norepinephrine and ≤25th percentile for DHEA-S). We evaluated associations between latent profile and composite biomarker index values using multivariable linear regression, adjusting for socio-demographic, behavioral, metabolic, and HIV-related factors. RESULTS Among 90 women, 62% were WLWH, 53% were non-Hispanic Black, and median age was 55 years. In full multivariable models, there was no statistically significant association between psychosocial stress and composite biomarker index values among all women independent of HIV status. High (vs. low) psychosocial stress was positively associated with higher mean composite biomarker index values among all monoracial Black women (adjusted β = 1.32; 95% CI: 0.20-2.43), Black WLWH (adjusted β = 1.93; 95% CI: 0.02-3.83) and Black HIV-negative women (adjusted β = 2.54; 95% CI: 0.41-4.67). CONCLUSIONS Despite a null association in the overall sample, greater psychosocial stress was positively associated with higher neuroendocrine biomarker concentrations among Black women, highlighting a plausible mechanism by which psychosocial stress could contribute to cardiovascular disease risk.
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Affiliation(s)
- Matthew E. Levy
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America
- Westat, Rockville, Maryland, United States of America
- * E-mail:
| | - Ansley Waters
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America
- Division of Clinical Epidemiology, Office of Epidemiology, Virginia Department of Health, Richmond, Virginia, United States of America
| | - Sabyasachi Sen
- Division of Endocrinology, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Amanda D. Castel
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, United States of America
| | - Michael Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, DC, United States of America
| | - Sherry Molock
- Department of Psychology, The George Washington University, Washington, DC, United States of America
| | - Federico Asch
- Cardiovascular Core Laboratories and Cardiac Imaging Research, MedStar Health Research Institute, MedStar Heart and Vascular Institute, Washington, DC, United States of America
| | - Lakshmi Goparaju
- Department of Medicine, Georgetown University Medical Center, Washington, DC, United States of America
| | - Seble Kassaye
- Department of Medicine, Georgetown University Medical Center, Washington, DC, United States of America
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Brody LR, Firpo-Perretti Y, Bruck-Segal D, Dale SK, Ruffing EG, Cassiello-Robbins C, Weber KM, Cohen MH. Positive Psychological Factors and Life Themes in Relation to Health Outcomes in Women Living with HIV. Int J Behav Med 2021; 29:469-479. [PMID: 34713412 PMCID: PMC9046468 DOI: 10.1007/s12529-021-10032-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This mixed methods study identified positive psychological factors and life themes expressed in autobiographical narratives of predominantly Black women living with HIV (WLWH) and investigated these in relation to depressive symptoms, antiretroviral therapy (ART) adherence (≥ 95% of time), and undetectable HIV viral load (VL) (< 80 copies/ml). METHOD Ninety-eight WLWH from the Women's Interagency HIV Study Chicago site (M age = 45.3; 91% Black) narrated three autobiographical life turning points, reliably coded for positive factors and life themes. ART adherence, VL and depressive symptoms, assessed with Center for Epidemiologic Studies Depression Scale total score (TOT) including its four factors (negative affect (NA), positive affect (PA), somatic symptoms (SS), and interpersonal problems (IP)), were collected over two time points: concurrently with narratives and 6 months later. Composite scores across the two time points were used in all analyses. RESULTS Ten positive psychological factors (gratitude, insight, compassion, meaning-making, acceptance, mindfulness, generativity, optimism, self-reliance, and benevolent God beliefs) and three positive life themes (health improvements, positive relationships, and accomplishments) were identified in narratives. Higher accomplishments, overall positive factors, insight, mindfulness, self-reliance, optimism, meaning-making, and acceptance related to lower depressive symptoms (TOT, NA, SS, or IP). Positive factors and life themes did not significantly relate to PA. Higher compassion related to higher ART adherence. Higher accomplishments related to undetectable VL independent of ART adherence. CONCLUSION Findings that positive psychological factors and life accomplishments may relate to better health, especially to lower depression, potentially contribute to developing positive psychology interventions for Black WLWH.
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Affiliation(s)
- Leslie R Brody
- Department of Psychological and Brain Sciences, Boston University, Boston, USA.
| | | | - Dana Bruck-Segal
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | | | - Elizabeth G Ruffing
- Department of Psychological and Brain Sciences, Boston University, Boston, USA
| | | | - Kathleen M Weber
- Hektoen Institute of Medicine, Cook County Health and Hospitals System, Chicago, USA
| | - Mardge H Cohen
- Departments of Medicine, Stroger Hospital, Cook County Health and Hospitals System and Rush Medical School, Chicago, USA
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Massad LS, Xie X, Minkoff HL, Michel KG, D’Souza G, Wang CC, Konkle-Parker D, Ofotokun I, Fischl MA, Rahangdale L, Strickler HD. Frequency of high-grade squamous cervical lesions among women over age 65 years living with HIV. Am J Obstet Gynecol 2021; 225:411.e1-411.e7. [PMID: 33957115 DOI: 10.1016/j.ajog.2021.04.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Current US cervical cancer screening guidelines recommend screening cessation at the age of 65 years provided women have adequate previous screening and no history of precancer. Women living with HIV are at higher risk of cervical cancer than women living without HIV. Furthermore, limited data exists to quantify the risk of cervical cancer among women who otherwise would qualify for screening cessation. OBJECTIVE This study aimed to determine whether guidelines recommending women to discontinue cervical cancer screening at the age of 65 years are appropriate for women living with HIV. STUDY DESIGN Semiannual Papanicolaou testing was performed as part of surveillance visits in the Women's Interagency HIV Study. Launched in October 1994, the Women's Interagency HIV Study is a federally funded US multisite cohort study that has enrolled 3678 women living with HIV and 1304 women living without HIV; we included data throughout September 2019 onward. Conventional Papanicolaou tests were collected at scheduled 6-month visits and read centrally according to the 1991 Bethesda System criteria. Results were analyzed among women at least 65 years of age. The primary endpoint was high-grade cytology, including high-grade squamous intraepithelial lesions; atypical glandular cells; atypical squamous cells, cannot exclude high-grade lesions; and malignant cytology. Wilcoxon rank-sum tests were used to compare the continuous variables, and Chi-square tests or the Fisher exact tests were used to compare the categorical variables. The Kaplan-Meier method was used to calculate the cumulative incidence. Poisson regression was used to compare 2 incidence rates. RESULTS Of 169 eligible women (121 women living with HIV and 48 women living without HIV) who contributed 678.4 person-years of observation after reaching the age of 65 years, 2.2% had high-grade cytologic abnormalities. However, no cancer was found. Furthermore, 20 women had previous precancer results, and 74 women had abnormal Papanicolaou test results in the previous decade. Among 50 women (38 women living with HIV and 12 women living without HIV) with a previous hysterectomy and no history of cervical precancer, the cumulative incidence rates of high-grade squamous intraepithelial lesions were 0.6 (95% confidence interval, 0.0-3.2) per 100 person-years for women living with HIV and 0.0 (95% confidence interval, 0.0-8.1) per 100 person-years for women living without HIV (P=.61). Only 48 women (27 women living with HIV and 21 women living without HIV) had cervices and met the current guidelines to discontinue screening; their risk of experiencing high-grade squamous intraepithelial lesions was 2.2 (95% confidence interval, 0.6-5.5) per 100 person-years overall and did not vary by HIV status (2.3 [95% confidence interval, 0.5-6.8] per 100 person-years for women living with HIV and 1.8 [95% confidence interval, 0.0-9.8] per 100 person-years for women living without HIV; P=.81). CONCLUSION Most women living with HIV do not meet the criteria for cervical cancer screening cessation and will need to continue screening over the age of 65 years; however, women who meet the criteria for screening cessation have risks of high-grade squamous lesions similar to women living without HIV and may choose to discontinue.
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Sheira LA, Frongillo EA, Hahn J, Palar K, Riley ED, Wilson TE, Adedimeji A, Merenstein D, Cohen M, Wentz EL, Adimora AA, Ofotokun I, Metsch L, Turan JM, Tien PC, Weiser SD. Relationship between food insecurity and smoking status among women living with and at risk for HIV in the USA: a cohort study. BMJ Open 2021; 11:e054903. [PMID: 34489299 PMCID: PMC8422493 DOI: 10.1136/bmjopen-2021-054903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES People living with HIV (PLHIV) in the USA, particularly women, have a higher prevalence of food insecurity than the general population. Cigarette smoking among PLHIV is common (42%), and PLHIV are 6-13 times more likely to die from lung cancer than AIDS-related causes. This study sought to investigate the associations between food security status and smoking status and severity among a cohort of predominantly low-income women of colour living with and without HIV in the USA. DESIGN Women enrolled in an ongoing longitudinal cohort study from 2013 to 2015. SETTING Nine participating sites across the USA. PARTICIPANTS 2553 participants enrolled in the Food Insecurity Sub-Study of the Women's Interagency HIV Study, a multisite cohort study of US women living with HIV and demographically similar HIV-seronegative women. OUTCOMES Current cigarette smoking status and intensity were self-reported. We used cross-sectional and longitudinal logistic and Tobit regressions to assess associations of food security status and changes in food security status with smoking status and intensity. RESULTS The median age was 48. Most respondents were African-American/black (72%) and living with HIV (71%). Over half had annual incomes ≤US$12 000 (52%). Food insecurity (44%) and cigarette smoking (42%) were prevalent. In analyses adjusting for common sociodemographic characteristics, all categories of food insecurity were associated with greater odds of current smoking compared with food-secure women. Changes in food insecurity were also associated with increased odds of smoking. Any food insecurity was associated with higher smoking intensity. CONCLUSIONS Food insecurity over time was associated with smoking in this cohort of predominantly low-income women of colour living with or at risk of HIV. Integrating alleviation of food insecurity into smoking cessation programmes may be an effective method to reduce the smoking prevalence and disproportionate lung cancer mortality rate particularly among PLHIV.
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Affiliation(s)
- Lila A Sheira
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina System, Columbia, South Carolina, USA
| | - Judith Hahn
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Kartika Palar
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Elise D Riley
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Tracey E Wilson
- Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel Merenstein
- Family Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Mardge Cohen
- Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Eryka L Wentz
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adaora A Adimora
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Lisa Metsch
- Sociomedical Sciences, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, California, USA
- Department of Veteran Affairs Medical Center, San Francisco, California, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
- Center for AIDS Prevention Studies, University of California, San Francisco, California, USA
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46
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Psychosocial Mechanisms of Self-rated Successful Aging with HIV: A Structural Equation Model. AIDS Behav 2021; 25:2875-2885. [PMID: 34115265 DOI: 10.1007/s10461-021-03340-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 02/06/2023]
Abstract
This study tested a conceptual psychosocial model of self-rated successful aging (SRSA) with HIV. Our sample (n = 356) included older women living with HIV (OWLH): average age 56.5 years, 73% Black. SRSA was assessed using a research-based 10-point scale (higher scores = better outcomes). We conducted adjusted structural equation modeling. The global model included two latent variables-protective attributes (composite of positive psychosocial factors: resilience, personal mastery, optimism, spirituality) and psychological distress (composite of negative psychosocial factors: anxiety, depression, loneliness, internalized HIV-related stigma). The model showed good fit (χ2(58) = 76, p = 0.06; RMSEA = 0.03; CFI = 0.99). Increased protective attributes were associated with improved SRSA both directly and mediated by improved coping with stress. While psychological distress did not have a direct effect on SRSA, it was indirectly associated with worsened SRSA via diminished protective attributes and via decreased coping with stress. Findings suggest the need for interventions enhancing positive and mitigating negative psychosocial factors in OWLH.
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47
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Ascher SB, Scherzer R, Estrella MM, Muiru AN, Jotwani VK, Grunfeld C, Shigenaga J, Spaulding KA, Ng DK, Gustafson D, Spence AB, Sharma A, Cohen MH, Parikh CR, Ix JH, Shlipak MG. Kidney tubule health scores and their associations with incident CKD in women living with HIV. HIV Med 2021; 22:527-537. [PMID: 33751761 PMCID: PMC8803539 DOI: 10.1111/hiv.13081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Individual kidney tubule biomarkers are associated with chronic kidney disease (CKD) risk in people living with HIV (PLWH). Whether a combination of kidney biomarkers can be integrated into informative summary scores for PLWH is unknown. METHODS We measured eight urine biomarkers of kidney tubule health at two visits over a 3-year period in 647 women living with HIV in the Women's Interagency Health Study. We integrated biomarkers into factor scores using exploratory factor analysis. We evaluated associations between CKD risk factors and factor scores, and used generalized estimating equations to determine associations between factor scores and risk of incident CKD. RESULTS Factor analysis identified two unique factor scores: a tubule reabsorption score comprising alpha-1-microglobulin, beta-2-microglobulin and trefoil factor-3; and a tubule injury score comprising interleukin-18 and kidney injury molecule-1. We modelled the two factor scores in combination with urine epidermal growth factor (EGF) and urine albumin. Predominantly HIV-related CKD risk factors were independently associated with worsening tubule reabsorption scores and tubule injury scores. During a median follow-up of 7 years, 9.7% (63/647) developed CKD. In multivariable time-updated models that adjusted for other factor scores and biomarkers simultaneously, higher tubule reabsorption scores [risk ratio (RR) = 1.27, 95% confidence interval (CI): 1.01-1.59 per 1 SD higher time-updated score], higher tubule injury scores (RR = 1.36, 95% CI: 1.05-1.76), lower urine EGF (RR = 0.75, 95% CI: 0.64-0.87), and higher urine albumin (RR = 1.20, 95% CI: 1.02-1.40) were jointly associated with risk of incident CKD. CONCLUSIONS We identified two novel and distinct dimensions of kidney tubule health that appear to quantify informative metrics of CKD risk in PLWH.
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Affiliation(s)
- S B Ascher
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, CA, USA
- Division of Hospital Medicine, University of California Davis, Sacramento, CA, USA
| | - R Scherzer
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, CA, USA
| | - M M Estrella
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, CA, USA
- Department of Medicine, Division of Nephrology, University of California, San Francisco, CA, USA
| | - A N Muiru
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, CA, USA
- Department of Medicine, Division of Nephrology, University of California, San Francisco, CA, USA
| | - V K Jotwani
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, CA, USA
- Department of Medicine, Division of Nephrology, University of California, San Francisco, CA, USA
| | - C Grunfeld
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, CA, USA
| | - J Shigenaga
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, CA, USA
| | - K A Spaulding
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, CA, USA
| | - D K Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - D Gustafson
- Department of Neurology, The State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - A B Spence
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - A Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - M H Cohen
- Department of Medicine, Stroger Hospital and Rush University, Chicago, IL, USA
| | - C R Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J H Ix
- Division of Nephrology-Hypertension, University of California, San Diego, CA, USA
| | - M G Shlipak
- Kidney Health Research Collaborative, Department of Medicine, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, CA, USA
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Shitole SG, Lazar JM, Hanna DB, Kim RS, Anastos K, Garcia MJ, Tien PC, Lima JAC, Kaplan RC, Kizer JR. HIV, hepatitis C virus and risk of new-onset left ventricular dysfunction in women. AIDS 2021; 35:1647-1655. [PMID: 33859109 PMCID: PMC8286303 DOI: 10.1097/qad.0000000000002920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND HIV and HCV have each been linked with cardiac dysfunction. Studies of HIV have often lacked appropriate controls and primarily involved men, whereas data for HCV are sparse. METHODS We performed repeat echocardiography over a median interval of 12 years in participants from the Women's Interagency HIV Study in order to evaluate the relationships of HIV and HCV with incident left ventricular (LV) dysfunction (systolic or diastolic). RESULTS Of the 311 women included (age 39 ± 9), 70% were HIV-positive and 20% HCV-positive. Forty three participants (13.8%) developed LV dysfunction, of which 79.1% was diastolic. Compared with participants with neither infection, the group with HIV--HCV coinfection showed a significantly increased risk of incident LV dysfunction after adjustment for risk factors [RR = 2.96 (95% CI = 1.05-8.31)], but associations for the HCV monoinfected and HIV monoinfected groups were not statistically significant [RR = 2.54 (0.83-7.73) and RR = 1.66 (0.65-4.25), respectively]. Comparison of HCV-positive and HCV-negative women showed a significantly increased risk independent of covariates [RR = 1.96 (1.02-3.77)] but this was not the case for HIV-positive vs. HIV-negative women [RR = 1.43 (0.76-2.69)]. There was no evidence of HCV-by-HIV interaction. A more restrictive definition of LV diastolic dysfunction led to fewer incident cases, but a similar, though nonsignificant, risk estimate for HCV. CONCLUSION Among mostly middle-aged women, HCV but not HIV infection was associated with a pronounced risk of incident LV dysfunction. Although the influence of residual confounding cannot be excluded, these findings bolster the potential benefits that could be realized by adopting recent recommendations for expanding HCV screening and treatment.
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Affiliation(s)
- Sanyog G Shitole
- Cardiology Section, San Francisco VA Healthcare System and Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Jason M Lazar
- Division of Cardiology, Department of Medicine, State University of New York Health Science Center - Brooklyn, Brooklyn
| | - David B Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
| | - Ryung S Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
| | - Kathryn Anastos
- Division of General Internal Medicine, Department of Medicine
| | - Mario J Garcia
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Health System, Bronx, NY
| | - Phyllis C Tien
- Section of Infectious Diseases, San Francisco VA Healthcare System, and Departments of Medicine and Clinical Pharmacy, University of California San Francisco, San Francisco, CA
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jorge R Kizer
- Cardiology Section, San Francisco VA Healthcare System and Department of Medicine, University of California San Francisco, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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49
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Kato Y, Kizer JR, Ostovaneh MR, Lazar J, Peng Q, van der Geest RJ, Lima JAC, Ambale-Venkatesh B. Extracellular volume-guided late gadolinium enhancement analysis for non-ischemic cardiomyopathy: The Women's Interagency HIV Study. BMC Med Imaging 2021; 21:116. [PMID: 34315432 PMCID: PMC8314536 DOI: 10.1186/s12880-021-00649-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantification of non-ischemic myocardial scar remains a challenge due to the patchy diffuse nature of fibrosis. Extracellular volume (ECV) to guide late gadolinium enhancement (LGE) analysis may achieve a robust scar assessment. METHODS Three cohorts of 80 non-ischemic-training, 20 non-ischemic-validation, and 10 ischemic-validation were prospectively enrolled and underwent 3.0 Tesla cardiac MRI. An ECV cutoff to differentiate LGE scar from non-scar was identified in the training cohort from the receiver-operating characteristic curve analysis, by comparing the ECV value against the visually-determined presence/absence of the LGE scar at the highest signal intensity (SI) area of the mid-left ventricle (LV) LGE. Based on the ECV cutoff, an LGE semi-automatic threshold of n-times of standard-deviation (n-SD) above the remote-myocardium SI was optimized in the individual cases ensuring correspondence between LGE and ECV images. The inter-method agreement of scar amount in comparison with manual (for non-ischemic) or full-width half-maximum (FWHM, for ischemic) was assessed. Intra- and inter-observer reproducibility were investigated in a randomly chosen subset of 40 non-ischemic and 10 ischemic cases. RESULTS The non-ischemic groups were all female with the HIV positive rate of 73.8% (training) and 80% (validation). The ischemic group was all male with reduced LV function. An ECV cutoff of 31.5% achieved optimum performance (sensitivity: 90%, specificity: 86.7% in training; sensitivity: 100%, specificity: 81.8% in validation dataset). The identified n-SD threshold varied widely (range 3 SD-18 SD), and was independent of scar amount (β = -0.01, p = 0.92). In the non-ischemic cohorts, results suggested that the manual LGE assessment overestimated scar (%) in comparison to ECV-guided analysis [training: 4.5 (3.2-6.4) vs. 0.92 (0.1-2.1); validation: 2.5 (1.2-3.7) vs. 0.2 (0-1.6); P < 0.01 for both]. Intra- and inter-observer analyses of global scar (%) showed higher reproducibility in ECV-guided than manual analysis with CCC = 0.94 and 0.78 versus CCC = 0.86 and 0.73, respectively (P < 0.01 for all). In ischemic validation, the ECV-guided LGE analysis showed a comparable scar amount and reproducibility with the FWHM. CONCLUSIONS ECV-guided LGE analysis is a robust scar quantification method for a non-ischemic cohort. Trial registration ClinicalTrials.gov; NCT00000797, retrospectively-registered 2 November 1999; NCT02501811, registered 15 July 2015.
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Affiliation(s)
- Yoko Kato
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Jorge R Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System, and Departments of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - Jason Lazar
- SUNY Downstate Medical Center, New York, NY, USA
| | - Qi Peng
- Albert Einstein College of Medicine, New York, NY, USA
| | - Rob J van der Geest
- Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Joao A C Lima
- Department of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Bharath Ambale-Venkatesh
- Division of Radiology, Johns Hopkins University School of Medicine, 600 N Wolfe Street MR 110, Baltimore, MD, 21287, USA.
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50
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Curtis KA, Rudolph DL, Pan Y, Delaney K, Anastos K, DeHovitz J, Kassaye SG, Hanson CV, French AL, Golub E, Adimora AA, Ofotokun I, Bolivar H, Kempf MC, Peters PJ, Switzer WM. Evaluation of the Abbott ARCHITECT HIV Ag/Ab combo assay for determining recent HIV-1 infection. PLoS One 2021; 16:e0242641. [PMID: 34197451 PMCID: PMC8248699 DOI: 10.1371/journal.pone.0242641] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Given the challenges and costs associated with implementing HIV-1 incidence assay testing, there is great interest in evaluating the use of commercial HIV diagnostic tests for determining recent HIV infection. A diagnostic test with the capability of providing reliable data for the determination of recent HIV infection without substantial modifications to the test protocol would have a significant impact on HIV surveillance. The Abbott ARCHITECT HIV Ag/Ab Combo Assay is an antigen/antibody immunoassay, which meets the criteria as the first screening test in the recommended HIV laboratory diagnostic algorithm for the United States. METHODS In this study, we evaluated the performance characteristics of the ARCHITECT HIV Ag/Ab Combo signal-to-cutoff ratio (S/Co) for determining recent infection, including estimation of the mean duration of recent infection (MDRI) and false recent rate (FRR), and selection of recency cutoffs. RESULTS The MDRI estimates for the S/Co recency cutoff of 400 is within the 4 to 12 months range recommended for HIV incidence assays, and the FRR rate for this cutoff was 1.5%. Additionally, ARCHITECT Combo S/Co values were compared relative to diagnostic test results from two prior prospective HIV-1 diagnostic studies in order to validate the use of the S/Co for both diagnostic and recency determination. CONCLUSION Dual-use of the ARCHITECT Combo assay data for diagnostic and incidence purposes would reduce the need for separate HIV incidence testing and allow for monitoring of recent infection for incidence estimation and other public health applications.
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Affiliation(s)
- Kelly A. Curtis
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Donna L. Rudolph
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Yi Pan
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kevin Delaney
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kathryn Anastos
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States of America
| | - Jack DeHovitz
- Downstate Medical Center, State University of New York, Brooklyn, New York, United States of America
| | - Seble G. Kassaye
- Department of Medicine / Division of Infectious Diseases, Georgetown University, Washington, DC, United States of America
| | - Carl V. Hanson
- California State Department of Health, Berkeley, California, United States of America
| | - Audrey L. French
- Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, United States of America
| | - Elizabeth Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Igho Ofotokun
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Hector Bolivar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Mirjam-Colette Kempf
- School of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Philip J. Peters
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - William M. Switzer
- Division of HIV/ AIDS Prevention, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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