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Palfai TP, Winter MR, Magane KM, Heeren TC, Bernier LB, Murray GE, Saitz R, Kim TW, Stein MD. Pain and unhealthy alcohol use among people living with HIV: A prospective cohort study. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 39317678 DOI: 10.1111/acer.15447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 08/03/2024] [Accepted: 08/31/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Unhealthy alcohol use is prevalent among people living with HIV/AIDS (PLWH) and contributes to impaired functioning, diminished quality of life, and poorer HIV outcomes. Common cooccurring conditions such as chronic pain may be associated with negative outcomes both directly and through its influence on unhealthy drinking itself. However, there is relatively little known about how pain influences unhealthy drinking among PLWH over time. The current study examined whether pain was associated with indices of unhealthy alcohol use, namely heavy drinking and alcohol use disorder (AUD) assessed 12 months later. METHODS The study sample (n = 207) was from the Boston Alcohol Research Collaboration on HIV/AIDS (ARCH) Cohort, a prospective cohort of PLWH with a history of illicit substance or unhealthy alcohol use. We conducted logistic regression analyses to examine the associations between pain and both heavy drinking and AUD status (DSM-5 criteria) (yes/no) over time. In secondary analyses, we examined whether pain was associated with greater AUD severity and whether pain interference was associated with heavy drinking and AUD outcomes. RESULTS We found that pain at baseline was associated with greater odds of AUD [aOR = 2.29 (95% CI: 1.13, 4.64), p = 0.02] but not heavy drinking [aOR = 0.91 (95% CI: 0.44, 1.88), p = 0.79] at 12 months. Pain was also associated with more severe AUD. Analyses of pain interference showed similar results. CONCLUSIONS Pain is prospectively associated with higher odds of AUD among PLWH with a substance/unhealthy alcohol use history. Providers should routinely address pain among PLWH to improve AUD outcomes.
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Affiliation(s)
- Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Michael R Winter
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kara M Magane
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lauren B Bernier
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Grace E Murray
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Theresa W Kim
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Michael D Stein
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Zuniga JM, Prachniak C, Policek N, Magula N, Gandhi A, Anderson J, Diallo DD, Lima VD, Ravishankar S, Acharya S, Achrekar A, Adeleke M, Aïna É, Baptiste S, Barrow G, Begovac J, Bukusi E, Castel A, Castellanos E, Cestou J, Chirambo G, Crowley J, Dedes N, Ditiu L, Doherty M, Duncombe C, Durán A, Futterman D, Hader S, Kounkeu C, Lawless F, Lazarus JV, Lex S, Lobos C, Mayer K, Mejia M, Moheno HR, d'Arminio Monforte A, Morán-Arribas M, Nagel D, Ndugwa R, Ngunu C, Poonkasetwattana M, Prins M, Quesada A, Rudnieva O, Ruth S, Saavedra J, Toma L, Wanjiku Njenga L, Williams B. IAPAC-Lancet HIV Commission on the future of urban HIV responses. Lancet HIV 2024; 11:e607-e648. [PMID: 39043198 DOI: 10.1016/s2352-3018(24)00124-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 07/25/2024]
Affiliation(s)
- José M Zuniga
- International Association of Providers of AIDS Care, Washington, DC, USA; Fast-Track Cities Institute, Washington, DC, USA.
| | | | | | | | - Anisha Gandhi
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | | | | | | | | | | | | | | | | | - Solange Baptiste
- International Treatment Preparedness Coalition, Johannesburg, South Africa
| | | | | | - Elizabeth Bukusi
- Kenya Medical Research Institute, Nairobi, Kenya; University of Nairobi, Nairobi, Kenya
| | | | | | - Jorge Cestou
- Chicago Department of Public Health, Chicago, IL, USA
| | | | | | | | | | - Meg Doherty
- World Health Organization, Geneva, Switzerland
| | - Chris Duncombe
- International Association of Providers of AIDS Care, Washington, DC, USA
| | - Adriana Durán
- Ministry of Health, City of Buenos Aires, Buenos Aires, Argentina
| | | | | | - Chyrol Kounkeu
- Cameroonian Association for the Development and Empowerment of Vulnerable People, Yaoundé, Cameroon
| | - Fran Lawless
- Mayor's Office of Health Policy, New Orleans, LA, USA
| | - Jeffrey V Lazarus
- University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Policy, New York, NY, USA
| | | | | | - Kenneth Mayer
- Fenway Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | - Carol Ngunu
- Nairobi City County Department of Health, Nairobi, Kenya
| | | | - Maria Prins
- Academic Medical Center, Amsterdam, Netherlands
| | - Amara Quesada
- Action for Health Initiatives, Quezon City, Philippines
| | | | - Simon Ruth
- Thorne Harbour Health, Melbourne, VIC, Australia
| | | | - Lance Toma
- San Francisco Community Health Center, San Francisco, CA, USA
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Van Pelt AE, Casline E, Phillips G, Cestou J, Mustanski B, Cook G, Beidas RS. Co-designing strategies to implement long-acting injectable PrEP for sexual minority men in Chicago: a study protocol for an innovation tournament and implementation mapping. Implement Sci Commun 2024; 5:29. [PMID: 38528628 PMCID: PMC10962141 DOI: 10.1186/s43058-024-00574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Participatory design approaches can improve successful selection and tailoring of implementation strategies by centering the voices of key constituents. To reduce incidence of the human immunodeficiency virus (HIV) in the USA, co-design of implementation strategies is needed for long-acting injectable cabotegravir (CAB-LA), a new form of HIV pre-exposure prophylaxis, among the disproportionately impacted population of sexual minority men (SMM). This manuscript describes the protocol for participatory design approaches (i.e., innovation tournament and implementation mapping) to inform implementation of CAB-LA among SMM (≥ 12 years), particularly Black and Latino populations, in Chicago. METHODS This research incorporates innovative methods to accomplish two objectives: (1) to crowdsource ideas for the design of implementation strategies for CAB-LA through a virtual innovation tournament and (2) to leverage the ideas from the innovation tournament to operationalize implementation strategies for CAB-LA thorough the systematic process of implementation mapping. A committee of constituents with diverse expertise and perspectives (e.g., SMM, implementation scientists, HIV clinicians, public health leadership, and community partners) will provide input throughout the design process. DISCUSSION This research will produce a menu of co-designed implementation strategies, which can guide plans for CAB-LA integration in Chicago and provide insights for other EHE regions. Further, as the first innovation tournament focused on HIV prevention, this research can provide a framework for participatory approaches across the care continuum. Given that the co-design of implementation strategies often does not involve the participation of individuals with lived experiences, this work will center the voices of those who will benefit most.
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Affiliation(s)
- Amelia E Van Pelt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave Suite 2100, Chicago, IL, 60611, USA.
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, 633 N St Clair St Suite 2000, Chicago, IL, 60611, USA.
| | - Elizabeth Casline
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, 633 N St Clair St Suite 2000, Chicago, IL, 60611, USA
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave Suite 2100, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave Suite 1400, Chicago, IL, 60611, USA
| | - Jorge Cestou
- Syndemic Infectious Disease Bureau, Chicago Department of Public Health, 333 South State Street Room 200, Chicago, IL, 60604, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave Suite 2100, Chicago, IL, 60611, USA
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, 633 N St Clair St Suite 2000, Chicago, IL, 60611, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave Suite 1400, Chicago, IL, 60611, USA
| | - Grace Cook
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, 633 N St Clair St Suite 2000, Chicago, IL, 60611, USA
| | - Rinad S Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave Suite 2100, Chicago, IL, 60611, USA
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, 633 N St Clair St Suite 2000, Chicago, IL, 60611, USA
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Liu Y, Ramos SD, Hanna DB, Jones DL, Lazar JM, Kizer JR, Cohen MH, Haberlen SA, Adimora AA, Lahiri CD, Wise JM, Friedman MR, Plankey M, Chichetto NE. Psychosocial Syndemic Classes and Longitudinal Transition Patterns Among Sexual Minority men Living with or Without HIV in the Multicenter AIDS Cohort Study (MACS). AIDS Behav 2023; 27:4094-4105. [PMID: 37418062 PMCID: PMC10615787 DOI: 10.1007/s10461-023-04123-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: 06/26/2023] [Indexed: 07/08/2023]
Abstract
Mental health and substance use epidemics interact to create psychosocial syndemics, accelerating poor health outcomes. Using latent class and latent transition analyses, we identified psychosocial syndemic phenotypes and their longitudinal transition pathways among sexual minority men (SMM) in the Multicenter AIDS Cohort Study (MACS, n = 3,384, mean age 44, 29% non-Hispanic Black, 51% with HIV). Self-reported depressive symptoms and substance use indices (i.e., smoking, hazardous drinking, marijuana, stimulant, and popper use) at the index visit, 3-year and 6-year follow-up were used to model psychosocial syndemics. Four latent classes were identified: "poly-behavioral" (19.4%), "smoking and depression" (21.7%), "illicit drug use" (13.8%), and "no conditions" (45.1%). Across all classes, over 80% of SMM remained in that same class over the follow-ups. SMM who experienced certain psychosocial clusters (e.g., illicit drug use) were less likely to transition to a less complex class. These people could benefit from targeted public health intervention and greater access to treatment resources.
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Affiliation(s)
- Yiyang Liu
- University of Florida, Gainesville, FL, USA
| | - Stephen D Ramos
- University of California - San Diego, San Diego, La Jolla, CA, USA
| | | | - Deborah L Jones
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jorge R Kizer
- San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA, USA
| | - Mardge H Cohen
- Stroger Hospital, Cook County Health and Hospitals System, Chicago, IL, USA
| | | | | | - Cecile D Lahiri
- Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA
| | - Jenni M Wise
- University of Alabama at Birmingham, Birmingham, AL, England
| | - Mackey R Friedman
- School of Public Health. Newark, Rutgers, the State University of New Jersey, New Brunswick, NJ, Canada
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Chandru BA, Varma RP. Factors affecting ability of TB patients to follow treatment guidelines - applying a capability approach. Int J Equity Health 2023; 22:176. [PMID: 37658369 PMCID: PMC10474720 DOI: 10.1186/s12939-023-01991-7] [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] [Received: 04/04/2023] [Accepted: 08/15/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Negotiating anti-Tuberculosis treatment is a complicated process comprising daily consumption of multiple medications at stipulated times and dosages, as well as periodic follow-ups and investigations, may not be uniform for all Tuberculosis (TB) patients and some may perform better than others. In this context, we conducted a study in Thiruvananthapuram district, Kerala to ascertain the ability of those suffering from TB to follow treatment guidelines. METHODS This study used an embedded mixed methods design. We collected cross-sectional data from 135 drug sensitive pulmonary TB patients aged 18 years or above in Thiruvananthapuram, Kerala using a structured questionnaire to get the proportion of patients following all treatment guidelines. We also did eight in-depth interviews (four men and four women) from within the survey sample. The in-depth interviews were inductively analysed for getting deeper insights about reasons for the choices people made regarding the treatment guidelines. Written informed consent was taken from all participants and the study was implemented after the necessary programmatic and ethical clearances. RESULTS Of the 105 men and 30 women studied, uninterrupted daily drug consumption was reported by 80 persons (59.3%, 95% Confidence Intervals (CI) 50.8-67.2%). Overall, 38 (28.2%, 95% CI 21.3%-36.3%) persons were able to follow all seven aspects of advised guidelines. Living in an extended/ joint family (Adjusted Odds ratio (AOR) 2.6, 95% CI 1.1-6.0), approximate monthly household expenditure of over rupees 13,500 (AOR 2.9, 95% CI 1.3-6.7) and no perceived delay in seeking initial care (AOR 3.2, 95% CI 1.2-8.7) were significantly associated with following all aspects of treatment guidelines. In-depth interviews revealed reflective treatment related behaviours were influenced by bodily experiences, moral perceptions, social construct of TB, programmatic factors and substance use. Sometimes behaviours were non-reflective also. Programmatic stress was on individual agency for changing behaviour but capability and opportunity for these were influenced social aspects like stigma, gender roles and poverty. CONCLUSION TB patients live amidst a syndemic of biomedical and social problems. These problems influence the capabilities and opportunities of such TB patients to follow treatment guidelines. Interventions should balance focus on individual agency and social abd economic factors.
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Affiliation(s)
- B Aravind Chandru
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Medical College Post Office, Thiruvananthapuram, Kerala, India
| | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Medical College Post Office, Thiruvananthapuram, Kerala, India.
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Vereeken S, Peckham E, Gilbody S. Can we better understand severe mental illness through the lens of Syndemics? Front Psychiatry 2022; 13:1092964. [PMID: 36683979 PMCID: PMC9853558 DOI: 10.3389/fpsyt.2022.1092964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
Current health care systems do not sufficiently address contributors, also known as modifiable behavior factors, to severe mental illnesses (SMI). Instead treatment is focused on decreasing symptom-experience rather than reducing the detrimental effect of biological predisposition and behavioral influences on illness. Health care services and patients alike call for a more comprehensive, individual approach to mental health care, especially for people with SMI. A Syndemics framework has been previously used to identify ecological and social contributors to an HIV epidemic in the 1990s, and the same framework is transferable to mental health research to identify the relationship between contributing factors and the outcomes of SMI. Using this approach, a holistic insight into mental illness experience could inform more effective health care strategies that lessen the burden of disease on people with SMI. In this review, the components of a Syndemic framework, the scientific contributions to the topic so far, and the possible future of mental health research under the implementation of a Syndemic framework approach are examined.
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Affiliation(s)
- Silke Vereeken
- Mental Health and Addiction, Health Sciences, University of York, York, United Kingdom
| | - Emily Peckham
- Mental Health and Addiction, Health Sciences, University of York, York, United Kingdom
| | - Simon Gilbody
- Mental Health and Addiction, Health Sciences, University of York, York, United Kingdom.,Hull York Medical School, York, United Kingdom
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Bulled N, Singer M, Ostrach B. Syndemics and intersectionality: A response commentary. Soc Sci Med 2022; 295:114743. [DOI: 10.1016/j.socscimed.2022.114743] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/23/2021] [Accepted: 12/30/2021] [Indexed: 12/11/2022]
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Abstract
In this article, we address the nature of syndemics and whether, as some have asserted, these epidemiological phenomena are global configurations. Our argument that syndemics are not global rests on recognition that they are composed of social/environment contexts, disease clusters, demographics, and biologies that vary across locations. These points are illustrated with the cases of syndemics involving COVID-19, diabetes mellitus, and HIV/AIDS. We draw on theoretical discourse from epidemiology, biology, and anthropology to present what we believe is a more accurate framework for thinking about syndemics with shared elements.
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Affiliation(s)
- Merrill Singer
- Department of Anthropology, University of Connecticut, Storrs, Connecticut, USA
| | - Nicola Bulled
- InCHIP, University of Connecticut, Storrs, Connecticut, USA
| | - Thomas Leatherman
- Department of Anthropology, University of Massachusetts, Amherst, Massachusetts, USA
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Chayama KL, Ng C, Small W, Ivsins A, McNeil R. "It's a burden, it's a nuisance. I wish I didn't have these other ailments": a qualitative exploration of comorbidities management among older people living with HIV who use drugs in Vancouver, British Columbia. J Int AIDS Soc 2021; 24:e25785. [PMID: 34636148 PMCID: PMC8505831 DOI: 10.1002/jia2.25785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION People living with HIV (PLHIV) who use illicit drugs (other than or in addition to cannabis) are living longer due to antiretroviral therapy (ART). Older PLHIV who use drugs have an increased risk for comorbidities, and managing multiple health conditions is a growing concern among this population. However, in-depth understandings of the lived realities and complexities of living with HIV alongside comorbidities among older PLHIV who use drugs remain limited. We sought to explore how older PLHIV who use drugs manage their comorbid conditions in a setting with universal ART access. METHODS Between January 2019 and March 2020, semi-structured, in-depth interviews were conducted in Vancouver, Canada with 42 older PLHIV who use drugs and were living with at least one comorbidity. All participants were currently on ART, and had initiated treatment at least 2 years prior to the interviews. Data were analysed using inductive and deductive approaches. RESULTS Several themes were identified through this analysis. First, comorbidities were perceived as more urgent health concerns and prioritized over HIV. Second, stigma and discrimination hindered access to care for comorbidities. Third, the concurrent management of HIV and comorbidities was often challenging due to unmanaged or poorly managed comorbidities. Fourth, the potential impact of ART on the development of comorbidities was a source of concern and frustration. Finally, integrated treatment approaches facilitated engagement with HIV and comorbidities care. CONCLUSIONS Our findings underscore the need for HIV care to shift from a primary focus on managing HIV to an integrated, patient-centred approach that addresses both HIV and non-HIV-related health needs, as well as an equitable and non-judgemental delivery of such care for an ageing population of PLHIV who use drugs.
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Affiliation(s)
- Koharu Loulou Chayama
- British Columbia Centre on Substance UseVancouverBritish ColumbiaCanada
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cara Ng
- British Columbia Centre on Substance UseVancouverBritish ColumbiaCanada
| | - Will Small
- British Columbia Centre on Substance UseVancouverBritish ColumbiaCanada
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Andrew Ivsins
- British Columbia Centre on Substance UseVancouverBritish ColumbiaCanada
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Ryan McNeil
- British Columbia Centre on Substance UseVancouverBritish ColumbiaCanada
- Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
- Program in Addiction MedicineYale School of MedicineNew HavenConnecticutUSA
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Peprah E, Armstrong-Hough M, Cook SH, Mukasa B, Taylor JY, Xu H, Chang L, Gyamfi J, Ryan N, Ojo T, Snyder A, Iwelunmor J, Ezechi O, Iyegbe C, O’Reilly P, Pascal Kengne A. An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3111. [PMID: 33803504 PMCID: PMC8003038 DOI: 10.3390/ijerph18063111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2-4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke. CONCLUSION We call for a parallel program of implementation research to promote the adoption of evidence-based interventions, which could improve health outcomes for PWH with cardiopulmonary diseases and address the health inequities experienced by PWH in African countries.
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Affiliation(s)
- Emmanuel Peprah
- School of Global Public Health, New York University, New York, NY 10012, USA; (M.A.-H.); (S.H.C.); (J.G.); (N.R.); (T.O.); (A.S.)
| | - Mari Armstrong-Hough
- School of Global Public Health, New York University, New York, NY 10012, USA; (M.A.-H.); (S.H.C.); (J.G.); (N.R.); (T.O.); (A.S.)
| | - Stephanie H. Cook
- School of Global Public Health, New York University, New York, NY 10012, USA; (M.A.-H.); (S.H.C.); (J.G.); (N.R.); (T.O.); (A.S.)
| | | | | | - Huichun Xu
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Linda Chang
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Joyce Gyamfi
- School of Global Public Health, New York University, New York, NY 10012, USA; (M.A.-H.); (S.H.C.); (J.G.); (N.R.); (T.O.); (A.S.)
| | - Nessa Ryan
- School of Global Public Health, New York University, New York, NY 10012, USA; (M.A.-H.); (S.H.C.); (J.G.); (N.R.); (T.O.); (A.S.)
| | - Temitope Ojo
- School of Global Public Health, New York University, New York, NY 10012, USA; (M.A.-H.); (S.H.C.); (J.G.); (N.R.); (T.O.); (A.S.)
| | - Anya Snyder
- School of Global Public Health, New York University, New York, NY 10012, USA; (M.A.-H.); (S.H.C.); (J.G.); (N.R.); (T.O.); (A.S.)
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO 63103, USA;
| | - Oliver Ezechi
- Nigerian Institute of Medical Research, Lagos, Nigeria;
| | - Conrad Iyegbe
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA; (C.I.); (P.O.); (A.P.K.)
| | - Paul O’Reilly
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA; (C.I.); (P.O.); (A.P.K.)
| | - Andre Pascal Kengne
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA; (C.I.); (P.O.); (A.P.K.)
- South African Medical Research Council, Cape Town, South Africa
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