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Siddiqi KA, Ostermann J, Zhang J, Khan MM, Olatosi B. Ageing with HIV in the United States: Changing trends in inpatient hospital stays and comorbidities, 2003-2015. HIV Med 2023; 24:93-103. [PMID: 35674220 DOI: 10.1111/hiv.13325] [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: 02/12/2022] [Accepted: 05/04/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION As people with HIV (PWH) age, they experience prolonged exposure to HIV and antiretroviral therapy, increased risks of developing age-related HIV-associated non-AIDS (HANA) comorbidities and higher rates of hospitalization. Few studies have explored the ageing of PWH and its impact on hospital stays in the US. This study examined trends, characteristics and comorbidities associated with hospital stays with HIV (HSWH) as compared with hospital stays without HIV (HSWOH). METHODS Thirteen years of pooled National Inpatient Sample (NIS) data from 2003 through 2015 were analysed to describe yearly trends. Trends were evaluated for eight major HANA conditions (cardiovascular disease, cancer, diabetes, liver disease, bone loss, kidney disease, pulmonary disease and neurological disease) across four age groups (18-34, 35-49, 50-64, 65+ years). RESULTS Although overall rates of hospitalization reduced across all age groups, the proportion of HIV-related hospitalization increased among older Americans. The average number of chronic conditions was higher for HSWH among all age groups and disproportionately increased for older PWH. Although age-adjusted rates of cardiovascular disease, cancer, bone loss and pulmonary disease were lower for HSWH relative to HSWOH, rates increased disproportionately over the study period. The prevalence of all major HANA conditions except cancer and diabetes increased among the elderly (65+), and the prevalence of cardiovascular disease, cancer, bone loss, kidney disease and pulmonary disease also increased among patients aged 50-64 years. CONCLUSIONS Higher rates of hospitalizations and HANA comorbidities were observed among older HIV patients. The ageing of PWH suggests increased future hospital resource utilization for HSWH. Appropriate training of healthcare providers is essential to managing increased comorbidity burdens of older PWH during hospital stays in the US.
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Affiliation(s)
- Khairul A Siddiqi
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jan Ostermann
- University of South Carolina, Columbia, South Carolina, USA
| | - Jiajia Zhang
- University of South Carolina, Columbia, South Carolina, USA
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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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Swann SA, Kaida A, Nicholson V, Brophy J, Campbell AR, Carter A, Elwood C, Gebremedhen T, Gormley R, King EM, Lee M, Lee V, Maan EJ, Magagula P, Nyman S, Pang D, Pick N, Povshedna T, Prior JC, Singer J, Tognazzini S, Murray MCM, Cote HCF. British Columbia CARMA-CHIWOS Collaboration (BCC3): protocol for a community-collaborative cohort study examining healthy ageing with and for women living with HIV. BMJ Open 2021; 11:e046558. [PMID: 34362800 PMCID: PMC8351488 DOI: 10.1136/bmjopen-2020-046558] [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] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Women living with HIV (WLWH) experience accelerated ageing and an increased risk of age-associated diseases earlier in life, compared with women without HIV. This is likely due to a combination of viral factors, gender differences, hormonal imbalance and psychosocial and structural conditions. This interdisciplinary cohort study aims to understand how biological, clinical and sociostructural determinants of health interact to modulate healthy ageing in WLWH. METHODS AND ANALYSIS The British Columbia Children and Women: AntiRetroviral therapy and Markers of Aging-Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CARMA-CHIWOS) Collaboration (BCC3) study will enrol WLWH (n=350) and sociodemographically matched HIV-negative women (n=350) living in British Columbia. A subset of BCC3 participants will be past participants of CARMA, n≥1000 women and children living with and without HIV, 2008-2018 and/or CHIWOS, n=1422 WLWH, 2013-2018. Over two study visits, we will collect biological specimens for virus serologies, hormones and biological markers as well as administer a survey capturing demographic and sociostructural-behavioural factors. Sociodemographics, comorbidities, number and type of chronic/latent viral infections and hormonal irregularities will be compared between the two groups. Their association with biological markers and psychostructural and sociostructural factors will be investigated through multivariable regression and structural equation modelling. Retrospective longitudinal analyses will be conducted on data from past CARMA/CHIWOS participants. As BCC3 aims to follow participants as they age, this protocol will focus on the first study visits. ETHICS AND DISSEMINATION This study has been approved by the University of British Columbia Children's and Women's Research Ethics Board (H19-00896). Results will be shared in peer-reviewed journals, conferences and at community events as well as at www.hivhearme.ca and @HIV_HEAR_me. WLWH are involved in study design, survey creation, participant recruitment, data collection and knowledge translation. A Community Advisory Board will advise the research team throughout the study.
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Affiliation(s)
- Shayda A Swann
- Experimental Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Angela Kaida
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jason Brophy
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Amber R Campbell
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Allison Carter
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Faculty of Medicine, The Kirby Institute, Sydney, New South Wales, Australia
| | - Chelsea Elwood
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Obstetrics and Gynecology, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Tsion Gebremedhen
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Epidemiology and Population Health, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Elizabeth M King
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Vonnie Lee
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Evelyn J Maan
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Patience Magagula
- Afro-Caribbean Positive Network of BC, Vancouver, British Columbia, Canada
| | - Sheila Nyman
- Bear Rock Consulting, Lone Butte, British Columbia, Canada
| | - Davi Pang
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Neora Pick
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Division of Infectious Diseases, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Tetiana Povshedna
- Pathology and Laboratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Jerilynn C Prior
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Menstrual Cycle and Ovulatory Research, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shelly Tognazzini
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Melanie C M Murray
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Division of Infectious Diseases, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Helene C F Cote
- British Columbia Women's Hospital and Health Centre Women's Health Research Institute, Vancouver, British Columbia, Canada
- Pathology and Laboratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Olivieri-Mui B, McGuire J, Griffith J, Cahill S, Briesacher B. Exploring the Association Between the Quality of HIV Care in Nursing Homes and Hospitalization. J Healthc Qual 2021; 43:174-182. [PMID: 32658007 PMCID: PMC7790902 DOI: 10.1097/jhq.0000000000000277] [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: 11/25/2022]
Abstract
ABSTRACT Persons living with HIV/AIDS (PLWH) are living long enough to need age-related and HIV-related nursing home (NH) care. Nursing home quality of care has been associated with risk for hospitalization, but it is unknown if quality of HIV care in NHs affects hospitalization in this population. We assessed HIV care quality with four national measures adapted for the NH setting. We applied the measures to 2011-2013 Medicare claims linked to Minimum Data Set assessments of resident health, prescription dispensing data, and national reports of NH characteristics. Cox proportional hazards models calculated the risk of all-cause and HIV/AIDS-related hospitalization by HIV care compliance. We identified 1,246 PLWH in 201 NHs with 382 all-cause and 63 HIV/AIDS-related hospitalizations. Nursing home HIV care compliance varied from 24.9% to 64.7%. After regression adjustment, we could detect no difference in all-cause or HIV/AIDS-related hospitalizations by NH HIV care compliance. We postulate that the lack of association may be due to inappropriate HIV care quality measures that do not accurately represent NHs ability to care for PLWH. There is urgent need to create valid NH HIV care quality measures.
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Knettel BA, Corrigan KL, Cherenack EM, Ho N, Carr S, Cahill J, Chino JP, Ubel P, Watt MH, Suneja G. HIV, cancer, and coping: The cumulative burden of a cancer diagnosis among people living with HIV. J Psychosoc Oncol 2021; 39:734-748. [PMID: 33407058 PMCID: PMC8397369 DOI: 10.1080/07347332.2020.1867691] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES People living with HIV (PLWH) have increased risk for cancer and worse cancer-specific survival. We explored the emotional burden of cancer and HIV as a potential driver of cancer mortality. RESEARCH APPROACH Semi-structured qualitative interviews with PLWH and cancer. PARTICIPANTS 27 PLWH who had either completed cancer treatment, were currently undergoing treatment, or experienced challenges in completing treatment. METHODOLOGICAL APPROACH An inductive qualitative approach using the constant comparative method. FINDINGS Participants drew strong parallels between being diagnosed with HIV and cancer. Many described HIV-related stigma that hindered social support. Cancer treatment side effects were a major challenge, impacting treatment adherence for both cancer and HIV. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS There is a need for convenient, affordable, and visible services to support PLHIV as they navigate cancer care. Services should be tailored to the unique needs of this population by addressing HIV-related stigma, building social support, and fostering resilience.
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Affiliation(s)
- Brandon A. Knettel
- Duke University School of Nursing, Durham, NC
- Duke Global Health Institute, Durham, NC
| | | | - Emily M. Cherenack
- Duke Global Health Institute, Durham, NC
- Department of Psychology and Neuroscience, Duke University, Durham, NC
| | - Noelani Ho
- Margolis Center for Health Policy, Duke University, Durham, NC
| | - Stuart Carr
- Department of Pediatrics Infectious Disease, Duke University Medical Center, Durham, NC
| | - Joan Cahill
- Department of Radiation Oncology, Duke Cancer Institute, Durham, NC
| | - Junzo P. Chino
- Duke University School of Medicine, Durham, NC
- Department of Radiation Oncology, Duke Cancer Institute, Durham, NC
| | - Peter Ubel
- Margolis Center for Health Policy, Duke University, Durham, NC
| | - Melissa H. Watt
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
| | - Gita Suneja
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT
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Ibañez GE, Fennie K, Larkey L, Hu N, Algarin AB, Valdivia C, Lavretsky H. A tai chi/qigong intervention for older adults living with HIV: a study protocol of an exploratory clinical trial. Trials 2020; 21:804. [PMID: 32962749 PMCID: PMC7506206 DOI: 10.1186/s13063-020-04728-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/08/2020] [Indexed: 01/18/2023] Open
Abstract
Background Almost half of people living with HIV (PLWH) in the USA are over 50 years of age; this is expected to increase to 70% by 2020. Yet, few interventions exist for older PLWH that address psychological and physical symptoms combined, both prevalent in this population. There is a need to find innovative and accessible interventions that can help older PLWH to manage their symptoms. Mind-body interventions, like tai chi/qigong (TCQ), improve both physical and psychological health. TCQ is a series of slow, low-impact meditative movements that integrates breathwork, meditation, and stances. Methods The present study is an exploratory clinical trial that will evaluate the acceptability and feasibility of a 12-week, small group TCQ intervention (n = 24), a sham qigong control condition (n = 24), and a standard of care control condition (n = 24) for older people living with HIV/AIDS. It will also explore any preliminary associations between the TCQ intervention and symptom alleviation. Participants will be recruited from community-based health and social services organizations in Miami, FL, and randomized to one of the 3 conditions. Discussion We will assess feasibility and acceptability through questionnaires and adherence to TCQ. We will assess preliminary associations with symptoms such as depression, anxiety, social support, chronic HIV-related fatigue, and clinical outcomes. These will be described through proportions, means, and changes over time through graphing techniques. Outcomes will be assessed at baseline, at post-intervention, and at 3 months follow-up. These preliminary analyses also will provide information necessary to estimate effect size and power needed for a larger clinical trial. Trial registration ClinicalTrials.gov NCT03840525. Registered on 16 July 2018.
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Affiliation(s)
- Gladys E Ibañez
- Department of Epidemiology, Florida International University, 11200 SW 8th St AHC5, Miami, FL, 33199, USA.
| | - Kristopher Fennie
- Division of Natural Sciences, New College of Florida, 5800 Bay Shore Road, Sarasota, FL, 34243, USA
| | - Linda Larkey
- College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, USA
| | - Nan Hu
- Department of Biostatistics, Florida International University, 11200 SW 8th St AHC5, Miami, FL, 33199, USA.,Division of Public Health, Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, 84132, USA
| | - Angel B Algarin
- Department of Epidemiology, Florida International University, 11200 SW 8th St AHC5, Miami, FL, 33199, USA.,Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, 92093, USA
| | - Chelsea Valdivia
- Department of Biostatistics, Florida International University, 11200 SW 8th St AHC5, Miami, FL, 33199, USA
| | - Helen Lavretsky
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, The University of California, Los Angeles (UCLA), 760 Westwood Plaza, Los Angeles, CA, 90095, USA
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Gray TF. Burdened by a Secret: Caring for Older Adults With HIV in Critical Care. AACN Adv Crit Care 2019; 30:79-84. [PMID: 30842079 DOI: 10.4037/aacnacc2019552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Tamryn F Gray
- Tamryn F. Gray is a Postdoctoral Research Fellow, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Harvard Medical School, 375 Longwood Avenue, Boston, MA 02215
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Sabbagh W, Darwich NS. Pneumocystis Jiroveci Pneumonia and Newly Diagnosed Human Immunodeficiency Virus (AIDS) in a 63-Year-Old Woman. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:927-931. [PMID: 30087316 PMCID: PMC6095065 DOI: 10.12659/ajcr.909612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 63 Final Diagnosis: Pneumocystis jirovici pneumonia Symptoms: Cough Medication: — Clinical Procedure: Bronchoscopy Specialty: Infectious Diseases
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Affiliation(s)
- Wissam Sabbagh
- Department of Medicine, Good Samaritan Hospital, Dayton, OH, USA
| | - Noor S Darwich
- Faculty of Medicine, University of Jordan, Amman, Jordan
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Harris LM, Emlet CA, Pierpaoli Parker C, Furlotte C. Timing of Diagnosis: Understanding Resilience Narratives of HIV Positive Older Adults Diagnosed Pre- and Post-HAART. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:78-103. [PMID: 29135386 DOI: 10.1080/01634372.2017.1402841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Despite the growing population of older adults living with human immunodeficiency virus/ acquired immune deficiency syndrome (HIV/AIDS), few studies have examined this population in terms of timing of HIV diagnosis. This study explores resilience and protective factors among HIV-positive older adults, 17 of whom were diagnosed prior to the development of highly active antiretroviral therapy (HAART), and 13 of whom were diagnosed after the development of HAART. METHODS We explored the concepts of resilience and protective factors in 30 older adults living with HIV in Ontario, Canada. A qualitative approach was used to conduct in-depth interviews and grounded theory techniques were used to analyze the interview transcripts. RESULTS Having lived with HIV for nearly 30 years, the pre-HAART group had developed more personal strategies for enhancing resilience, including self-care behaviors. They were more regimented and dedicated to their daily health, and were more engaged in their medical care as opposed to the post-HAART group who viewed self-care as staying adherent and refraining from risky health behaviors. IMPLICATIONS Although HAART has radically changed the prognosis of HIV, we have limited information about the differences between those who were diagnosed before and after the development of HAART. We will present recommendations for addressing previous trauma and improving self-care.
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Affiliation(s)
- Lesley M Harris
- a University of Louisville, Kent School of Social Work , Louisville
| | | | | | - Charles Furlotte
- d Stonechurch Family Health Centre, McMaster Family Health Team , Hamilton , Canada
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11
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Lam JO, Sugar EA, Cranston RD, Weber KM, Burk RD, Wiley DJ, Reddy S, Margolick JB, Strickler HD, Wentz A, Jacobson L, Coles CL, Bream JH, Rositch AF, Guo Y, Xiao W, Gillison ML, D'Souza G. The association of medication use with clearance or persistence of oral HPV infection. Cancer Causes Control 2016; 27:1491-1498. [PMID: 27804058 DOI: 10.1007/s10552-016-0826-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/25/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE Persistent oral human papillomavirus (HPV) infection increases risk for oropharyngeal carcinoma, and people living with HIV have higher rates of oral HPV infection and related cancers. Some prescription medications have immunomodulatory effects, but the impact of medication use on oral HPV natural history is unknown. METHODS Scope® oral rinse-and-gargle samples were collected semi-annually from 1,666 participants and tested for 37 types of oral HPV DNA using PCR; 594 HPV-infected participants with 1,358 type-specific oral HPV infections were identified. Data were collected on recent (past 6 months) use of medications. The relationship between medication use and oral HPV clearance was evaluated using Wei-Lin-Weissfeld regression, adjusting for biologic sex, prevalent versus incident infection, age, HIV status and CD4+ T cell count. RESULTS Out of 11 medications examined, oral HPV clearance was significantly reduced in participants reporting recent use of antipsychotics (HR 0.75, 95% CI 0.57-0.99), anxiolytics/sedatives (HR 0.78, 95% CI 0.63-0.96) and antidepressants (HR 0.82, 95% CI 0.67-0.999). Among antipsychotics users, effect modification by HIV status was observed, with reduced clearance in HIV-infected (HR 0.67, 95% CI 0.49-0.91), but not HIV-uninfected participants (p-interaction = 0.009). After adjusted analysis, antipsychotic use remained significantly associated with reduced oral HPV clearance overall (aHR 0.75, 95% CI 0.57-0.99), and when restricted to only HIV-infected participants (aHR 0.66, 95% CI 0.48-0.90). After adjustment, anxiolytic/sedative use and antidepressant use were no longer significantly associated with reduced oral HPV clearance. CONCLUSIONS Some medications were associated with decreased oral HPV clearance, most notably antipsychotic medications. These medications are prescribed for conditions that may have immunomodulating effects, so characteristics of underlying illness may have partially contributed to reduced oral HPV clearance.
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Affiliation(s)
- Jennifer O Lam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth A Sugar
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Ross D Cranston
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen M Weber
- Hektoen Institute of Medicine, The CORE Center at John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA
| | - Robert D Burk
- Departments of Pediatrics, Microbiology and Immunology, and Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Dorothy J Wiley
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Susheel Reddy
- Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joseph B Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Howard D Strickler
- Departments of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Alicia Wentz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Lisa Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Christian L Coles
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jay H Bream
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Yingshi Guo
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Weihong Xiao
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Maura L Gillison
- Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
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