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Satre DD, Sarovar V, Levine T, Leibowitz AS, Lea AN, Ridout KK, Hare CB, Luu MN, Flamm J, Dilley JW, Davy-Mendez T, Sterling SA, Silverberg MJ. Factors associated with suicidal ideation among people with HIV engaged in care. J Affect Disord 2024; 358:369-376. [PMID: 38723683 DOI: 10.1016/j.jad.2024.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND People with HIV (PWH) are at elevated risk for suicidal ideation (SI), yet few studies have examined how substance use, clinical and sociodemographic factors are associated with SI among PWH. METHOD We used substance use (Tobacco, Alcohol, Prescription Medication, and Other Substance Use [TAPS]) and depression (PHQ-9) data from computerized screening of adult PWH in primary care clinics in Northern California, combined with health record data on psychiatric diagnoses, HIV diagnosis, treatment, and control (HIV RNA, CD4), insurance, and neighborhood deprivation index (NDI) to examine factors associated with SI (PHQ-9 item 9 score > 0). Adjusted odds ratios (aOR) for SI were obtained from logistic regression models. RESULTS Among 2829 PWH screened (92 % male; 56 % white; mean (SD) age of 54 (13) years; 220 (8 %) reported SI. Compared with no problematic use, SI was higher among those reporting one (aOR = 1.65, 95 % CI = 1.17, 2.33), two (aOR = 2.23, 95 % CI = 1.42, 3.49), or ≥ 3 substances (aOR = 4.49, 95 % CI = 2.41, 8.39). SI risk was higher for those with stimulant use (aOR = 3.55, 95 % CI = 2.25, 5.59), depression (aOR = 4.18, 95 % CI = 3.04, 5.74), and anxiety diagnoses (aOR = 1.67, 95 % CI = 1.19, 2.34), or Medicaid (aOR = 2.11, 95%CI = 1.24, 3.60) compared with commercial/other insurance. SI was not associated with HIV-related measures or NDI. LIMITATIONS SI was assessed with a single PHQ-9 item. Simultaneous SI and exposure data collection restricts the ability to establish substance use as a risk factor. CONCLUSIONS HIV care providers should consider multiple substance use, stimulant use, depression or anxiety, and public insurance as risk factors for SI and provide interventions when needed.
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Affiliation(s)
- Derek D Satre
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America; Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America.
| | - Varada Sarovar
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Tory Levine
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Amy S Leibowitz
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Alexandra N Lea
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Kathryn K Ridout
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America; The Permanente Medical Group, Oakland, CA 94612, United States of America
| | - C Bradley Hare
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Mitchell N Luu
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Jason Flamm
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - James W Dilley
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America
| | - Thibaut Davy-Mendez
- University of North Carolina at Chapel Hill, Department of Medicine, Division of Infectious Diseases, Chapel Hill, NC 27599, United States of America
| | - Stacy A Sterling
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, San Francisco, CA 94107, United States of America; Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
| | - Michael J Silverberg
- Kaiser Permanente Northern California, Division of Research, Pleasanton, CA 94588, United States of America
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Huyst V, Dewinter J, Noens I, Platteau T, Tsoumanis A. Measuring the prevalence of autistic traits in a cohort of adults living with HIV or taking HIV pre-exposure prophylaxis and mapping safer-sex barriers and facilitators: a study protocol. BMJ Open 2023; 13:e075667. [PMID: 37775292 PMCID: PMC10546106 DOI: 10.1136/bmjopen-2023-075667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Autistic individuals identify with a wider range of sexual orientations than non-autistic individuals, including higher rates of bisexual orientation in autistic men. Gay, bisexual and other men who have sex with men are at greater risk for HIV. Prevalence data of autistic traits in people living with HIV or using Pre-Exposure Prophylaxis (PrEP) for HIV are lacking so far. Such data, combined with insights in barriers and facilitators for safer sex in autistic people living with HIV or using PrEP, are a first step to improve health support for autistic people in HIV clinics. This support is crucial since autistic individuals have worse physical and mental health outcomes. The objective of this research is to determine the prevalence of autistic traits within the group of people living with HIV or using PrEP in Belgium and to describe specific facilitators and barriers for sexual safer behaviour in people living with HIV and PrEP users with autistic traits. METHODS AND ANALYSIS The research is a cross-sectional, observational and multicentre study with recruitment of individual participants. The research consists of two phases. In phase 1, adults coming for HIV/AIDS care or HIV PrEP in participating Belgian HIV Reference Centres will be invited to fill in the validated Autism Spectrum Quotient questionnaire. In phase 2, participants with a score above the predefined cut-off for autistic traits (>26), who agreed to be informed about this score, will be invited to complete an additional survey, inquiring facilitators and barriers for sexual safer behaviour. ETHICS AND DISSEMINATION OF RESULTS Institutional Review Board Institute of Tropical Medicine Antwerp, 25 July 2022, REF 1601/22 and University Hospital of Antwerp, 12 September 2022, Project ID 3679: BUN B3002022000111. Study results will be published in peer-reviewed journals and presented to Belgian HIV Reference Centres and at conferences.
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Affiliation(s)
- Veerle Huyst
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jeroen Dewinter
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Ilse Noens
- Parenting and Special Education Research Unit, University of Leuven, Leuven, Belgium
| | - Tom Platteau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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A comprehensive analysis of excess depressive disorder in women and men living with HIV in France compared to the general population. Sci Rep 2022; 12:6364. [PMID: 35430622 PMCID: PMC9013369 DOI: 10.1038/s41598-022-10263-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/30/2022] [Indexed: 01/14/2023] Open
Abstract
AbstractWe aimed to estimate the prevalence of depressive disorder in people living with HIV (PLWH) and evaluate its association with non-HIV-specific and HIV-specific factors in PLWH and in PLWH compared to the general population (GP). We used cross-sectional data from the QuAliV study, conducted within the ANRS-CO3 Aquitaine-AQUIVIH-NA cohort of PLWH in Nouvelle-Aquitaine (2018–2020), and a nationally-representative survey in the GP (EHIS-ESPS, 2014–2015), we included all participants aged ≥ 18 years old who had completed the Patient Health Questionnaire-8 (PHQ-8). Depressive disorder was defined as Patient Health Questionnaire-8 score greater or equal to 10. Its association with non-HIV-specific (demographic, socio-economic, behavioral, health status), HIV-specific factors (immuno-viral markers, antiretrovirals, level of perceived HIV-stigma), and HIV-status was assessed using Poisson regression models with robust variance in women and men separately. We included 914 PLWH (683 men/231 women). More than one in five PLWH had depressive disorder. It was strongly associated with being younger and experiencing severe pain in both sexes. Unemployment in women, being single, and lack of family ties in men were also associated with depressive disorder. More than 30% of our sample reported HIV-stigma, with a dose–response relationship between level of perceived HIV-stigma and depressive disorder. The crude prevalence of depressive disorder was 2.49 (95%CI 1.92–3.22) and 4.20 (95%CI 3.48–5.05) times higher in women and men living with HIV respectively compared to GP counterparts and 1.46 (95%CI 1.09–1.95) and 2.45 (95%CI 1.93–3.09) times higher after adjustment for non-HIV specific factors. The adjusted prevalence ratio of depressive disorder was not significantly different in HIV-stigma free women, but remained twice as high in HIV-stigma free men. The prevalence of depressive disorder compared to the GP tended to decrease with age in PLWH. Excess depressive disorder remains a major concern in PLWH. Our findings reaffirm the importance of regular screening. Tackling social inequalities and HIV-stigma should be prioritized to ensure that PLWH achieve good mental as well as physical health outcomes.
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Mufson L, Morrison C, Shea E, Kluisza L, Robbins R, Chen Y, Mellins CA. Screening for depression with the PHQ-9 in young adults affected by HIV. J Affect Disord 2022; 297:276-282. [PMID: 34695500 PMCID: PMC9762407 DOI: 10.1016/j.jad.2021.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/07/2021] [Accepted: 10/20/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is common among young adults with perinatally acquired HIV (YAPHIV), however it is often underdiagnosed and untreated. The PHQ-9 and PHQ-2 are widely used screening instruments for MDD. This study evaluates the accuracy of recommended PHQ-9 and PHQ-2 cut-scores of 10 and 3 for YAPHIV and YA who were perinatally HIV exposed but uninfected (YAPHEU). METHODS The PHQ-9 was administered to participants (n = 203) in a longitudinal cohort study using the DISC-IV as the gold standard for diagnosing depression. PHQ-9 and PHQ-2 sensitivity and specificity were calculated. ROC curves were constructed for the overall sample and YAPHIV and YAPHEU subsamples. RESULTS Almost all participants were Black and Latinx, ages 18-29. Overall, the recommended PHQ-9 cut-score of ≥10 yielded a sensitivity of 0.47 (95%CI [0.23,0.72]) and specificity of 0.86 (95%CI [0.80, 0.91]). Results indicate that PHQ-9 cut-scores of 7 and PHQ-2 cut-scores of 2 increased sensitivity to 0.76 (95%CI [0.50, 0.93]) and 0.71(95%CI [0.44,0.90]), and decreased specificity to 0.72 (95%CI [0.65, 0.79]) and 0.73 (95%CI [0.66, 0.79]) respectively. Among subsamples, existing PHQ-9 cut-scores were more accurate for MDD diagnoses in YAPHEU (N = 11) than YAPHIV(N = 6). No race/ethnicity or age differences were found. LIMITATIONS Participants were recruited from clinics in NYC and may not reflect all YAPHIV and YAPHEU. Without a white HIV comparison group, no conclusions could be made on the impact of race/ethnicity on optimized PHQ-9 cut-scores. CONCLUSIONS Using tailored cut scores for HIV-affected populations may increase identification of those experiencing or at risk for MDD. Given the need for increased depression screening in HIV care, use of optimized cut-scores could benefit at-risk populations in the US and globally.
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Affiliation(s)
- Laura Mufson
- Division of Child and Adolescent Psychiatry, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Corey Morrison
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr #15, New York, NY 10032, USA
| | - Eileen Shea
- Department of Psychiatry, Mental Health Data Science, Columbia University Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
| | - Luke Kluisza
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr #15, New York, NY 10032, USA
| | - Reuben Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr #15, New York, NY 10032, USA
| | - Ying Chen
- Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032,New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr #15, New York, NY 10032, USA
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr #15, New York, NY 10032, USA
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Li CW, Chen YC, Lee NY, Chen PL, Li MC, Li CY, Ko WC, Ko NY. Efavirenz Is Not Associated with an Increased Risk of Depressive Disorders in Patients Living with HIV: An 11-Year Population-Based Study in Taiwan. Healthcare (Basel) 2021; 9:healthcare9121625. [PMID: 34946352 PMCID: PMC8701138 DOI: 10.3390/healthcare9121625] [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: 09/30/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: This study aimed to determine the association between the use of efavirenz and depressive disorders among human immunodeficiency virus (HIV)-infected patients. (2) Methods: A retrospective cohort study was conducted using Taiwan's National Health Insurance Database. We identified patients receiving anti-retroviral therapy (ART) between 2000 and 2009; these patients were followed until 2010 for diagnoses of depressive disorders using the Cox proportional hazard model to estimate hazard ratios. (3) Results: After up to 11 years of follow-up, the incidence of depressive disorders for the efavirenz-treated group was estimated at 12.2/1000 person-years (PYs), and the control group was at 12.5/1000 PY (p = 0.822). The independent risk factors for depressive disorders included an insurance premium of less than NTD 17,820 (New Taiwan Dollars-NTD) (adjusted hazard ratio (aHR) 2.59, 95% confidence interval (CI), 1.79-3.76, p < 0.001), and between NTD 17,821 and NTD 26,400 (aHR 1.55, 95% CI, 1.04-2.31, p = 0.030), living in Southern Taiwan (aHR 1.49, 95% CI, 1.21-1.84, p = 0.002), and with a psychiatric history (excluding depressive disorders) (aHR 4.59, 95% CI, 3.51-6.01, p = 0.030). (4) Conclusions: This study concluded that ART-treated patients with a past history of psychiatric disorders, lower insurance premium, and living in Southern Taiwan have an increased risk of depressive disorders, which are not associated with the use of efavirenz.
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Affiliation(s)
- Chia-Wen Li
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-W.L.); (N.-Y.L.); (P.-L.C.); (M.-C.L.); (W.-C.K.)
- Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Yen-Chin Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Nan-Yao Lee
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-W.L.); (N.-Y.L.); (P.-L.C.); (M.-C.L.); (W.-C.K.)
- Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Po-Lin Chen
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-W.L.); (N.-Y.L.); (P.-L.C.); (M.-C.L.); (W.-C.K.)
- Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Ming-Chi Li
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-W.L.); (N.-Y.L.); (P.-L.C.); (M.-C.L.); (W.-C.K.)
- Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung 406, Taiwan
- Correspondence: (C.-Y.L.); (N.-Y.K.); Tel.: +886-6-2353535 (ext. 5838) (N.-Y.K.); Fax: +886-6-2377550 (N.-Y.K.)
| | - Wen-Chien Ko
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-W.L.); (N.-Y.L.); (P.-L.C.); (M.-C.L.); (W.-C.K.)
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Nai-Ying Ko
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Correspondence: (C.-Y.L.); (N.-Y.K.); Tel.: +886-6-2353535 (ext. 5838) (N.-Y.K.); Fax: +886-6-2377550 (N.-Y.K.)
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Abstract
After participating in this activity, learners should be better able to:• Assess strategies for diagnosing depressive disorders in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)• Identify factors that contribute to the development of depressive disorders in HIV/AIDS• Evaluate strategies for managing depressive disorders in HIV/AIDS ABSTRACT: Depressive disorders and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are associated with major socioeconomic burdens. The negative impact of depressive disorders on HIV/AIDS is well known, including on treatment outcomes. Unfortunately, depressive disorders are underdiagnosed and undertreated in seropositive persons. This review summarizes clinically useful information on depressive disorders in HIV/AIDS. More specifically, we address assessment, differential diagnosis, contributing factors, management, and common challenges in the treatment of depressive disorders in seropositive individuals. Assessment and diagnosis of depression may be challenging in seropositive persons because of several biopsychosocial particularities associated with HIV/AIDS. One of the difficulties is the overlap between depression and HIV/AIDS symptoms, particularly in individuals with advanced AIDS, requiring consideration of a broad differential diagnosis. Several factors related to HIV/AIDS status contribute to the higher rates of depressive disorders, including infectious-immunological, psychosocial, and exogenous factors. The treatment of depressive disorders in HIV/AIDS involves three groups of interventions: (1) pharmacological interventions, (2) psychotherapeutic interventions, and (3) management of other contributing factors. Challenges in management include poor adherence to treatment and the risk of suicide. We provide evidence-based recommendations to improve assessment and management of depressive disorders in seropositive persons.
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Matshoba T, Mashaphu S, Tomita A, Paruk S. HIV knowledge, attitudes and practices amongst patients with severe mental illnesses and chronic medical illnesses in Durban, South Africa. S Afr J Psychiatr 2021; 27:1586. [PMID: 34230865 PMCID: PMC8252175 DOI: 10.4102/sajpsychiatry.v27i0.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Studies exploring HIV knowledge, attitudes and practices (KAP) of individuals with severe mental illness (SMI) have suggested their poorer knowledge about HIV. In KwaZulu-Natal (KZN) province, South Africa (SA), the epicentre of the country's HIV epidemic, improving KAP is essential for reduce its incidence amongst individuals with SMI. Comparing the KAP related to HIV between those with SMI and chronic medical illnesses (CMI) such as hypertension and diabetes may expose gaps in KAP related to HIV in the mentally ill who are more vulnerable to HIV. AIM This study aimed to compare the KAP related to HIV between people living with SMI and CMI. SETTING Outpatient clinics in Durban, SA. METHODS A cross-sectional structured questionnaire survey was conducted amongst 214 adult outpatients with SMI and CMI attending two general public sector hospitals in Durban, KZN. The KAP questionnaire consisted of three sections: general information, prevention and transmission of HIV. RESULTS Interviews were conducted with 124 patients with SMI and 90 with CMI. Most were female (69.5%), single (57.5%) and unemployed (59.4%). The diagnosis of SMI was associated with poorer general information of HIV (p = 0.02), but not with its prevention and transmission compared with those with CMI. Educational level was associated with poorer performance in all three domains: general information of HIV (p = 0.01), prevention (p = 0.01) and transmission (p = 0.02) amongst all the participants. CONCLUSION Gaps in the KAP of HIV amongst individuals with SMI compared with those with CMI suggested a need to provide focused health promotion regarding sexual health and HIV to the mentally ill at psychiatric facilities.
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Affiliation(s)
- Thembeka Matshoba
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sibongile Mashaphu
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa,KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saeeda Paruk
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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HIV-1 Tat Protein Promotes Neuroendocrine Dysfunction Concurrent with the Potentiation of Oxycodone's Psychomotor Effects in Female Mice. Viruses 2021; 13:v13050813. [PMID: 33946474 PMCID: PMC8147167 DOI: 10.3390/v13050813] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 02/06/2023] Open
Abstract
Human immunodeficiency virus (HIV) is associated with neuroendocrine dysfunction which may contribute to co-morbid stress-sensitive disorders. The hypothalamic-pituitary-adrenal (HPA) or -gonadal (HPG) axes are perturbed in up to 50% of HIV patients. The mechanisms are not known, but we have found the HIV-1 trans-activator of transcription (Tat) protein to recapitulate the clinical phenotype in male mice. We hypothesized that HPA and/or HPG dysregulation contributes to Tat-mediated interactions with oxycodone, an opioid often prescribed to HIV patients, in females. Female mice that conditionally-expressed the Tat1-86 protein [Tat(+) mice] or their counterparts that did not [Tat(-) control mice] were exposed to forced swim stress (or not) and behaviorally-assessed for motor and anxiety-like behavior. Some mice had glucocorticoid receptors (GR) or corticotropin-releasing factor receptors (CRF-R) pharmacologically inhibited. Some mice were ovariectomized (OVX). As seen previously in males, Tat elevated basal corticosterone levels and potentiated oxycodone's psychomotor activity in females. Unlike males, females did not demonstrate adrenal insufficiency and oxycodone potentiation was not regulated by GRs or CRF-Rs. Rather OVX attenuated Tat/oxycodone interactions. Either Tat or oxycodone increased anxiety-like behavior and their combination increased hypothalamic allopregnanolone. OVX increased basal hypothalamic allopregnanolone and obviated Tat or oxycodone-mediated fluctuations. Together, these data provide further evidence for Tat-mediated dysregulation of the HPA axis and reveal the importance of HPG axis regulation in females. HPA/HPG disruption may contribute vulnerability to affective and substance use disorders.
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Hutton HE, Cardin N, Ereme K, Chander G, Xu X, McCaul ME. Psychiatric Disorders and Substance Use Among African American Women in HIV Care. AIDS Behav 2020; 24:3083-3092. [PMID: 32306211 DOI: 10.1007/s10461-020-02858-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
African-American (AA) women are overrepresented among women with HIV (WWH). In the United States, psychiatric disorders are prevalent among WWH and associated with adverse outcomes. However, little research has examined psychiatric disorders among AA WWH. 315 AA women who were hazardous/heavy drinkers (HD) or moderate/non-drinkers (ND) were recruited from an HIV clinic in a study on alcohol use disorders. We compared sample prevalence of Axis-1 psychiatric diagnoses using the Structured Clinical Interview for DSM-IV with those from general population AA women in the National Comorbidity Survey-Replication (NCS-R). While 29.9% of general population AA women had any lifetime disorder, 66.9% of HD and 62.4% of ND WWH met criteria for a lifetime Axis-1 disorder. Specifically, lifetime PTSD and lifetime MDD were over threefold higher; current PTSD and current MDD respectively were 11-fold and threefold higher. PTSD was the most frequent comorbid diagnosis. HD and ND WWH did not differ in prevalence of psychiatric diagnoses despite significantly higher rates of substance use among HD women. Diagnostic evaluation and intervention for psychiatric disorders should be a priority in HIV medical care settings to improve health outcomes. Interventions should be tailored to address the particular stressors, challenges, and resiliencies among AA WWH.
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Affiliation(s)
- Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
| | - Noa Cardin
- Department of Health Science, Towson University, Towson, MD, USA
| | - Keemi Ereme
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xiaoqiang Xu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
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Abbamonte JM, Sawhney M, Alcaide ML, Weiss SM, Kumar M, Asfar T, Jones DL. The association of HIV and cocaine use to cigarette smoking in the context of depression and perceived stress. AIDS Care 2020; 32:1229-1237. [PMID: 32539456 PMCID: PMC7529880 DOI: 10.1080/09540121.2020.1778627] [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: 01/14/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
Mental well-being can contribute to cigarette smoking and negatively impact disease progression among people living with HIV (PLWH). This study examined potential associations between cocaine use (COC), depression, and HIV status in predicting cigarette smoking; hypothesizing that depression would be highest in cocaine users and predict cigarette smoking. An exploratory analysis including stress was also examined as a potential predictor of cigarette use. More than half of the sample (65%) endorsed smoking at some point in the past, and 52% endorsed being current smokers at the time of the study. Smokers were most likely to be cocaine users (87.1%), cocaine using PLWH (74.3%), or PLWH (36.6%). Neither HIV status (χ2(1) = 1.5, p = .221), perceived stress (χ2(1) = 0.75 p = .386), nor depressive symptomatology (χ2(1) = 1.2, p = .274) were related to smoking. Non-cocaine users were approximately 95.4% less likely to smoke than cocaine users, controlling for all other variables. Overall, cocaine use was the greatest predictor of cigarette smoking and quantity of cigarettes smoked. Perceived stress and depression were not associated with cigarette smoking in the sample. Future interventions targeting cigarette use should include a cocaine-related component to encourage smoking cessation among this high-risk group.
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Affiliation(s)
- J M Abbamonte
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - M Sawhney
- Liffrig Family School of Education & Behavioral Sciences, University of Mary, Bismarck, ND, USA
| | - M L Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - S M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - M Kumar
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - T Asfar
- Department of Public Health, University of Miami Miller School of Medicine, Miami, FL, USA
| | - D L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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11
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Portilla-Tamarit I, Ruiz-Robledillo N, Díez-Martínez M, Ferrer-Cascales R, Alcocer-Bruno C, Portilla J. The Role of Mental Health Conditions in the Diagnosis of Neurocognitive Impairment in People Living with HIV. Diagnostics (Basel) 2020; 10:diagnostics10080543. [PMID: 32751759 PMCID: PMC7460528 DOI: 10.3390/diagnostics10080543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
The aims of the present study were to evaluate the prevalence of undiagnosed mental health conditions (UMHC) in people living with HIV (PLWHIV) on antiretroviral treatment and with long-term suppressed HIV viremia, and its association with neurocognitive impairment (NCI). A cross-sectional observational study on HIV subjects, ≥18 years old, on stable antiretroviral treatment and with HIV viral load <50 copies/mL was carried out. Patients with known comorbidities, substances abuse, anxiety or depression were excluded. UMHC were evaluated by the Millon Clinical Multiaxial Inventory-III and NCI by Frascati criteria. The association between NCI and sociodemographic, clinical HIV variables and mental health conditions was analyzed. Further, the relationship between mental health conditions scores and NCI diagnosis was evaluated. Eighty patients were included, 37.5% had at least one undiagnosed mental health condition, and 26.3% had NCI. The most frequent mental health conditions were: anxiety (21.3%); bipolar disorder (11.3%); and substance dependence (8.8%). Only longer time since HIV diagnosis (p = 0.030) and at least one mental health condition diagnosis (p = 0.002) showed an association with NCI. Participants with NCI presented higher scores in anxiety, alcohol dependence and post-traumatic stress. Undiagnosed mental health conditions are frequent in PLWHIV. These disorders cannot be identified by HIV clinicians or basic screening questionnaires, and they are not usually self-reported by patients. UMHC could act as confounders in the evaluation of NCI.
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Affiliation(s)
- Irene Portilla-Tamarit
- Department of Health Psychology, University of Alicante, 03690 Alicante, Spain; (I.P.-T.); (R.F.-C.); (C.A.-B.)
- Alicante Institute for Health and Biomedical Research (ISABIAL–FISABIO Foundation), 03010 Alicante, Spain; (M.D.-M.); (J.P.)
- Department of Infectious Diseases, General University Hospital of Alicante, 03010 Alicante, Spain
- Spanish Network of Excellence on HIV Research, RIS, 28029 Madrid, Spain
| | - Nicolás Ruiz-Robledillo
- Department of Health Psychology, University of Alicante, 03690 Alicante, Spain; (I.P.-T.); (R.F.-C.); (C.A.-B.)
- Alicante Institute for Health and Biomedical Research (ISABIAL–FISABIO Foundation), 03010 Alicante, Spain; (M.D.-M.); (J.P.)
- Correspondence: ; Tel.: +34-96590-3990
| | - Marcos Díez-Martínez
- Alicante Institute for Health and Biomedical Research (ISABIAL–FISABIO Foundation), 03010 Alicante, Spain; (M.D.-M.); (J.P.)
- Department of Infectious Diseases, General University Hospital of Alicante, 03010 Alicante, Spain
- Spanish Network of Excellence on HIV Research, RIS, 28029 Madrid, Spain
| | - Rosario Ferrer-Cascales
- Department of Health Psychology, University of Alicante, 03690 Alicante, Spain; (I.P.-T.); (R.F.-C.); (C.A.-B.)
- Alicante Institute for Health and Biomedical Research (ISABIAL–FISABIO Foundation), 03010 Alicante, Spain; (M.D.-M.); (J.P.)
| | - Cristian Alcocer-Bruno
- Department of Health Psychology, University of Alicante, 03690 Alicante, Spain; (I.P.-T.); (R.F.-C.); (C.A.-B.)
| | - Joaquín Portilla
- Alicante Institute for Health and Biomedical Research (ISABIAL–FISABIO Foundation), 03010 Alicante, Spain; (M.D.-M.); (J.P.)
- Department of Infectious Diseases, General University Hospital of Alicante, 03010 Alicante, Spain
- Spanish Network of Excellence on HIV Research, RIS, 28029 Madrid, Spain
- Department of Clinical Medicine, Miguel Hernández University, 03016 Alicante, Spain
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12
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Salahuddin MF, Qrareya AN, Mahdi F, Jackson D, Foster M, Vujanovic T, Box JG, Paris JJ. Combined HIV-1 Tat and oxycodone activate the hypothalamic-pituitary-adrenal and -gonadal axes and promote psychomotor, affective, and cognitive dysfunction in female mice. Horm Behav 2020; 119:104649. [PMID: 31821792 PMCID: PMC7071558 DOI: 10.1016/j.yhbeh.2019.104649] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/26/2019] [Accepted: 11/26/2019] [Indexed: 12/31/2022]
Abstract
The majority of HIV+ patients present with neuroendocrine dysfunction and ~50% experience co-morbid neurological symptoms including motor, affective, and cognitive dysfunction, collectively termed neuroHIV. In preclinical models, the neurotoxic HIV-1 regulatory protein, trans-activator of transcription (Tat), promotes neuroHIV pathology that can be exacerbated by opioids. We and others find gonadal steroids, estradiol (E2) or progesterone (P4), to rescue Tat-mediated pathology. However, the combined effects of Tat and opioids on neuroendocrine function and the subsequent ameliorative capacity of gonadal steroids are unknown. We found that conditional HIV-1 Tat expression in naturally-cycling transgenic mice dose-dependently potentiated oxycodone-mediated psychomotor behavior. Tat increased depression-like behavior in a tail-suspension test among proestrous mice, but decreased it among diestrous mice (who already demonstrated greater depression-like behavior); oxycodone reversed these effects. Combined Tat and oxycodone produced apparent behavioral disinhibition of anxiety-like responding which was greater on diestrus than on proestrus. These mice made more central entries in an open field, but spent less time there and demonstrated greater circulating corticosterone. Tat increased the E2:P4 ratio of circulating steroids on diestrus and acute oxycodone attenuated this effect, but repeated oxycodone exacerbated it. Corticotropin-releasing factor was increased by Tat expression, acute oxycodone exposure, and was greater on diestrus compared to proestrus. In human neuroblastoma cells, Tat exerted neurotoxicity that was ameliorated by E2 (1 or 10 nM) or P4 (100, but not 10 nM) independent of oxycodone. Oxycodone decreased gene expression of estrogen and κ-opioid receptors. Thus, neuroendocrine function may be an important target for HIV-1 Tat/opioid interactions.
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Affiliation(s)
- Mohammed F Salahuddin
- Department of BioMolecular Sciences, University of Mississippi, School of Pharmacy, University, MS 38677-1848, USA
| | - Alaa N Qrareya
- Department of BioMolecular Sciences, University of Mississippi, School of Pharmacy, University, MS 38677-1848, USA
| | - Fakhri Mahdi
- Department of BioMolecular Sciences, University of Mississippi, School of Pharmacy, University, MS 38677-1848, USA
| | - Dejun Jackson
- Department of BioMolecular Sciences, University of Mississippi, School of Pharmacy, University, MS 38677-1848, USA
| | - Matthew Foster
- Department of BioMolecular Sciences, University of Mississippi, School of Pharmacy, University, MS 38677-1848, USA
| | - Tamara Vujanovic
- Department of BioMolecular Sciences, University of Mississippi, School of Pharmacy, University, MS 38677-1848, USA
| | - J Gaston Box
- Department of BioMolecular Sciences, University of Mississippi, School of Pharmacy, University, MS 38677-1848, USA
| | - Jason J Paris
- Department of BioMolecular Sciences, University of Mississippi, School of Pharmacy, University, MS 38677-1848, USA; Research Institute of Pharmaceutical Sciences, University of Mississippi, University, MS 38677, USA.
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13
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Closson K, Osborne C, Smith DM, Kesselring S, Eyawo O, Card K, Sereda P, Jabbari S, Franco-Villalobos C, Ahmed T, Gabler K, Patterson T, Hull M, Montaner JSG, Hogg RS. Correction to: Factors Associated with Mood Disorder Diagnosis Among a Population Based Cohort of Men and Women Living With and Without HIV in British Columbia Between 1998 and 2012. AIDS Behav 2020; 24:345-355. [PMID: 31820184 DOI: 10.1007/s10461-019-02693-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Using data from the Comparison of Outcomes and Service Utilization Trends (COAST) study we examined factors associated with mood disorder diagnosis (MDD) among people living with HIV (PLHIV) and HIV-negative individuals in British Columbia, Canada. MDD cases were identified between 1998 and 2012 using International Classification of Disease 9 and 10 codes. A total of 491,796 individuals were included and 1552 (23.7%) and 60,097 (12.4%) cases of MDD were identified among the HIV-positive and HIV-negative populations, respectively. Results showed HIV status was associated with greater odds of MDD among men and lower odds among women. Among PLHIV, MDD was significantly associated with: identifying as gay, bisexual or other men who have sex with men compared to heterosexuals; higher viral load; history of injection drug use; and concurrent anxiety, dysthymia, and substance use disorders. Findings highlight the need for comprehensive and holistic HIV and mental health care.
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Affiliation(s)
- Kalysha Closson
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
| | - Chuck Osborne
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | | | - Sarah Kesselring
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Oghenowede Eyawo
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Kiffer Card
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Shahab Jabbari
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Conrado Franco-Villalobos
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Tareq Ahmed
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Karyn Gabler
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | | | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- University of British Columbia, Vancouver, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- University of British Columbia, Vancouver, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081, Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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14
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Borderline Personality Disorder in Patients With Medical Illness: A Review of Assessment, Prevalence, and Treatment Options. Psychosom Med 2019; 81:584-594. [PMID: 31232916 DOI: 10.1097/psy.0000000000000724] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Borderline personality disorder (BPD) occurs in 0.7% to 3.5% of the general population. Patients with BPD experience excessive comorbidity of psychiatric and somatic diseases and are known to be high users of health care services. Because of a range of challenges related to adverse health behaviors and their interpersonal style, patients with BPD are often regarded as "difficult" to interact with and treat optimally. METHODS This narrative review focuses on epidemiological studies on BPD and its comorbidity with a specific focus on somatic illness. Empirically validated treatments are summarized, and implementation of specific treatment models is discussed. RESULTS The prevalence of BPD among psychiatric inpatients (9%-14%) and outpatients (12%-18%) is high; medical service use is very frequent, annual societal costs vary between &OV0556;11,000 and &OV0556;28,000. BPD is associated with cardiovascular diseases and stroke, metabolic disease including diabetes and obesity, gastrointestinal disease, arthritis and chronic pain, venereal diseases, and HIV infection as well as sleep disorders. Psychotherapy is the treatment of choice for BPD. Several manualized treatments for BPD have been empirically validated, including dialectical behavior therapy, transference-focused psychotherapy, mentalization-based therapy, and schema-focused therapy. CONCLUSIONS Health care could be substantially improved if all medical specialties would be familiar with BPD, its pathology, medical and psychiatric comorbidities, complications, and treatment. In mental health care, several empirically validated treatments that are applicable in a wide range of clinical settings are available.
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15
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Satre DD, Anderson AN, Leibowitz AS, Levine-Hall T, Slome S, Flamm J, Hare CB, McNeely J, Weisner CM, Horberg MA, Volberding P, Silverberg MJ. Implementing electronic substance use disorder and depression and anxiety screening and behavioral interventions in primary care clinics serving people with HIV: Protocol for the Promoting Access to Care Engagement (PACE) trial. Contemp Clin Trials 2019; 84:105833. [PMID: 31446142 PMCID: PMC6760257 DOI: 10.1016/j.cct.2019.105833] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Substance use disorders (SUDs) and psychiatric disorders are common among people with HIV (PWH) and lead to poor outcomes. Yet these conditions often go unrecognized and untreated in primary care. METHODS The Promoting Access to Care Engagement (PACE) trial currently in process examines the impact of self-administered electronic screening for SUD risk, depression and anxiety in three large Kaiser Permanente Northern California primary care clinics serving over 5000 PWH. Screening uses validated measures (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]; and the Adult Outcomes Questionnaire [AOQ], which includes the Patient Health Questionnaire [PHQ-9] and Generalized Anxiety Disorder [GAD-2]) delivered via three modalities (secure messaging, tablets in waiting rooms, and desktop computers in exam rooms). Results are integrated automatically into the electronic health record. Based on screening results and physician referrals, behavioral health specialists embedded in primary care initiate motivational interviewing- and cognitive behavioral therapy-based brief treatment and link patients to addiction and psychiatry clinics as needed. Analyses examine implementation (screening and treatment rates) and effectiveness (SUD, depression and anxiety symptoms; HIV viral control) outcomes using a stepped-wedge design, with a 12-month intervention phase implemented sequentially in the clinics, and a 24-month usual care period prior to implementation in each clinic functioning as sequential observational phases for comparison. We also evaluate screening and treatment costs and implementation barriers and facilitators. DISCUSSION The study examines innovative, technology-facilitated strategies for improving assessment and treatment in primary care. Results may help to inform substance use, mental health, and HIV services. TRIAL REGISTRATION NCT03217058.
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Affiliation(s)
- Derek D Satre
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America.
| | - Alexandra N Anderson
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Amy S Leibowitz
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Sally Slome
- Kasier Permanente Oakland Medical Center, 3801 Howe St, Oakland, CA 94611, United States of America
| | - Jason Flamm
- Kaiser Permanente Sacramento Medical Center, 2025 Morse Ave, Sacramento, CA 95825, United States of America
| | - C Bradley Hare
- Kaiser Permanente San Francisco Medical Center, 2238 Geary Blvd, San Francisco, CA 94115, United States of America
| | - Jennifer McNeely
- New York University School of Medicine, 550 1st Ave., New York, NY 10016, United States of America
| | - Constance M Weisner
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, United States of America; Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, 2101 East Jefferson, Rockville, MD 20852, United States of America
| | - Paul Volberding
- AIDS Research Institute, University of California San Francisco, San Francisco, CA, 94158, United States of America
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California Region, 2000 Broadway, Oakland, CA 94612, United States of America
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16
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Blanco C, Volkow ND. Management of opioid use disorder in the USA: present status and future directions. Lancet 2019; 393:1760-1772. [PMID: 30878228 DOI: 10.1016/s0140-6736(18)33078-2] [Citation(s) in RCA: 247] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/15/2018] [Accepted: 11/26/2018] [Indexed: 02/06/2023]
Abstract
Opioid use disorder is characterised by the persistent use of opioids despite the adverse consequences of its use. The disorder is associated with a range of mental and general medical comorbid disorders, and with increased mortality. Although genetics are important in opioid use disorder, younger age, male sex, and lower educational attainment level and income, increase the risk of opioid use disorder, as do certain psychiatric disorders (eg, other substance use disorders and mood disorders). The medications for opioid use disorder, which include methadone, buprenorphine, and extended-release naltrexone, significantly improve opioid use disorder outcomes. However, the effectiveness of medications for opioid use disorder is limited by problems at all levels of the care cascade, including diagnosis, entry into treatment, and retention in treatment. There is an urgent need for expanding the use of medications for opioid use disorder, including training of health-care professionals in the treatment and prevention of opioid use disorder, and for development of alternative medications and new models of care to expand capabilities for personalised interventions.
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Affiliation(s)
- Carlos Blanco
- National Institute on Drug Abuse, Bethesda, MD, USA.
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17
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Belenky N, Pence BW, Cole SR, Dusetzina SB, Edmonds A, Oberlander J, Plankey M, Adedimeji A, Wilson TE, Cohen J, Cohen MH, Milam JE, Adimora AA. Impact of Medicare Part D on mental health treatment and outcomes for dual eligible beneficiaries with HIV. AIDS Care 2019; 31:505-512. [PMID: 30189747 PMCID: PMC6342646 DOI: 10.1080/09540121.2018.1516283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Abstract
Depression is common among women with HIV and untreated depression can result in poor quality of life and worsen HIV outcomes. Women with HIV who are dually enrolled in Medicaid and Medicare faced a potential disruption in medication access when Medicare Part D was implemented in 2006. The goal of this study was to estimate the effects of Medicare Part D implementation on antidepressant use, depressive symptoms, and hospitalization in Medicaid-Medicare dual eligible women with HIV. This study used 2003-2008 data from the Women's Interagency HIV Study. The effects of Medicare Part D were estimated using a difference-in-differences approach, adjusting for temporal trends using a matched control group of Medicaid-only enrollees. Before Medicare Part D implementation, dual eligibles differed from Medicaid-only enrollees in antidepressant use and hospitalization, despite having identical prescription drug coverage through Medicaid. For dual enrollees, the transition to Medicare Part D was not associated with changes in antidepressant use, depressive symptoms, or hospitalization. We did not find disruptive effects on antidepressant use and related outcomes among dual eligibles in this study. Stable antidepressant use may be due to better access to medical care for dual eligibles through Medicare both before and after Medicare Part D implementation, which may have eclipsed any effects of the transition. It may also signal that classification of antidepressants as a protected drug class under Medicare Part D was effective in preventing psychiatric medication disruption.
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Affiliation(s)
- Nadya Belenky
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephen R. Cole
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stacie B. Dusetzina
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jonathan Oberlander
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Social Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael Plankey
- Division of Infectious Diseases and Travel Medicine, Department of Medicine, Georgetown University, Washington, DC
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Tracey E. Wilson
- Department of Community Health Sciences School of Public Health, State University of New York, Downstate Medical Center, Brooklyn, New York
| | - Jennifer Cohen
- Department of Clinical Pharmacy, University of California, San Francisco, California
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital and Rush University, Chicago, Illinois
| | - Joel E. Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Adaora A. Adimora
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, NC
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18
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George Dalmida S, Kraemer KR, Ungvary S, Di Valerio E, Koenig HG, Holstad MM. The Psychosocial and Clinical Well-Being of Women Living with Human Immunodeficiency Virus/AIDS. Nurs Clin North Am 2019; 53:203-225. [PMID: 29779514 DOI: 10.1016/j.cnur.2018.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study examined factors impacting the psychological well-being of women living with human immunodeficiency virus/AIDS and the impact of depression on clinical outcomes. Nearly two-thirds of participants in this cross-sectional study reported significant depressive symptoms. Compared with women living with human immunodeficiency virus/AIDS without depressive symptoms, those with depression reported significantly poorer health outcomes. Health care providers should regularly screen these women for and adequately treat depression, and must collaborate with mental health providers and pastoral care counselors to address the mental health needs of women living with human immunodeficiency virus/AIDS to optimize their human immunodeficiency virus-related outcomes.
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Affiliation(s)
- Safiya George Dalmida
- University of Alabama, Capstone College of Nursing, 650 University Boulevard, Tuscaloosa, AL 35487, USA.
| | - Kyle R Kraemer
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL 35487-0348, USA
| | - Stephen Ungvary
- Department of Psychology, University of Alabama, Box 870348, Tuscaloosa, AL 35487-0348, USA
| | - Elizabeth Di Valerio
- Department of Biological Sciences, University of Alabama, Box 870344, Tuscaloosa, AL 35487, USA
| | - Harold G Koenig
- Department of Psychiatry, Duke University Medical Center, 10 Duke Medicine Circle, Durham, NC 27710, USA; Department of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Marcia McDonnell Holstad
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, USA
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19
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Okafor CN, Plankey MW, Li M, Chen X, Surkan PJ, Shoptaw S, Martin E, Cohen R, Sacktor N, Cook RL. Association of Marijuana Use with Changes in Cognitive Processing Speed and Flexibility for 17 Years in HIV-Seropositive and HIV-Seronegative Men. Subst Use Misuse 2019; 54:525-537. [PMID: 30700235 PMCID: PMC6443451 DOI: 10.1080/10826084.2018.1495736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The long-term effects of marijuana on cognition, particularly in the context of HIV is not clear, as extant research shows mixed findings. OBJECTIVE To determine associations between current and cumulative exposure to marijuana and changes in cognitive processing speed and flexibility in 788 HIV-seropositive (HIV+) and 1,132 HIV-seronegative (HIV-) men followed for up to 17 years in the Multicenter AIDS Cohort Study. RESULTS Among HIV+ men only, current daily marijuana use compared to none-use, was significantly associated with a greater annual percentage decline in cognitive processing speed assessed with the Trail Making Test A (TMTA) (β=-0.41, 95% confidence interval (CI): -0.88, -0.03, p=0.03)] and Symbol Digit Modalities Test (SDMT) (β= -0.14, 95% CI: -0.28, -0.01, p=0.04). Further, monthly marijuana use was associated with greater annual percentage decline in cognitive flexibility assessed with the Trail Making Test B (TMTB) (β= -0.70, 95% CI: -1.34, -0.05; p=0.03] and cognitive processing speed (SDMT) (β= -0.21, 95% CI: -0.40, -0.01, p=0.03). Among the HIV- men only, each 5-marijuana use-years (equivalent to 5-years of daily marijuana use) was significantly associated with a 0.17 annual percentage decline in cognitive processing speed only (TMTA) (β= -0.18, 95% CI: -0.36, -0.01; p=0.04). CONCLUSIONS Our findings suggest that marijuana use, particularly current use, may be associated with worse cognitive processing speed, but the magnitude of the estimates was not clinically meaningful.
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Affiliation(s)
- Chukwuemeka N Okafor
- a Division of Infectious Diseases , David Geffen School of Medicine at University of California, Los Angeles , Los Angeles , California , USA.,b David Geffen School of Medicine , Department of Family Medicine at University of California , Los Angeles , California , USA
| | - Michael W Plankey
- c Department of Medicine, Division of Infectious Diseases , Georgetown University Medical Center , Washington, DC , USA
| | - Michael Li
- b David Geffen School of Medicine , Department of Family Medicine at University of California , Los Angeles , California , USA
| | - Xinguang Chen
- d Department of Epidemiology , College of Public Health and Health Professions, College of Medicine, University of Florida , Gainesville , Florida , USA
| | - Pamela J Surkan
- e Social and Behavioral Interventions Program, Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Steve Shoptaw
- b David Geffen School of Medicine , Department of Family Medicine at University of California , Los Angeles , California , USA
| | - Eileen Martin
- f Department of Psychiatry , Rush University Medical Center , Chicago , Illinois , USA
| | - Ronald Cohen
- g Center for Cognitive Aging and Memory, Institute on Aging, and the Departments of Neurology, Psychiatry, and Aging and Geriatric Research , University of Florida , Gainesville , Florida , USA
| | - Ned Sacktor
- h Department of Neurology, Johns Hopkins Bayview Medical Center , John Hopkins University , Baltimore , Maryland , USA
| | - Robert L Cook
- d Department of Epidemiology , College of Public Health and Health Professions, College of Medicine, University of Florida , Gainesville , Florida , USA
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Belayneh Z, Alemu W, Mekuriaw B, Abebe Z. Bipolar spectrum disorders and associated factors among adults attending an antiretroviral therapy clinic in Gedeo zone health centers, southern Ethiopia. Neuropsychiatr Dis Treat 2019; 15:503-509. [PMID: 30863072 PMCID: PMC6388964 DOI: 10.2147/ndt.s187669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Bipolar spectrum disorders (BPSDs) are more common among HIV-positive individuals than the general population. Although BPSDs have very diverse and devastating consequences (immune suppression, cognitive impairment and poor medication adherence), little is known about BPSDs among HIV-positive individuals in Ethiopia. Therefore, this study was aimed to assess the prevalence and associated factors of BPSDs among adults attending antiretroviral therapy (ART) clinics in Gedeo zone health centers, southern Ethiopia. PATIENTS AND METHODS An institutional-based cross-sectional study was conducted by screening 412 randomly selected HIV-positive individuals using Mood Disorder Questionnaire. SPSS version 20 was used for data analysis. Bivariable and multivariable logistic regression models were fitted to identify factors associated with BPSDs. Adjusted OR (AOR) with corresponding 95% CI was computed to determine the association. RESULTS Of the total 412 participants, 11.2% were screened positive for BPSDs. Lower CD4 count (AOR =2.97; 95% CI: 1.11, 7.90), past history of mental health problem (AOR =3.35; 95% CI: 1.576, 7.144), poor social support (AOR =2.6; 95% CI: 1.06, 6.63) and poor ART drug adherence (AOR =3.59; 95% CI: 1.78, 7.21) had a positive association with BPSDs. CONCLUSION In this study, the prevalence of BPSDs was high among adult patients attending ART clinics in Gedeo zone health centers. Poor social support, poor ART drug adherence, lower CD4 level and history of mental illness had statistically significant association with BPSDs. This demonstrates a need for the integration of Mental Health and Psycho Social Support with HIV/AIDS care services. Moreover, establishing good social support and controlling ART adherence were found to be very crucial too.
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Affiliation(s)
- Zelalem Belayneh
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia,
| | - Wagaye Alemu
- Department of Epidemiology and Biostatistics, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Birhanie Mekuriaw
- Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia,
| | - Zegeye Abebe
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Prevalence and correlates of HIV testing and HIV-positive status in the US: Results from the National Epidemiological Survey on Alcohol and Related Conditions III (NESARC-III). J Psychiatr Res 2018; 105:1-8. [PMID: 30118996 PMCID: PMC7551804 DOI: 10.1016/j.jpsychires.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 11/22/2022]
Abstract
We used the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III), a nationally representative sample of US adults (n = 34,653), to estimate the prevalence and correlates of HIV testing and HIV status. The diagnostic interview used was the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 Version. We found that in 2012-2013, the prevalence of a history of HIV testing was 53.0% among females and 47.0% among males. Among individuals tested, the prevalence of HIV was 1.06%, resulting in a known estimated prevalence of 0.54% in the full sample. In adjusted results, being non-white, aged 30-44, having college, being non-heterosexual, having history of unprotected sex or history of childhood sexual abuse and lower mental health-related quality of life increased the odds of having been tested, whereas being foreign-born, 45 years or older, family income ≥$20,000, being unemployed or a student, living in a rural setting and older age at first sex lowered those odds. Among those tested, being 30-64, being non-heterosexual, having history of unprotected sex or having a sexually transmitted disease in the last year was associated with greater odds of being HIV+. Having some college decreased those odds. In the adjusted results all psychiatric disorders were associated with increased rates of HIV testing, but only a lifetime history of drug use disorder and antisocial personality disorders were associated with HIV status among those tested. Despite CDC recommendations, only about half of US adults have ever been tested for HIV, interfering with efforts to eradicate HIV infection.
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Parreco J, Alawa N, Rattan R, Tashiro J, Sola JE. Teenage Trauma Patients Are at Increased Risk for Readmission for Mental Diseases and Disorders. J Surg Res 2018; 232:415-421. [PMID: 30463750 DOI: 10.1016/j.jss.2018.06.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 05/28/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Most studies of readmission after trauma are limited to single institutions or single states. The purpose of this study was to determine the risk factors for readmission after trauma for mental illness including readmissions to different hospitals across the United States. MATERIALS AND METHODS The Nationwide Readmission Database for 2013 and 2014 was queried for all patients aged 13 to 64 y with a nonelective admission for trauma and a nonelective readmission within 30 d. Multivariable logistic regression was performed for readmission for mental diseases and disorders. RESULTS During the study period, 53,402 patients were readmitted within 30 d after trauma. The most common major diagnostic category on readmission was mental diseases and disorders (12.1%). The age group with the highest percentage of readmissions for mental diseases and disorders was 13 to 17 y (38%). On multivariable regression, the teenage group was also the most likely to be readmitted for mental diseases and disorders compared to 18-44 y (odds ratio [OR] 0.45, P < 0.01) and 45-64 y (OR 0.24, P < 0.01). Other high-risk comorbidities included HIV infection (OR 2.4, P < 0.01), psychosis (OR 2.2, P < 0.01), drug (OR 2.0, P < 0.01), and alcohol (OR 1.4, P < 0.01) abuse. CONCLUSIONS Teenage trauma patients are at increased risk for hospital readmission for mental illness. Efforts to reduce these admissions should be targeted toward individuals with high-risk comorbidities such as HIV infection, psychosis, and substance abuse.
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Affiliation(s)
- Joshua Parreco
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Nawara Alawa
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Rishi Rattan
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Jun Tashiro
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Juan E Sola
- Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
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23
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Trauma and Growth: Impact of AIDS Activism. AIDS Res Treat 2018; 2018:9696725. [PMID: 29992054 PMCID: PMC5994318 DOI: 10.1155/2018/9696725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/11/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Our goal was to assess the long-term impact of AIDS activism of ACT UP/New York on the current adjustment of those who were members during its peak years (1987-1992), including assessment of trauma sequelae as well as posttraumatic growth. Methods A 90-minute semistructured interview and 6 validated self-report scales were administered. We relied on purposive and snowball sampling to recruit potential participants. Areas covered include demographics, ACT UP participation, and psychiatric problems. Self-report scales provided approximate diagnoses of PTSD and depression, as well as coping, optimism, and related concepts. Results Participants included 102 men (40% HIV-positive) and 23 women. Seventeen percent reported current symptoms suggesting PTSD, slightly above the range in general population studies. Symptoms consistent with depression were reported by 8% overall, with higher rates for HIV+ men. Enhanced sense of self, belief in change, and empowerment were reported by 93% of respondents, independent of concurrent PTSD or depression. Conclusions Twenty-eight years later, ACT UP study participants recall their activist days during the AIDS epidemic as the peak experience of their lives. While some continue to have symptoms of stress and depression, most found that their activism has enriched their subsequent lives.
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Closson K, Osborne C, Smith DM, Kesselring S, Eyawo O, Card K, Sereda P, Jabbari S, Franco-Villalobos C, Ahmed T, Gabler K, Patterson T, Hull M, Montaner JSG, Hogg RS. Factors Associated with Mood Disorder Diagnosis Among a Population Based Cohort of Men and Women Living With and Without HIV in British Columbia Between 1998 and 2012. AIDS Behav 2018; 22:1530-1540. [PMID: 28612214 DOI: 10.1007/s10461-017-1825-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Using data from the Comparison of Outcomes and Service Utilization Trends (COAST) study we examined factors associated with mood disorder diagnosis (MDD) among people living with HIV (PLHIV) and HIV-negative individuals in British Columbia, Canada. MDD cases were identified between 1998 and 2012 using International Classification of Disease 9 and 10 codes. A total of 491,796 individuals were included and 1552 (23.7%) and 60,097 (12.4%) cases of MDD were identified among the HIV-positive and HIV-negative populations, respectively. Results showed HIV status was associated with greater odds of MDD among men and lower odds among women. Among PLHIV, MDD was significantly associated with: identifying as gay, bisexual or other men who have sex with men compared to heterosexuals; higher viral load; history of injection drug use; and concurrent anxiety, dysthymia, and substance use disorders. Findings highlight the need for comprehensive and holistic HIV and mental health care.
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25
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Dalseth N, Reed RS, Hennessy M, Eisenberg MM, Blank MB. Does Diagnosis Make a Difference? Estimating the Impact of an HIV Medication Adherence Intervention for Persons with Serious Mental Illness. AIDS Behav 2018; 22:265-275. [PMID: 28536741 PMCID: PMC6281165 DOI: 10.1007/s10461-017-1795-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The heightened risk of persons with serious mental illness to contract and transmit human immunodeficiency virus (HIV) is a public health problem. Here we evaluate the interaction between psychiatric diagnosis and response to a community based-intervention targeted at treatment adherence in 236 HIV+ persons with co-occurring mental illness. To examine differential effectiveness of the intervention for categories of patient diagnosis, we reanalyzed the data after stratifying participants into two diagnostic groups: (1) participants with depressive disorders without psychosis and (2) participants with a psychotic or bipolar disorder. Outcomes included viral load and mental health quality of life (SF-12 Mental Health). We found that HIV+ persons with non-psychotic depressive disorders demonstrated a larger decrease in HIV viral load and more improvement in measures of mental health quality of life when compared to HIV+ persons with psychotic and bipolar disorders. We suggest that successful adherence interventions should be informed by psychiatric symptomatology. TRIAL REGISTRATION clinicaltrials.gov 29 identifier NCT00264823.
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Affiliation(s)
- Natasha Dalseth
- Department of Psychiatry and Behavioral Science, Lewis Katz School of Medicine, Temple University, Episcopal Campus, 100 E Lehigh Ave MAB 305, Philadelphia, PA, 19125, USA.
| | - Regina Szucs Reed
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Marlene M Eisenberg
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael B Blank
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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26
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Durbin A, Brown HK, Antoniou T, Sirotich F, Bansal S, Heifetz M, Roesslein K, Lunsky Y. Mental Health Disorders and Publicly Funded Service Use by HIV Positive Individuals: A Population-Based Cross-Sectional Study in Ontario, Canada. AIDS Behav 2017; 21:3457-3463. [PMID: 29098454 DOI: 10.1007/s10461-017-1949-5] [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: 11/28/2022]
Abstract
We compared use of community and hospital-based mental health and addiction (MH&A) services by adults with and without HIV. This population-based study examined the probability and intensity of MH&A service use by individuals with (n = 5095) and without HIV (n = 2,753,091) in Ontario, Canada between 2013 and 2014. Adults with HIV were more likely than HIV-negative adults to use MH&A primary and psychiatric care, and to have MH&A emergency department visits and hospital admissions; they also used more of each service. Use of MH&A hospital services was particularly high for persons in the HIV group compared to the no HIV group.
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Affiliation(s)
- Anna Durbin
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Hilary K Brown
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Interdisciplinary Centre for Health and Society, University of Toronto Scarborough, Scarborough, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Tony Antoniou
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Frank Sirotich
- Research and Evaluation, Canadian Mental Health Association-Toronto Branch, Toronto, ON, Canada
- Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Symron Bansal
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Marina Heifetz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kay Roesslein
- LOFT Community Services/McEwan Housing & Support Services, Toronto, ON, Canada
| | - Yona Lunsky
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Kent ST, Schwartz JE, Shimbo D, Overton ET, Burkholder GA, Oparil S, Mugavero MJ, Muntner P. Race and sex differences in ambulatory blood pressure measures among HIV+ adults. ACTA ACUST UNITED AC 2017. [PMID: 28624171 DOI: 10.1016/j.jash.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ambulatory blood pressure monitoring (ABPM) can identify phenotypes that cannot be measured in the clinic. Determining race and sex disparities in ABPM measures among HIV+ individuals may improve strategies to diagnose and treat hypertension in this high-risk population. We compared ABPM measures between 24 African-American and 25 white HIV+ adults (36 men and 13 women). Awake systolic blood pressure (SBP) and diastolic blood pressure (DBP) were similar in African-Americans and whites. After multivariable adjustment, sleep SBP and DBP were 9.7 mm Hg (95% confidence interval [95% CI]: 4.7, 14.8) and 8.4 mm Hg (95% CI: 4.3, 12.5) higher, respectively, among African-Americans compared with whites. After multivariable adjustment, SBP and DBP dipping ratios were 5.2% (95% CI: 1.7%, 8.7%) and 6.1% (95% CI 2.0%, 10.3%) smaller among African-Americans compared with whites. After multivariable adjustment, awake and sleep SBP and DBP were higher in men compared to women. There was no difference in SBP or DBP dipping ratios comparing men and women. The prevalence of awake masked hypertension was 42% in men versus 17% in women, and the prevalence of sleep masked hypertension was 57% among African-Americans versus 18% among whites. These data suggest that ABPM measures differ by race and sex in HIV+ adults.
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Affiliation(s)
- Shia T Kent
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph E Schwartz
- Department of Psychiatry, Applied Behavioral Medicine Research Institute, Stony Brook University, Stony Brook, NY, USA; Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Daichi Shimbo
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Edgar T Overton
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Greer A Burkholder
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Durbin A, Sirotich F, Lunsky Y, Roesslein K, Durbin J. Needs among persons with human immunodeficiency virus and intellectual and developmental disabilities in community mental health care: a cross-sectional study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:292-299. [PMID: 27506468 DOI: 10.1111/jir.12322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The experience of having human immunodeficiency virus (HIV) is often associated with co-occurring mental health issues. Community mental health services are an important source of support for persons with HIV living in the community. Persons with intellectual disability (ID) are vulnerable to HIV and may have unique support needs beyond those without ID receiving community care. This study compared support needs of men with HIV in community mental health programmes, with and without ID. METHODS The sample was composed of 138 HIV-positive men with and without ID receiving mental health case management from one community organisation in Ontario, Canada, on 31 March 2013. Staff-rated needs across 16 domains grouped into four clusters were measured using the Camberwell Assessment of Need: Basic needs (accommodation, food, public transportation, money and benefits); self-care/functional needs (looking after the home, self-care and daytime activities); health/safety needs (physical health, psychological distress, psychotic symptoms, safety to self and safety to others); and social needs (company, intimate relationships and sexual expression). Adjusted logistic regression models examined the association between ID and each need domain. RESULTS One-quarter of the sample (n = 34/138, 24.6%) had co-occurring ID. Those with ID were more likely to have needs in the basic cluster [odds ratios: food 4.05 (1.14, 14.44), P:0.031; benefits 2.58 (1.05, 6.32), P:0.038)] and self-care/functional cluster [looking after the home (2.75 (1.17, 6.49), P:0.021); self-care (2.72 (1.18, 6.27), P:0.019)], but were less likely to have need for sexual expression: 0.35 (0.14,0.90), P:0.030) (social cluster). There were no differences in the domains in the health/safety cluster. CONCLUSION Despite elevated cognitive needs in the basic and self-care/functional clusters for the ID group, limited other differences suggest that with moderate additional targeting, community mental health programmes for persons with HIV may be appropriate for men with ID.
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Affiliation(s)
- A Durbin
- Department of Research and Evaluation, Canadian Mental Health Association-Toronto Branch (CMHA), Toronto, Ontario, Canada
| | - F Sirotich
- Department of Research and Evaluation, Canadian Mental Health Association-Toronto Branch (CMHA), Toronto, Ontario, Canada
- Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Y Lunsky
- Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Mental Health and Addictions Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - K Roesslein
- LOFT Community Services/McEwan Housing and Support Services, Toronto, Ontario, Canada
| | - J Durbin
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Performance Measurement and Evaluation Research, Provincial System and Support Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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29
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Brandt C, Zvolensky MJ, Woods SP, Gonzalez A, Safren SA, O'Cleirigh CM. Anxiety symptoms and disorders among adults living with HIV and AIDS: A critical review and integrative synthesis of the empirical literature. Clin Psychol Rev 2017; 51:164-184. [PMID: 27939443 PMCID: PMC5195877 DOI: 10.1016/j.cpr.2016.11.005] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 09/09/2016] [Accepted: 11/04/2016] [Indexed: 12/21/2022]
Abstract
There are over 35 million people worldwide infected with the Human Immunodeficiency Virus (HIV) and its progression to Acquired Immunodeficiency Syndrome (AIDS; WHO, 2014). With the advent of combined antiretroviral therapy (i.e., cART) in 1996, persons living with HIV/AIDS (PLWHA) now have much longer life expectancies. However, living with HIV remains challenging, as it is associated with a number of significant and recurrent (chronic) stressors including physical pain, side effects of cART, social stigma, and discrimination, among other social stressors. Presumably, as a result of these types of stressors, a disproportionately high number of PLWHA struggle with clinically-significant psychiatric symptoms and disorders. Although much scientific and clinical attention has focused on depressed mood and psychopathology among PLWHA, there has been comparably less focus on anxiety and its disorders. The paucity of work in this area is concerning from a public health perspective, as anxiety symptoms and disorders are the most common class of psychiatric disorders and often maintain a large negative impact on life functioning.
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Affiliation(s)
- Charles Brandt
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, United States.
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, United States; Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, 1515 Holcomb Blvd. Houston, Texas, 77030, United States
| | - Steven P Woods
- Department of Psychology, University of Houston, 126 Heyne Building, Houston, TX, 77204, United States
| | - Adam Gonzalez
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, 101 Nicolls Rd, Stony Brook, NY, United States
| | - Steven A Safren
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33124, United States
| | - Conall M O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, Suite 701, Boston Ma, 02114, United States
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30
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Walter KN, Petry NM. Lifetime suicide attempt history, quality of life, and objective functioning among HIV/AIDS patients with alcohol and illicit substance use disorders. Int J STD AIDS 2016; 27:476-85. [PMID: 25953963 PMCID: PMC5023430 DOI: 10.1177/0956462415585668] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/10/2015] [Indexed: 12/13/2022]
Abstract
This cross-sectional study evaluated lifetime prevalence of suicide attempts in 170 HIV/AIDS patients with substance use disorders and the impact of suicide attempt history on subjective indices of quality of life and objective indices of cognitive and physical functioning. All patients met the diagnostic criteria for past-year cocaine or opioid use disorders and 27% of patients also had co-occurring alcohol use disorders. Compared to their counterparts without a history of a suicide attempt, patients with a history of a suicide attempt (n = 60, 35.3%) had significantly poorer emotional and cognitive quality of life scores (ps < .05), but not physical, social, or functional/global quality-of-life scores. Lifetime suicide attempt status was unrelated to objective indices of cognitive functioning, but there was a non-significant trend (p = .07) toward lower viral loads in those with a lifetime suicide attempt relative to those without. The findings indicate that suicide attempt histories are prevalent among HIV/AIDS patients with substance use disorders and relate to poorer perceived emotional and cognitive quality of life, but not objective functioning. HIV/AIDS patients with substance use disorders should be screened for lifetime histories of suicide attempts and offered assistance to improve perceived emotional and cognitive functioning.
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Affiliation(s)
| | - Nancy M Petry
- University of Connecticut School of Medicine, Farmington, CT, USA
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Amanor-Boadu S, Hipolito MS, Rai N, McLean CK, Flanagan K, Hamilton FT, Oji V, Lambert SF, Le HN, Kapetanovic S, Nwulia EA. Poor CD4 count is a predictor of untreated depression in human immunodeficiency virus-positive African-Americans. World J Psychiatry 2016; 6:128-35. [PMID: 27014603 PMCID: PMC4804261 DOI: 10.5498/wjp.v6.i1.128] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/05/2015] [Accepted: 12/18/2015] [Indexed: 02/05/2023] Open
Abstract
AIM To determine if efforts to improve antiretroviral therapy (ART) adherence minimizes the negative impact of depression on human immunodeficiency virus (HIV) outcomes. METHODS A cross-sectional study of a clinic-based cohort of 158 HIV seropositive (HIV+) African Americans screened for major depressive disorder (MDD) in 2012. CD4 T lymphocyte (CD4+) counts were obtained from these individuals. Self-report on adherence to ART was determined from questionnaire administered during clinic visits. The primary outcome measure was conditional odds of having a poorer CD4+ count (< 350 cells/mm(3)). Association between CD4+ count and antidepressant-treated or untreated MDD subjects was examined controlling for self-reported adherence and other potential confounders. RESULTS Out of 147 individuals with available CD4+ T lymphocyte data, 31% hadCD4+ count < 350 cells/mm(3) and 28% reported poor ART adherence. As expected the group with > 350 cells/mm(3) CD4+ T lymphocyte endorsed significantly greater ART adherence compared to the group with < 350 cells/mm(3) CD4+ T lymphocyte count (P < 0.004). Prevalence of MDD was 39.5% and 66% of individuals with MDD took antidepressants. Poor CD4+ T lymphocyte count was associated with poor ART adherence and MDD. Adjusting for ART adherence, age, sex and education, which were potential confounders, the association between MDD and poor CD4+ T lymphocyte remained significant only in the untreated MDD group. CONCLUSION Therefore, CD4+ count could be a clinical marker of untreated depression in HIV+. Also, mental health care may be relevant to primary care of HIV+ patients.
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Durbin A, Sirotich F, Antoniou T, Roesslein K, Durbin J, Lunsky Y. Unmet needs among men with human immunodeficiency virus in community mental health care: a cross-sectional study. AIDS Care 2016; 28:878-83. [PMID: 26971736 DOI: 10.1080/09540121.2016.1154133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
While community-based mental health services play an important role in caring for persons with HIV (human immunodeficiency virus) and co-existing mental health disorders, the extent to which their support needs are addressed in this setting is unknown. Accordingly, we examined if HIV infection was associated with unmet support needs among men living with and without HIV receiving community mental health care. This cross-sectional study examined 215 men (135 living with HIV and 80 without HIV) receiving case management services in urban Ontario. Using the Camberwell Assessment of Need, we ascertained the prevalence of support needs in 13 domains grouped into three clusters: Basic needs (accommodation, food, benefits, and money management); self-care/functional needs (daytime activities, self-care, and looking after the home); and health/safety needs (physical, psychological distress, psychotic symptoms, safety to self, and safety to others). We used generalized estimating equations with a logit link to examine the association between HIV and unmet need in each domain. Compared to HIV-negative men, men with HIV were more likely to have mood and concurrent disorders, and intellectual and developmental disabilities. Following multivariable analyses, men with HIV had greater unmet needs related to food (odds ratio + 95% confidence interval: 9.36 (4.03, 21.75), p < 0.001); money (OR: 1.90 (1.04, 3.47), p = 0.036) [basic need domains]; psychological distress (OR: 2.39 (1.68, 3.41), p < 0.001); drug use (OR: 5.10 (2.16, 12.08) p < 0.001); and safety to self (OR: 3.35 (1.51, 7.52), p < 0.003) [health and safety domains]. Despite living in a setting with universal health insurance, men with HIV receiving community mental health support had greater unmet need in basic and health domains than HIV-negative men receiving such support. Further research is required to develop and evaluate interventions to best support community-dwelling persons with HIV and mental health disorders.
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Affiliation(s)
- Anna Durbin
- a Canadian Mental Health Association - Toronto Branch (CMHA) , Toronto , ON , Canada
| | - Frank Sirotich
- a Canadian Mental Health Association - Toronto Branch (CMHA) , Toronto , ON , Canada.,b Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Tony Antoniou
- c Department of Family and Community Medicine , St. Michael's Hospital , Toronto , ON , Canada.,d Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , ON , Canada.,e Institute for Clinical Evaluative Sciences , Toronto , ON , Canada
| | - Kay Roesslein
- f LOFT Community Services/McEwan Housing & Support Services, Toronto, ON, Canada
| | - Janet Durbin
- g Provincial System Support Program , Centre for Addiction and Mental Health , Toronto , ON , Canada.,h Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Yona Lunsky
- e Institute for Clinical Evaluative Sciences , Toronto , ON , Canada.,h Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,i Centre for Addiction and Mental Health , Toronto , ON , Canada
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Kent ST, Bromfield SG, Burkholder GA, Falzon L, Oparil S, Overton ET, Mugavero MJ, Schwartz JE, Shimbo D, Muntner P. Ambulatory Blood Pressure Monitoring in Individuals with HIV: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0148920. [PMID: 26882469 PMCID: PMC4755611 DOI: 10.1371/journal.pone.0148920] [Citation(s) in RCA: 18] [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: 07/21/2015] [Accepted: 01/23/2016] [Indexed: 01/25/2023] Open
Abstract
Introduction Abnormal diurnal blood pressure (BP) rhythms may contribute to the high cardiovascular disease risk in HIV-positive (HIV+) individuals. To synthesize the current literature on ambulatory BP monitoring (ABPM) in HIV+ individuals, a systematic literature review and meta-analysis were performed. Methods Medical databases were searched through November 11, 2015 for studies that reported ABPM results in HIV+ individuals. Data were extracted by 2 reviewers and pooled differences between HIV+ and HIV-negative (HIV-) individuals in clinic BP and ABPM measures were calculated using random-effects inverse variance weighted models. Results Of 597 abstracts reviewed, 8 studies with HIV+ cohorts met the inclusion criteria. The 420 HIV+ and 714 HIV- individuals in 7 studies with HIV- comparison groups were pooled for analyses. The pooled absolute nocturnal systolic and diastolic BP declines were 3.16% (95% confidence interval [CI]: 1.13%, 5.20%) and 2.92% (95% CI: 1.64%, 4.19%) less, respectively, in HIV+ versus HIV- individuals. The pooled odds ratio for non-dipping systolic BP (nocturnal systolic BP decline <10%) in HIV+ versus HIV- individuals was 2.72 (95% CI: 1.92, 3.85). Differences in mean clinic, 24-hour, daytime, or nighttime BP were not statistically significant. I2 and heterogeneity chi-squared statistics indicated the presence of high heterogeneity for all outcomes except percent DBP dipping and non-dipping SBP pattern. Conclusions An abnormal diurnal BP pattern may be more common among HIV+ versus HIV- individuals. However, results were heterogeneous for most BP measures, suggesting more research in this area is needed.
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Affiliation(s)
- Shia T. Kent
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
| | - Samantha G. Bromfield
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Greer A. Burkholder
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Suzanne Oparil
- Department of Medicine, Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Edgar T. Overton
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Michael J. Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
- Applied Behavioral Medicine Research Institute, Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, United States of America
| | - Daichi Shimbo
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Kent ST, Burkholder GA, Tajeu GS, Overton ET, Muntner P. Mechanisms Influencing Circadian Blood Pressure Patterns Among Individuals with HIV. Curr Hypertens Rep 2016; 17:88. [PMID: 26429228 DOI: 10.1007/s11906-015-0598-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
HIV+ individuals have an increased risk for cardiovascular disease (CVD), but the mechanisms behind this association are poorly understood. While hypertension is a well-established CVD risk factor, clinic-based blood pressure (BP) assessment by itself cannot identify several important BP patterns, including white coat hypertension, masked hypertension, nighttime hypertension, and nighttime BP dipping. These BP patterns can be identified over a 24-h period by ambulatory BP monitoring (ABPM). In this review, we provide an overview of the potential value of conducting ABPM in HIV+ individuals. ABPM phenotypes associated with increased CVD risk include masked hypertension (i.e., elevated out-of-clinic BP despite non-elevated clinic BP), nighttime hypertension, and a non-dipping BP pattern (i.e., a drop in BP of <10 % from daytime to nighttime). These adverse ABPM phenotypes may be highly relevant in the setting of HIV infection, given that increased levels of inflammatory biomarkers, high psychosocial burden, high prevalence of sleep disturbance, and autonomic dysfunction have been commonly reported in HIV+ persons. Additionally, although antiretroviral therapy (ART) is associated with lower AIDS-related morbidity and CVD risk, the mitochondrial toxicity, oxidative stress, lipodystrophy, and insulin resistance associated with long-term ART use potentially lead to adverse ABPM phenotypes. Existing data on ABPM phenotypes in the setting of HIV are limited, but suggest an increased prevalence of a non-dipping BP pattern. In conclusion, identifying ABPM phenotypes may provide crucial information regarding the mechanisms underlying the excess CVD risk in HIV+ individuals.
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Affiliation(s)
- Shia T Kent
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd RPBH 220, Birmingham, AL, 35294, USA.
| | - Greer A Burkholder
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabriel S Tajeu
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd RPBH 220, Birmingham, AL, 35294, USA
| | - E Turner Overton
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd RPBH 220, Birmingham, AL, 35294, USA
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Hammond ER, Lai S, Wright CM, Treisman GJ. Cocaine Use May be Associated with Increased Depression in Persons Infected with HIV. AIDS Behav 2016; 20:345-52. [PMID: 26370100 DOI: 10.1007/s10461-015-1187-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
HIV infection, depression, and cocaine use are independently associated with increased inflammatory signal production. There is increasing evidence about the role of inflammation in depression. In HIV disease, cocaine use may increase disease progression as well as alter T cell functioning resulting in cytokine activation and thereby increasing susceptibility to depression. We examined the association between cocaine use and depression among 447 African American persons infected with HIV who were frequent cocaine users or non-users, enrolled in an observational study in Baltimore, Maryland, between August 2003 and December 2012. The overall prevalence of depression was 40.9 % (183 of 447) participants. Among persons who were depressed, the prevalence of cocaine use was 81.4 % (149 of 183), compared to 69.3 % among persons who were not depressed (183 of 264), P = 0.004. Cocaine use was associated with nearly twofold increased odds of depression, unadjusted odds ratio (OR) 1.94, (95 % CI 1.23, 3.06); P = 0.004, compared to never using cocaine, and OR 1.02, (95 % CI 1.10, 1.05); P = 0.04 in adjusted analysis. A dose-response relationship between increasing duration of cocaine use and depression was observed. Frequency and duration of cocaine use may be associated with depression. We speculate that depression among cocaine users with HIV may involve an inflammatory component that needs further examination.
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Affiliation(s)
- Edward R Hammond
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Meyer 119 Psychiatry, 600 North Wolfe Street, Baltimore, MD, 21287 7119, USA
| | - Shenghan Lai
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carolyn M Wright
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Meyer 119 Psychiatry, 600 North Wolfe Street, Baltimore, MD, 21287 7119, USA
| | - Glenn J Treisman
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Meyer 119 Psychiatry, 600 North Wolfe Street, Baltimore, MD, 21287 7119, USA.
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Skalski LM, Towe SL, Sikkema KJ, Meade CS. The Impact of Marijuana Use on Memory in HIV-Infected Patients: A Comprehensive Review of the HIV and Marijuana Literatures. CURRENT DRUG ABUSE REVIEWS 2016; 9:126-141. [PMID: 27138170 PMCID: PMC5093083 DOI: 10.2174/1874473709666160502124503] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 03/11/2016] [Accepted: 04/29/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The most robust neurocognitive effect of marijuana use is memory impairment. Memory deficits are also high among persons living with HIV/AIDS, and marijuana is the most commonly used drug in this population. Yet research examining neurocognitive outcomes resulting from co-occurring marijuana and HIV is limited. OBJECTIVE The primary objectives of this comprehensive review are to: (1) examine the literature on memory functioning in HIV-infected individuals; (2) examine the literature on memory functioning in marijuana users; (3) synthesize findings and propose a theoretical framework to guide future research. METHOD PubMed was searched for English publications 2000-2013. Twenty-two studies met inclusion criteria in the HIV literature, and 23 studies in the marijuana literature. RESULTS Among HIV-infected individuals, memory deficits with medium to large effect sizes were observed. Marijuana users also demonstrated memory problems, but results were less consistent due to the diversity of samples. CONCLUSION A compensatory hypothesis, based on the cognitive aging literature, is proposed to provide a framework to explore the interaction between marijuana and HIV. There is some evidence that individuals infected with HIV recruit additional brain regions during memory tasks to compensate for HIV-related declines in neurocognitive functioning. Marijuana is associated with disturbance in similar brain systems, and thus it is hypothesized that the added neural strain of marijuana can exhaust neural resources, resulting in pronounced memory impairment. It will be important to test this hypothesis empirically, and future research priorities are discussed.
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Affiliation(s)
- Linda M. Skalski
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Sheri L. Towe
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kathleen J. Sikkema
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Christina S. Meade
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
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Rowson SA, Harrell CS, Bekhbat M, Gangavelli A, Wu MJ, Kelly SD, Reddy R, Neigh GN. Neuroinflammation and Behavior in HIV-1 Transgenic Rats Exposed to Chronic Adolescent Stress. Front Psychiatry 2016; 7:102. [PMID: 27378953 PMCID: PMC4913326 DOI: 10.3389/fpsyt.2016.00102] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/30/2016] [Indexed: 12/23/2022] Open
Abstract
Highly active antiretroviral therapy (HAART) has improved prognosis for people living with HIV (PLWH) and dramatically reduced the incidence of AIDS. However, even when viral load is controlled, PLWH develop psychiatric and neurological disorders more frequently than those living without HIV. Adolescents with HIV are particularly susceptible to the development of psychiatric illnesses and neurocognitive impairments. While both psychiatric and neurocognitive disorders have been found to be exacerbated by stress, the extent to which chronic stress and HIV-1 viral proteins interact to impact behavior and relevant neuroinflammatory processes is unknown. Determination of the individual contributions of stress and HIV to neuropsychiatric disorders is heavily confounded in humans. In order to isolate the influence of HIV-1 proteins and chronic stress on behavior and neuroinflammation, we employed the HIV-1 transgenic (Tg) rat model, which expresses HIV-1 proteins with a gag and pol deletion, allowing for viral protein expression without viral replication. This Tg line has been characterized as a model of HAART-controlled HIV-1 infection due to the lack of viral replication but continued presence of HIV-1 proteins. We exposed male and female adolescent HIV-1 Tg rats to a mixed-modality chronic stress paradigm consisting of isolation, social defeat and restraint, and assessed behavior, cerebral vascularization, and neuroinflammatory endpoints. Stress, sex, and presence of the HIV-1 transgene impacted weight gain in adolescent rats. Female HIV-1 Tg rats showed decreases in central tendency during the light cycle in the open field regardless of stress exposure. Both male and female HIV-1 Tg rats exhibited decreased investigative behavior in the novel object recognition task, but no memory impairments. Adolescent stress had no effect on the tested behaviors. Microglia in female HIV-1 Tg rats exhibited a hyper-ramified structure, and gene expression of complement factor B was increased in the hippocampus. In addition, adolescent stress exposure increased microglial branching and junctions in female wild-type rats without causing any additional increase in HIV-1 rats. These data suggest that the presence of HIV-1 proteins during development leads to alterations in behavioral and neuroinflammatory endpoints that are not further impacted by concurrent chronic adolescent stress.
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Affiliation(s)
- Sydney A Rowson
- Molecular and Systems Pharmacology Graduate Studies Program, Emory University , Atlanta, GA , USA
| | | | - Mandakh Bekhbat
- Neuroscience Graduate Studies Program, Emory University , Atlanta, GA , USA
| | | | - Matthew J Wu
- Neuroscience and Behavioral Biology, Emory College , Atlanta, GA , USA
| | - Sean D Kelly
- Department of Physiology, Emory University , Atlanta, GA , USA
| | - Renuka Reddy
- Neuroscience and Behavioral Biology, Emory College , Atlanta, GA , USA
| | - Gretchen N Neigh
- Neuroscience Graduate Studies Program, Emory University, Atlanta, GA, USA; Department of Physiology, Emory University, Atlanta, GA, USA; Department of Psychiatry and Behavioral Science, Emory University, Atlanta, GA, USA
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Hahn YK, Masvekar RR, Xu R, Hauser KF, Knapp PE. Chronic HIV-1 Tat and HIV reduce Rbfox3/NeuN: evidence for sex-related effects. Curr HIV Res 2015; 13:10-20. [PMID: 25760045 DOI: 10.2174/1570162x13666150311163733] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 12/17/2014] [Accepted: 02/13/2015] [Indexed: 11/22/2022]
Abstract
The NeuN antibody has been widely used to identify and quantify neurons in normal and disease situations based on binding to a nuclear epitope in most types of neurons. This epitope was recently identified as the RNA-binding, feminizing locus on X-3 (Rbfox3), a member of the larger, mammalian Fox1 family of RNA binding proteins. Fox1 proteins recognize a unique UGCAUG mRNA motif and regulate alternative splicing of precursor mRNA to control post-transcriptional events important in neuronal differentiation and central nervous system development. Recent clinical findings show that Rbfox3/NeuN gene dosage is altered in certain human neurodevelopmental disorders, and redistribution has been noted in HIV(+) tissue. We hypothesized that HIV-1 Tat might affect Rbfox3/NeuN expression, and examined this question in vivo using inducible transgenic mice, and in vitro using human mesencephalic-derived neurons. Rbfox3/NeuN expression and localization in HIV+ basal ganglia and hippocampus was also examined. Chronic Tat exposure reduced Rbfox3/NeuN protein levels and increased cytoplasmic localization, similar to the effect of HIV exposure. Cytoplasmic Rbfox3/NeuN signal has occasionally been reported, although the meaning or function of cytoplasmic versus nuclear localization remains speculative. Importantly, Rbfox3/NeuN reductions were more significant in male mice. Although Rbfox3/NeuN-expressing cells were significantly decreased by Tat exposure, stereology showed that Nissl(+) neuron numbers remained normal. Thus, loss of Rbfox3/NeuN may relate more to functional change than to neuron loss. The effects of Tat by itself are highly relevant to HIV(+) individuals maintained on antiretroviral therapy, since Tat is released from infected cells even when viral replication is inhibited.
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Affiliation(s)
- Yun Kyung Hahn
- Department of Anatomy & Neurobiology, MCV Campus, Virginia Commonwealth University, P.O. Box 980709, Richmond, VA 23298-0709, USA.
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Skalski LM, Watt MH, MacFarlane JC, Proeschold-Bell RJ, Stout JE, Sikkema KJ. Mental Health and Substance Use Among Patients in a North Carolina HIV Clinic. N C Med J 2015; 76:148-55. [PMID: 26510216 DOI: 10.18043/ncm.76.3.148] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The HIV/AIDS epidemic is a significant public health concern in North Carolina, and previous research has pointed to elevated mental health distress and substance use among HIV-infected populations, which may impact patients' adherence to medications. The aims of this study were to describe the prevalence of mental health and substance use issues among patients of a North Carolina HIV clinic, to examine differences by demographic characteristics, and to examine factors associated with suboptimal adherence to HIV medications. METHODS This study was a secondary analysis of clinical data routinely collected through a health behavior questionnaire at a large HIV clinic in North Carolina. We analyzed data collected from February 2011 to August 2012. RESULTS The sample included 1,398 patients. Overall, 12.2% of patients endorsed current symptomology indicative of moderate or severe levels of depression, and 38.6% reported receiving a psychiatric diagnosis at some point in their life. Additionally, 19.1% had indications of current problematic drinking, and 8.2% reported problematic drug use. Nearly one-quarter (22.1%) reported suboptimal adherence to HIV medications. Factors associated with poor adherence included racial/ethnic minority, age less than 35 years, and indications of moderate or severe depression. LIMITATIONS The questionnaire was not completed systematically in the clinic, which may limit generalizability, and self-reported measures may have introduced social desirability bias. CONCLUSION Patients were willing to disclose mental health distress, substance use, and suboptimal medication adherence to providers, which highlights the importance of routinely assessing these behaviors during clinic visits. Our findings suggest that treating depression may be an effective strategy to improve adherence to HIV medications.
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Affiliation(s)
- Linda M Skalski
- doctoral student, Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Melissa H Watt
- assistant research professor, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Jessica C MacFarlane
- research assistant, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Rae Jean Proeschold-Bell
- assistant research professor, Duke Global Health Institute and Center for Health Policy & Inequalities Research, Duke University, Durham, North Carolina
| | - Jason E Stout
- associate professor of medicine, Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Kathleen J Sikkema
- professor, Department of Psychology and Neuroscience, Duke University; professor, Global Health Institute, Duke University; director, social and behavioral sciences, Duke Center for AIDS Research, Duke University; director of clinical psychology, Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
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Hasin DS, Grant BF. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1609-40. [PMID: 26210739 PMCID: PMC4618096 DOI: 10.1007/s00127-015-1088-0] [Citation(s) in RCA: 270] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/28/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. METHOD NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. RESULT The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. CONCLUSIONS Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, New York, NY, 10032, USA
- Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Room 3077, Rockville, MD, 20852, USA.
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Chan LG, Carvalhal A. Journeying with HIV patients across the health care spectrum - an examination of a seamless model of HIV Psychiatry of a large urban general hospital. Gen Hosp Psychiatry 2015; 37:538-41. [PMID: 26277772 DOI: 10.1016/j.genhosppsych.2015.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe a model of HIV psychiatry used in an urban hospital in Toronto and examine it against current literature. METHOD Using a narrative method, we elaborate on how this model delivers care across many different settings and the integral roles that the HIV psychiatrist plays in each of these settings. This is articulated against a backdrop of existing literature regarding models of HIV care. RESULTS This model is an example of an integrated model as opposed to a traditional consultation-liaison model and is able to deliver seamless care while remaining focused on patient-centric care. CONCLUSION An HIV psychiatrist delivers seamless and patient-centric care by journeying with patients across the healthcare spectrum and playing different roles in different care settings.
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Affiliation(s)
- Lai Gwen Chan
- Department of Psychological Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
| | - Adriana Carvalhal
- Medical Psychiatry Consultation Service, St Michael's Hospital; Department of Psychiatry, University of Toronto, Associated Scientist, Li Ka Shing, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
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Panagiotakopoulos L, Kelly S, Neigh GN. HIV-1 proteins accelerate HPA axis habituation in female rats. Physiol Behav 2015; 150:8-15. [PMID: 25666308 PMCID: PMC4529393 DOI: 10.1016/j.physbeh.2015.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/02/2015] [Accepted: 02/03/2015] [Indexed: 01/22/2023]
Abstract
Congenital infection by the Human Immunodeficiency Virus (HIV) has been shown to lead to multiple co-morbidities, and people living with HIV have a higher incidence of affective and anxiety disorders. A marked increase in mood disorders is evident during the sensitive phase of adolescence and this is further pronounced in females. Depression has been linked to dysfunction of the intracellular response system to corticosteroids at the level of the hippocampus (HC) and prefrontal cortex (PFC) with a notable role of the glucocorticoid receptor (GR) and its co-chaperones (FKBP5 and FKBP4). The current study examined the extent to which HIV protein expression in adolescent female rats altered the stress response at both the level of corticosterone output and molecular regulation of the glucocorticoid receptor in the brain. WT and HIV-1 genotype female rats were randomly allocated in control, acute stress and repeat stress groups. Corticosterone plasma levels and expression of GR, FKBP4, and FKBP5 in the HC and PFC were measured. The presence of HIV-1 proteins facilitates habituation of the corticosterone response to repeated stressors, such that HIV-1 TG rats habituated to repeated restraint and WT rats did not. This was reflected by interactions between stress exposure and HIV-1 protein expression at the level of GR co-chaperones. Although expression of the GR was similarly reduced after acute and repeat stress in both genotypes, expression of FKBP5 and FKBP4 was altered in a brain-region specific manner depending on the duration of the stress exposure and the presence or absence of HIV-1 proteins. Collectively, the data presented demonstrate that HIV-1 proteins accelerate habituation to repeated stressors and modify the influence of acute and repeat stressors on GR co-chaperones in a brain region-specific manner.
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Affiliation(s)
| | - Sean Kelly
- Department of Physiology, Emory University, United States
| | - Gretchen N Neigh
- Department of Physiology, Emory University, United States; Department of Psychiatry & Behavioral Sciences, Emory University, United States.
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43
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Dixon-Gordon KL, Whalen DJ, Layden BK, Chapman AL. A Systematic Review of Personality Disorders and Health Outcomes. ACTA ACUST UNITED AC 2015; 56:168-190. [PMID: 26456998 DOI: 10.1037/cap0000024] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Personality disorders have been associated with a wide swath of adverse health outcomes and correspondingly high costs to healthcare systems. To date, however, there has not been a systematic review of the literature on health conditions among individuals with personality disorders. The primary aim of this article is to review research documenting the associations between personality disorders and health conditions. A systematic review of the literature revealed 78 unique empirical English-language peer-reviewed articles examining the association of personality disorders and health outcomes over the past 15 years. Specifically, we reviewed research examining the association of personality disorders with sleep disturbance, obesity, pain conditions, and other chronic health conditions. In addition, we evaluated research on candidate mechanisms underlying health problems in personality disorders and potential treatments for such disorders. Results underscore numerous deleterious health outcomes associated with PD features and PD diagnoses, and suggest potential biological and behavioural factors that may account for these relations. Guidelines for future research in this area are discussed.
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Affiliation(s)
- Katherine L Dixon-Gordon
- University of Massachusetts Amherst, Department of Psychological and Brain Sciences, Amherst MA 01003; Tel: 413-545-0226;
| | - Diana J Whalen
- Washington University School of Medicine, Department of Psychiatry, Box 8511, St. Louis MO 63110; Tel: 314-286-2730;
| | - Brianne K Layden
- Simon Fraser University, Department of Psychology, 8888 University Drive, Burnaby BC V5A 1S6; Tel: 604-314-2762; ;
| | - Alexander L Chapman
- Simon Fraser University, Department of Psychology, 8888 University Drive, Burnaby BC V5A 1S6; Tel: 604-314-2762; ;
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Adejumo O, Oladeji B, Akpa O, Malee K, Baiyewu O, Ogunniyi A, Evans S, Berzins B, Taiwo B. Psychiatric disorders and adherence to antiretroviral therapy among a population of HIV-infected adults in Nigeria. Int J STD AIDS 2015; 27:938-49. [PMID: 26384949 DOI: 10.1177/0956462415600582] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/22/2015] [Indexed: 12/12/2022]
Abstract
Psychiatric disorders are common among people living with HIV in Nigeria. Adherence is necessary to optimise the outcome of antiretroviral therapy. In this study, we aimed to identify associations between antiretroviral adherence, measured by one-week and one-month self-reported missed doses, and psychiatric illness in a cohort previously assessed for psychiatric disorders using the Composite International Diagnostic Interview. The study participants comprised 151 adults with major depression, anxiety or suicidal symptoms, and 302 matched-control participants. Two controls were randomly selected for each case within the same gender and education level. We compared participants with psychiatric disorders (WPDs) and no psychiatric disorders (NPDs) on selected demographic and clinical variables, in addition to adherence. Participants with one or more missed doses in the preceding month had twice the odds of having a major depressive episode as those with no missed doses during this period (OR 2.22, 95% CI 1.03, 4.79). This association remained significant after adjusting for selected risk factors. There was no statistically significant difference between WPD and NPD groups on either one-week or one-month adherence, or on age, marital status, occupational class, HIV viral load at enrolment or current CD4 cell count. Among Nigerian adults with HIV, suboptimal antiretroviral adherence is associated with, and could be a sign of, depression. Routine self-report adherence assessments may potentially be utilised in identifying individuals at risk among this population.
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Affiliation(s)
| | | | - Onoja Akpa
- Department of Epidemiology and Medical Statistics, University of Ibadan, Nigeria
| | - Kay Malee
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Scott Evans
- Harvard School of Public Health, Boston, MA, USA
| | - Baiba Berzins
- Center for Global Health, Northwestern University, USA
| | - Babafemi Taiwo
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Slabbert FN, Harvey BH, Brink CB, Lubbe MS. The impact of HIV/AIDS on compliance with antidepressant treatment in major depressive disorder: A prospective study in a South African private healthcare cohort. AIDS Res Ther 2015; 12:9. [PMID: 26261459 PMCID: PMC4397684 DOI: 10.1186/s12981-015-0050-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 03/02/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND MDD and HIV/AIDS have a high prevalence worldwide with severe consequences for patients. In both conditions, compliance with treatment is key to successfully treat these disorders. In the current study, we examine the effect of MDD on the compliance with ADs in patients diagnosed with co-morbid HIV/AIDS and how different classes of ADs influence compliance in this group of patients. METHODS A prospective, cohort study design was used to analyse nationally representative medicine claims data submitted to a privately-owned South African Pharmaceutical Benefit Management (PBM) company. Two groups were distinguished in the database, namely patients with only MDD and patients with both MDD and HIV/AIDS, over a six-year study period. The study population was determined by the following inclusion criteria: patients older than 18 years, MDD should be diagnosed by a psychiatrist supported by an appropriate ICD-10 code, and all patients have to be on combination antiretroviral treatment (cARV) treatment. The medicine possession ratio (MPR) was used as proxy to determine patient compliance with AD medication. RESULTS 127 patients (i.e. 0.24%) met the criteria of co-morbid MDD and HIV/AIDS. Females have a significantly higher prevalence of MDD and HIV/AIDS when compared to males. Patients diagnosed with both HIV/AIDS and MDD (74.43. ± 32.03, 95% Cl: 71.51-77.34) have a statistical significantly (p < 0.0001) lower compliance with AD treatment vs. MDD patients (80.94% ± 29.44, 95% Cl: 80.56-81.33), but the practical significance thereof, is low (Cohen's d = 0.2255). In this group only 26.83% of TCA had acceptable compliance compared to the 58.57% of SNRIs. Noteworthy observations were that 75% (p < 0.0217; Cramer's V = 0.0388) of venlafaxine and 28.6% (p < 0.0197; Cramer's V = -0.0705) of the paroxetine items were compliant in patients diagnosed with both HIV/AIDS and MDD. CONCLUSIONS AD compliance is statistical significantly lower in depressed HIV/AIDS vs. depressed non-HIV/AIDS patients. However, these differences is of low practical or clinical significance, meaning that depressed HIV/AIDS patients would have missed approximately two AD doses (6.5% of a 30-day treatment period) more than the non-HIV/AIDS depressed patient over the same treatment period.
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46
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Sullivan KA, Messer LC, Quinlivan EB. Substance abuse, violence, and HIV/AIDS (SAVA) syndemic effects on viral suppression among HIV positive women of color. AIDS Patient Care STDS 2015; 29 Suppl 1:S42-8. [PMID: 25397666 DOI: 10.1089/apc.2014.0278] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The combined epidemics of substance abuse, violence, and HIV/AIDS, known as the SAVA syndemic, contribute to the disproportionate burden of disease among people of color in the US. To examine the association between HIV viral load suppression and SAVA syndemic variables, we used baseline data from 563 HIV+ women of color treated at nine HIV medical and ancillary care sites participating in HRSA's Special Project of National Significance Women of Color (WOC) Initiative. Just under half the women (n=260) were virally suppressed. Five psychosocial factors contributing to the SAVA syndemic were examined in this study: substance abuse, binge drinking, intimate partner violence, poor mental health, and sexual risk taking. Associations among the psychosocial factors were assessed and clustering confirmed. A SAVA score was created by summing the dichotomous (present/absent) psychosocial measures. Using generalized estimating equation (GEE) models to account for site-level clustering and individual-covariates, a higher SAVA score (0 to 5) was associated with reduced viral suppression; OR (adjusted)=0.81, 95% CI: 0.66, 0.99. The syndemic approach represents a viable framework for understanding viral suppression among HIV positive WOC, and suggests the need for comprehensive interventions that address the social/environmental contexts of patients' lives.
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Affiliation(s)
- Kristen A. Sullivan
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Lynne C. Messer
- School of Community Health, Portland State University, Portland, Oregon
| | - E. Byrd Quinlivan
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Nemeth CL, Glasper ER, Harrell CS, Malviya SA, Otis JS, Neigh GN. Meloxicam blocks neuroinflammation, but not depressive-like behaviors, in HIV-1 transgenic female rats. PLoS One 2014; 9:e108399. [PMID: 25271421 PMCID: PMC4182732 DOI: 10.1371/journal.pone.0108399] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/22/2014] [Indexed: 12/14/2022] Open
Abstract
Adolescents living with human immunodeficiency virus (HIV) comprise approximately 12% of the HIV-positive population worldwide. HIV-positive adolescents experience a higher rate of clinical depression, a greater risk of sexual and drug abuse behaviors, and a decreased adherence to highly active antiretroviral therapies (HAART). Using adolescent HIV-1 transgenic rats (HIV-1 tg) that display related immune response alterations and pathologies, this study tested the hypothesis that developmental expression of HIV-1-related proteins induces a depressive-like phenotype that parallels a decrease in hippocampal cell proliferation and an increase in pro-inflammatory cytokine expression in the hippocampus. Consistent with this hypothesis, adolescent HIV-1 tg rats demonstrated a depressive-like behavioral phenotype, had decreased levels of cell proliferation, and exhibited elevated expression of monocyte chemotactic protein-1 (Mcp-1) in the hippocampus relative to controls. Subsequently, we tested the ability of meloxicam, a selective COX-2 inhibitor, to attenuate behavioral deficits via inflammatory mechanisms. Daily meloxicam treatments did not alter the behavioral profile despite effectively reducing hippocampal inflammatory gene expression. Together, these data support a biological basis for the co-morbid manifestation of depression in HIV-positive patients as early as in adolescence and suggest that modifications in behavior manifest independent of inflammatory activity in the hippocampus.
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Affiliation(s)
- Christina L. Nemeth
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, United States of America
- Department of Physiology, Emory University, Atlanta, Georgia, United States of America
| | - Erica R. Glasper
- Department of Psychology, University of Maryland, College Park, Maryland, United States of America
| | - Constance S. Harrell
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, United States of America
- Department of Physiology, Emory University, Atlanta, Georgia, United States of America
| | - Sanjana A. Malviya
- Department of Physiology, Emory University, Atlanta, Georgia, United States of America
| | - Jeffrey S. Otis
- Division of Pulmonary, Allergy and Critical Care Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Gretchen N. Neigh
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, United States of America
- Department of Physiology, Emory University, Atlanta, Georgia, United States of America
- Center for Behavioral Neuroscience, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
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48
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Cholera R, Gaynes B, Pence B, Bassett J, Qangule N, Macphail C, Bernhardt S, Pettifor A, Miller W. Validity of the Patient Health Questionnaire-9 to screen for depression in a high-HIV burden primary healthcare clinic in Johannesburg, South Africa. J Affect Disord 2014; 167:160-6. [PMID: 24972364 PMCID: PMC4264106 DOI: 10.1016/j.jad.2014.06.003] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 06/02/2014] [Accepted: 06/03/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Integration of depression screening into primary care may increase access to mental health services in sub-Saharan Africa, but this approach requires validated screening instruments. We sought to validate the Patient Health Questionnaire-9 (PHQ-9) as a depression screening tool at a high HIV-burden primary care clinic in Johannesburg, South Africa. METHODS We conducted a validation study of an interviewer-administered PHQ-9 among 397 patients. Sensitivity and specificity of the PHQ-9 were calculated with the Mini International Neuropsychiatric Interview (MINI) as the reference standard; receiver operating characteristic (ROC) curve analyses were performed. RESULTS The prevalence of depression was 11.8%. One-third of participants tested positive for HIV. HIV-infected patients were more likely to be depressed (15%) than uninfected patients (9%; p=0.08). Using the standard cutoff score of ≥10, the PHQ-9 had a sensitivity of 78.7% (95% CI: 64.3-89.3) and specificity of 83.4% (95% CI: 79.1-87.2). The area under the ROC curve was 0.88 (95% CI: 0.83-0.92). Test performance did not vary by HIV status or language. In sensitivity analyses, reference test bias associated with the MINI appeared unlikely. LIMITATIONS We were unable to conduct qualitative work to adapt the PHQ-9 to this cultural context. CONCLUSION This is the first validation study of the PHQ-9 in a primary care clinic in sub-Saharan Africa. It highlights the potential for using primary care as an access point for identifying depressive symptoms during routine HIV testing. The PHQ-9 showed reasonable accuracy in classifying cases of depression, was easily implemented by lay health workers, and is a useful screening tool in this setting.
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Affiliation(s)
- Rushina Cholera
- Department of Epidemiology, UNC Gillings School of Global Public Health
| | | | - Brian Pence
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Jean Bassett
- Witkoppen Health and Welfare Center, Johannesburg, South Africa
| | | | - Catherine Macphail
- Collaborative Research Network for Mental Health and Well-being in Rural Communities, University of New England, Armidale, Australia & Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Audrey Pettifor
- Department of Epidemiology, UNC Gillings School of Global Public Health
| | - William Miller
- Department of Medicine, UNC School of Medicine; Department of Epidemiology, UNC Gillings School of Global Public Health
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49
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Paris JJ, Fenwick J, McLaughlin JP. Progesterone protects normative anxiety-like responding among ovariectomized female mice that conditionally express the HIV-1 regulatory protein, Tat, in the CNS. Horm Behav 2014; 65:445-53. [PMID: 24726788 PMCID: PMC4067900 DOI: 10.1016/j.yhbeh.2014.04.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/21/2014] [Accepted: 04/02/2014] [Indexed: 02/03/2023]
Abstract
Increased anxiety is co-morbid with human immunodeficiency virus (HIV) infection. Actions of the neurotoxic HIV-1 regulatory protein, Tat, may contribute to affective dysfunction. We hypothesized that Tat expression would increase anxiety-like behavior of female GT-tg bigenic mice that express HIV-1 Tat protein in the brain in a doxycycline-dependent manner. Furthermore, given reports that HIV-induced anxiety may occur at lower rates among women, and that the neurotoxic effects of Tat are ameliorated by sex steroids in vitro, we hypothesized that 17β-estradiol and/or progesterone would ameliorate Tat-induced anxiety-like effects. Among naturally-cycling proestrous and diestrous mice, Tat-induction via 7days of doxycycline treatment significantly increased anxiety-like responding in an open field, elevated plus maze and a marble-burying task, compared to treatment with saline. Proestrous mice demonstrated less anxiety-like behavior than diestrous mice in the open field and elevated plus maze, but these effects did not significantly interact with Tat-induction. Among ovariectomized mice, doxycycline-induced Tat protein significantly increased anxiety-like behavior in an elevated plus maze and a marble burying task compared to saline-treated mice, but not an open field (where anxiety-like responding was already maximal). Co-administration of progesterone (4mg/kg), but not 17β-estradiol (0.09mg/kg), with doxycycline significantly ameliorated anxiety-like responding in the elevated plus maze and marble burying tasks. When administered together, 17β-estradiol partially antagonized the protective effects of progesterone on Tat-induced anxiety-like behavior. These findings support evidence of steroid-protection over HIV-1 proteins, and extend them by demonstrating the protective capacity of progesterone on Tat-induced anxiety-like behavior of ovariectomized female mice.
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Affiliation(s)
- Jason J Paris
- Torrey Pines Institute for Molecular Studies, 11350 SW Village Parkway, Port Saint Lucie, FL 34987, USA.
| | - Jason Fenwick
- Torrey Pines Institute for Molecular Studies, 11350 SW Village Parkway, Port Saint Lucie, FL 34987, USA.
| | - Jay P McLaughlin
- Torrey Pines Institute for Molecular Studies, 11350 SW Village Parkway, Port Saint Lucie, FL 34987, USA.
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Abstract
In the HIV-infected population there is a high prevalence of psychiatric disorders, conditions that often coexist with drug and alcohol dependence. Symptoms associated with psychiatric disorders are frequently managed with benzodiazepines, a class of medication often abused. We examined whether HIV-infected patients were more likely to fill a benzodiazepine prescription than their uninfected counterparts using a privately insured, nationally representative sample receiving clinical care between January 2007 and December 2009. Odds ratios (OR) and 95% confidence intervals (CI) to quantify the likelihood of receiving a benzodiazepine were calculated using multivariate logistic regression models. We examined the presence of interaction between HIV infection and sex using backwards elimination and by comparing stratum-specific OR to identify clinically meaningful differences. Overall, 323,796 beneficiaries were included in the sample, of which 723 were HIV infected. Bivariate analyses showed that compared to the uninfected sample, HIV-infected patients were more likely to have filled a benzodiazepine prescription (24% vs. 19%) during the study period. HIV-infected patients were also more likely to be male (80% vs. 44%), black (21% vs. 7%) and have a diagnosis of depression (12% vs. 8%) or insomnia (6% vs. 3%) than were uninfected patients. Adjusted for other covariates, HIV infection was associated with an increase (OR): 1.68, 95% CI: 1.39, 2.02) in the likelihood of filling a benzodiazepine prescription. When stratified by sex, HIV-infected males were more likely (OR: 1.68, 95% CI: 1.05, 2.67) than uninfected males to fill a benzodiazepine prescription while there was no observed difference in the likelihood of filling a benzodiazepine prescription between HIV-infected and uninfected females (OR: 1.12, 95% CI: 0.73, 1.70). Our findings suggest that HIV-infected patients, particularly HIV-infected males, are more likely to fill benzodiazepine prescriptions than their uninfected counterparts, highlighting the need for further research to investigate reasons for these observed differences.
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Affiliation(s)
- Sarah E Wixson
- a Department of Pharmacy Practice and Science , Institute for Pharmaceutical Outcomes and Policy, University of Kentucky , Lexington , KY , USA
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