1
|
Thorne SL, Caraballo RS, Tie Y, Harris NS, Shouse RL, Brooks JT. E-Cigarette Use Among persons With Diagnosed HIV in the U.S. AJPM FOCUS 2023; 2:10.1016/j.focus.2022.100056. [PMID: 37206980 PMCID: PMC10193385 DOI: 10.1016/j.focus.2022.100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Introduction E-cigarettes emerged in the U.S. market in the late 2000s. In 2017, E-cigarette use among U.S. adults was 2.8%, with higher use among some population groups. Limited studies have assessed E-cigarette use among persons with diagnosed HIV. The purpose of this study is to describe the national prevalence estimates of E-cigarette use among persons with diagnosed HIV by selected sociodemographic, behavioral, and clinical characteristics. Methods Data were collected between June 2018 and May 2019 as part of the Medical Monitoring Project, an annual cross-sectional survey that produces nationally representative estimates of behavioral and clinical characteristics of persons with diagnosed HIV in the U.S. Statistically significant differences (p<0.05) were determined using chi-square tests. Data were analyzed in 2021. Results Among persons with diagnosed HIV, 5.9% reported currently using E-cigarettes, 27.1% had ever used them but were not using them currently, and 72.9% had never used them. Current use of E-cigarettes was highest among persons with diagnosed HIV who currently smoke conventional cigarettes (11.1%), those with major depression (10.8%), those aged 25-34 years (10.5%), those who reported injectable and noninjectable drug use in the past 12 months (9.7%), those diagnosed <5 years ago (9.5%), those who self-reported sexual orientation as other (9.2%), and non-Hispanic White people (8.4%). Conclusions Overall, findings suggest that a greater proportion of persons with diagnosed HIV used E-cigarettes than the overall U.S. adult population and that higher rates were observed among certain subgroups, including those who currently smoke cigarettes. E-cigarette use among persons with diagnosed HIV warrants continued attention because of its potential impact on HIV-related morbidity and mortality.
Collapse
Affiliation(s)
- Stacy L. Thorne
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ralph S. Caraballo
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yunfeng Tie
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Norma S. Harris
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - R. Luke Shouse
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John T. Brooks
- Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
2
|
Colliding Epidemics: Research Gaps and Implementation Science Opportunities for Tobacco Use and HIV/AIDS in Low- and Middle-Income Countries. J Smok Cessat 2022; 2022:6835146. [PMID: 35821759 PMCID: PMC9232349 DOI: 10.1155/2022/6835146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Tobacco use is a leading cause of cancer death among people living with HIV (PLWH) worldwide, and smoking prevalence tends to be higher among PLWH. The burden of both HIV/AIDS and tobacco use is increasingly concentrated in low- and middle-income countries (LMICs), where resources to address these challenges are often limited. However, there has been limited effort to date to integrate tobacco cessation into HIV programs in LMICs. Methods We searched the literature (searching was conducted between October 1 and December 31, 2020) using PubMed including search terms “tobacco” and “HIV” and “cessation” over the past ten years (searching for articles published between December 1, 2010, and December 1, 2020) to identify original research studies on tobacco cessation interventions conducted in LMICs for PLWH. We also conducted an analysis of NCI-funded research grants on tobacco cessation and HIV awarded during fiscal years 2010 to 2020. Results and Discussion. Existing evidence suggests that conventional tobacco cessation treatments may be less effective among PLWH. Moreover, while substantial evidence exists to support a range of cessation interventions, most of this evidence comes from HICs and is only partly applicable to the evolving social, economic, and cultural climate of many LMICs. There is an urgent need to develop, adapt, and implement effective tobacco control and cessation interventions targeted to PLWH in LMICs, as well as to generate evidence from these settings. Implementation science provides tools develop and test strategies to overcome barriers and to integrate and scale up cessation services within existing HIV treatment settings. Conclusion There is a unique opportunity to address HIV and tobacco use in a coordinated way in LMICs by integrating evidence-based tobacco cessation into HIV programs.
Collapse
|
3
|
Cioe PA, Pinkston M, Tashima KT, Kahler CW. Peer navigation for smoking cessation in smokers with HIV: Protocol for a randomized clinical trial. Contemp Clin Trials 2021; 110:106435. [PMID: 33992767 PMCID: PMC8590703 DOI: 10.1016/j.cct.2021.106435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Smoking prevalence in persons with HIV (PWH) is high (40%) and cessation rates remain low. Lack of social support and poor adherence to nicotine replacement therapy (NRT) are related to poor cessation outcomes; thus, both factors represent possible targets for smoking cessation interventions. Peer navigators (PNs) have been integrated into HIV care with great success to improve engagement and adherence to antiretroviral therapy. However, no clinical trial has evaluated the potential for PNs to provide social support and improve NRT adherence for smoking cessation. We developed a treatment protocol that targets social support, adherence, and self-efficacy for quitting by incorporating PNs into a smoking cessation program. This randomized trial will test whether this approach results in higher rates of 7-day point prevalence abstinence at 12- and 24-weeks, compared to standard treatment. METHODS Seventy-two smokers with HIV will be randomized to either Peer Navigation Social Support for smoking cessation (PNSS-S) or standard cessation counseling. All participants will meet with a nurse for a smoking cessation counseling session, which will include discussion of FDA-approved cessation pharmacotherapy. Participants assigned to PNSS-S will receive weekly phone calls from the PN for 12 weeks. The PN will address readiness to quit, using medication to quit, common barriers to cessation, high risk situations, slip management, and maintaining abstinence. Smoking cessation outcomes will be measured at 4, 12, and 24 weeks following the baseline appointment. CONCLUSION Results from this study will provide preliminary evidence of whether incorporating a peer navigator-based intervention into smoking cessation treatment can improve smoking cessation outcomes in PWH.
Collapse
Affiliation(s)
- Patricia A Cioe
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America.
| | - Megan Pinkston
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States of America; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Karen T Tashima
- Division of Infectious Diseases, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| |
Collapse
|
4
|
Webel AR, Schexnayder J, Cioe PA, Zuñiga JA. A Review of Chronic Comorbidities in Adults Living With HIV: State of the Science. J Assoc Nurses AIDS Care 2021; 32:322-346. [PMID: 33595986 PMCID: PMC8815414 DOI: 10.1097/jnc.0000000000000240] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT People living with HIV are living longer, high-quality lives; however, as they age, this population is at increased risk for developing chronic comorbidities, including cardiovascular disease, certain types of cancer (e.g., lung, anal, and liver), and diabetes mellitus. The purpose of this state-of-the-science review is to provide an evidence-based summary on common physical comorbidities experienced by people living and aging with HIV. We focus on those chronic conditions that are prevalent and growing and share behavioral risk factors that are common in people living with HIV. We will discuss the current evidence on the epidemiology, physiology, prevention strategies, screening, and treatment options for people living with HIV across resource settings.
Collapse
Affiliation(s)
- Allison R Webel
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Julie Schexnayder
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Patricia A Cioe
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Julie A Zuñiga
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| |
Collapse
|
5
|
Cioe PA, Mercurio AN, Lechner W, Costantino CC, Tidey JW, Eissenberg T, Kahler CW. A pilot study to examine the acceptability and health effects of electronic cigarettes in HIV-positive smokers. Drug Alcohol Depend 2020; 206:107678. [PMID: 31711874 PMCID: PMC9295550 DOI: 10.1016/j.drugalcdep.2019.107678] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/29/2019] [Accepted: 10/07/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Some HIV-positive smokers report ambivalence about quitting. Switching to electronic cigarettes (ECs) may be a viable option to reduce the negative health effects for smokers who are unable or unwilling to quit smoking combustible cigarettes (CCs). This study examined the acceptability and health-related effects of ECs in HIV-positive smokers who were not seeking smoking cessation treatment. METHODS HIV-positive smokers (N = 19) were enrolled and followed for 12 weeks. Cartridge-based ECs were provided at baseline, and E-liquid was provided weekly for 8 weeks. At baseline, weeks 1-8, and week 12, EC and CC use, cardiopulmonary function, respiratory symptoms, and carbon monoxide (CO) levels were measured. RESULTS At week 8, cigarettes per day (CPD) were reduced by more than 80%, with reduction maintained at week 12 (p's < .001). Cigarette dependence scores were 40% lower at week 8 than at baseline (p < .001). Seven (36.8%) participants reported transitioning completely from CCs to ECs. Mean CO decreased significantly from BL to week 8 (p < .05) and remained significantly lower at week 12 (p < .001). Intention to quit increased significantly over time. CONCLUSIONS Switching from CCs to ECs in HIV-positive smokers who are not ready to quit smoking in the next 30 days appears to be feasible. Beneficial effects were seen, such as reduced CPD, reduced CO and CC dependence, and increased motivation to quit. ECs may be promising as a harm reduction approach among HIV-positive smokers who are unable or unwilling to quit smoking.
Collapse
Affiliation(s)
- Patricia A Cioe
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Alana N Mercurio
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - William Lechner
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Catherine C Costantino
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Thomas Eissenberg
- Department of Psychology and Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| |
Collapse
|
6
|
Yingst J, Foulds J, Zurlo J, Steinberg MB, Eissenberg T, Du P. Acceptability of electronic nicotine delivery systems (ENDS) among HIV positive smokers. AIDS Care 2019; 32:1224-1228. [PMID: 31698920 DOI: 10.1080/09540121.2019.1687835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Electronic nicotine delivery systems (ENDS) have the potential to help smokers living with HIV/AIDS (PLWHA) to reduce harms from tobacco use. However, little is known about ENDS use among PLWHA. This study's aim was to evaluate the acceptability of two types of ENDS among PLWHA not planning to quit smoking. The study utilized a cross-over design where participants used two ENDS in a random order as smoking substitutes during two use periods separated by 7 days. Exhaled carbon monoxide (CO) was analyzed and participants reported daily cigarette and ENDS use and completed ratings on ENDS acceptability. Participants (n = 17) were a mean age of 49.1 years (SD = 8.8), were 53% white, and 59% male. All participants had controlled HIV disease status. Participants smoked a mean of 16.9 (SD = 7.9) CPD at baseline. Overall, CPD significantly decreased during both ENDS use periods (p < .01) but there were no differences in reduction between the different devices. CO decreased from baseline to follow-up only during the button-activated ENDS use period (p = .03), but there were no differences between ENDS devices. There were no significant differences in ratings of acceptability between ENDS devices. These results suggest that ENDS could be a harm reduction tool for smokers with HIV.
Collapse
Affiliation(s)
- Jessica Yingst
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - John Zurlo
- Department of Medicine, Penn State University College of Medicine, Hershey, PA USA
| | - Michael B Steinberg
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Thomas Eissenberg
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Ping Du
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA.,Department of Medicine, Penn State University College of Medicine, Hershey, PA USA
| |
Collapse
|
7
|
Kodidela S, Wang Y, Patters BJ, Gong Y, Sinha N, Ranjit S, Gerth K, Haque S, Cory T, McArthur C, Kumar A, Wan JY, Kumar S. Proteomic Profiling of Exosomes Derived from Plasma of HIV-Infected Alcohol Drinkers and Cigarette Smokers. J Neuroimmune Pharmacol 2019; 15:501-519. [PMID: 31065972 DOI: 10.1007/s11481-019-09853-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/10/2019] [Indexed: 12/12/2022]
Abstract
Abuse of alcohol and tobacco could exacerbate HIV pathogenesis by transferring materials through exosomes (small nanovesicles). Exosomes present a stable and accessible source of information concerning the health and/or disease status of patients, which can provide diagnostic and prognostic biomarkers for myriad conditions. Therefore, we aimed to study the specific exosomal proteins that are altered in both HIV-infected subjects and alcohol/tobacco users. Exosomes were isolated from plasma of the following subjects: a) HIV-negative subjects (healthy), b) HIV-positive subjects (HIV), c) HIV-negative alcohol drinkers (drinkers), d) HIV-negative tobacco smokers (smokers), e) HIV-positive drinkers (HIV + drinkers), and f) HIV-positive smokers (HIV + smokers). Quantitative proteomic profiling was then performed from these exosomes. Sixteen proteins were significantly altered in the HIV group, ten in drinkers, four in HIV + drinkers, and fifteen in smokers compared to healthy subjects. Only one protein, fibulin-1 (FBLN1), was significantly altered in HIV + smokers. Interestingly, hemopexin was not significantly altered in drinkers or HIV patients but was significantly altered in HIV + drinkers. Further, our study is the first to show properdin expression in plasma exosomes, which was decreased in HIV + smokers and HIV + drinkers compared to HIV patients. The present findings suggest that hemopexin and properdin show potential as markers for physiological effects that may arise in HIV-infected individuals who abuse alcohol and tobacco. Graphical abstract This study presents a proteomic analysis of plasma-derived exosomes from HIV-infected alcohol drinkers and smokers. Among the proteins altered due to drug-abuse, hemopexin and properdin were of highest significance. These proteins can be potential biomarkers for co-morbid conditions associated with drug abuse in HIV-patients.
Collapse
Affiliation(s)
- Sunitha Kodidela
- College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN, 38163, USA
| | - Yujie Wang
- Department of Pharmacy, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, 280 Mo He Road, Shanghai, 201999, China
| | - Benjamin J Patters
- College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN, 38163, USA
| | - Yuqing Gong
- College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN, 38163, USA
| | - Namita Sinha
- College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN, 38163, USA
| | - Sabina Ranjit
- College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN, 38163, USA
| | - Kelli Gerth
- College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN, 38163, USA
| | - Sanjana Haque
- College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN, 38163, USA
| | - Theodore Cory
- College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN, 38163, USA
| | - Carole McArthur
- Department of Oral and Craniofacial Science, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, 64108, USA
| | - Anil Kumar
- Division of Pharmacology and Toxicology, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jim Y Wan
- Division of Biostatistics, Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Santosh Kumar
- College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Ave, Memphis, TN, 38163, USA.
| |
Collapse
|
8
|
Cioe PA, Gordon REF, Guthrie KM, Freiberg MS, Kahler CW. Perceived barriers to smoking cessation and perceptions of electronic cigarettes among persons living with HIV. AIDS Care 2018; 30:1469-1475. [PMID: 29927614 PMCID: PMC6296254 DOI: 10.1080/09540121.2018.1489103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Smoking is more prevalent in persons living with HIV than the general population and is linked to increased morbidity and mortality. Some have suggested that based on current knowledge of harms and benefits, it may be feasible to advise smokers who are unable or unwilling to quit to switch to electronic cigarettes (ECs) as a less harmful alternative. We conducted 25 qualitative interviews with HIV-positive current or former smokers to explore perceived barriers to smoking cessation and perceptions of ECs. A high level of nicotine dependence, smoking as a form of stress management, motivational factors (including lack of readiness, low self-efficacy, ambivalence toward quitting), and having a social network of smokers were identified as cessation barriers. Low knowledge of ECs and uncertainty about EC safety and efficacy were barriers to EC uptake. However, current smokers indicated a willingness to try ECs. This study provides evidence that HIV-positive smokers face significant individual and environmental barriers to cessation. ECs may have potential as a harm reduction strategy in this population; however, there is a significant need for education regarding use and relative safety.
Collapse
Affiliation(s)
- Patricia A. Cioe
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Rebecca E. F. Gordon
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Kate M. Guthrie
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI
- Centers for Behavioral & Preventive Medicine, The Miriam Hospital, Providence, RI
| | - Matthew S. Freiberg
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Christopher W. Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| |
Collapse
|
9
|
Gamarel KE, Westfall AO, Lally MA, Hosek S, Wilson CM. Tobacco Use and Sustained Viral Suppression in Youth Living with HIV. AIDS Behav 2018; 22:2018-2025. [PMID: 28951979 PMCID: PMC5869110 DOI: 10.1007/s10461-017-1915-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tobacco has been associated with worse HIV disease progression in adult samples of people living with HIV; however, studies have yet to examine these effects in youth living with HIV (YLWH). This study examined the association between tobacco smoking behaviors and sustained viral suppression among a sample of 820 YLWH who were recruited through the Adolescent Medicine Trials Network for HIV Interventions. Participants completed a cross-sectional survey and then staff abstracted viral suppression data from medical records for up to 26 weeks prior to enrollment. Overall, 20.4% of youth reported daily or almost daily tobacco use. In multivariable analyses, older age and daily or almost daily tobacco smoking, and ART adherence remained statistically significant in predicting sustained viral suppression over the study period. These findings underscore the need for tobacco screening and interventions in HIV care settings in order to identify youth in need of additional smoking cessation services.
Collapse
Affiliation(s)
- Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA.
| | - Andrew O Westfall
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle A Lally
- Lifespan Hospital System, Providence, RI, USA
- Alpert Medical School, Brown University, Providence, RI, USA
| | - Sybil Hosek
- John Stroger Hospital of Cook County, Chicago, IL, USA
| | - Craig M Wilson
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
10
|
Tseng TY, Krebs P, Schoenthaler A, Wong S, Sherman S, Gonzalez M, Urbina A, Cleland CM, Shelley D. Combining Text Messaging and Telephone Counseling to Increase Varenicline Adherence and Smoking Abstinence Among Cigarette Smokers Living with HIV: A Randomized Controlled Study. AIDS Behav 2017; 21:1964-1974. [PMID: 27605365 DOI: 10.1007/s10461-016-1538-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Smoking represents an important health risk for people living with HIV (PLHIV). Low adherence to smoking cessation pharmacotherapy may limit treatment effectiveness. In this study, 158 participants recruited from three HIV care centers in New York City were randomized to receive 12-weeks of varenicline (Chantix) either alone as standard care (SC) or in combination with text message (TM) support or TM plus cell phone-delivered adherence-focused motivational and behavioral therapy (ABT). Generalized linear mixed-effect models found a significant decline in varenicline adherence from week 1-12 across treatment groups. At 12-weeks, the probability of smoking abstinence was significantly higher in SC+TM+ABT than in SC. The study demonstrates the feasibility of delivering adherence-focused interventions to PLHIV who smoke. Findings suggest intensive behavioral support is an important component of an effective smoking cessation intervention for this population, and a focus on improving adherence self-efficacy may lead to more consistent adherence and higher smoking abstinence.
Collapse
Affiliation(s)
- Tuo-Yen Tseng
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 708, New York, NY, 10016, USA
| | - Paul Krebs
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 708, New York, NY, 10016, USA
| | - Antoinette Schoenthaler
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 708, New York, NY, 10016, USA
| | - Selena Wong
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 708, New York, NY, 10016, USA
| | - Scott Sherman
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 708, New York, NY, 10016, USA
| | - Mirelis Gonzalez
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 708, New York, NY, 10016, USA
| | - Antonio Urbina
- Behavioral Health Research, St. Luke's Roosevelt Hospital, New York, NY, USA
| | - Charles M Cleland
- New York University Rory Meyers College of Nursing and Center for Drug Use and HIV Research, New York, NY, USA
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 708, New York, NY, 10016, USA.
| |
Collapse
|
11
|
Improving Health and Reducing Comorbidity Associated with HIV: The Development of TAVIE en santé, a Web-Based Tailored Intervention to Support the Adoption of Health Promoting Behaviors among People Living with HIV. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4092304. [PMID: 28393077 PMCID: PMC5368366 DOI: 10.1155/2017/4092304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/30/2017] [Indexed: 01/14/2023]
Abstract
Background. In the domain of health behavior change, the deployment and utilization of information and communications technologies as a way to deliver interventions appear to be promising. This article describes the development of a web-based tailored intervention, TAVIE en santé, to support people living with HIV in the adoption of healthy behaviors. Methods. This intervention was developed through an Intervention Mapping (IM) framework and is based on the theory of planned behavior. Results. Crucial steps of IM are the selection of key determinants of behavior and the selection of useful theory-based intervention methods to change the targeted determinants (active ingredients). The content and the sequence of the intervention are then created based on these parameters. TAVIE en santé is composed of 7 interactive web sessions hosted by a virtual nurse. It aims to develop and strengthen skills required for behavior change. Based on an algorithm using individual cognitive data (attitude, perceived behavioral control, and intention), the number of sessions, theory-based intervention methods, and messages contents are tailored to each user. Conclusion. TAVIE en santé is currently being evaluated. The use of IM allows developing intervention with a systematic approach based on theory, empirical evidence, and clinical and experiential knowledge.
Collapse
|
12
|
Gamarel KE, Neilands TB, Conroy AA, Dilworth SE, Lisha N, Taylor JM, Darbes LA, Johnson MO. A longitudinal study of persistent smoking among HIV-positive gay and bisexual men in primary relationships. Addict Behav 2017; 66:118-124. [PMID: 27930901 PMCID: PMC5525143 DOI: 10.1016/j.addbeh.2016.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/14/2016] [Accepted: 11/16/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We examined the stability of smoking behaviors, and factors associated with persistent smoking in a longitudinal study of HIV-positive gay and bisexual men in primary relationships. METHODS A sample of 377 HIV-positive men on antiretroviral therapy and their same-sex partners completed five assessments over two years. Participants completed semi-structured interviews which assessed smoking status, sociodemographic factors, relationship dynamics, and HIV-related disease characteristics. Latent transition analysis estimated the amount of transition in smoking over time. Latent class analysis examined factors associated with smoking status across the study period. RESULTS At baseline, 28.1% (n=106) of participants reported current smoking. Over 90% of the HIV-positive men remained in the same smoking category over time (68.4% persistent non-smokers; 24.1% persistent smokers). Men whose partners smoked and men with lower income had higher odds of being persistent smokers, whereas older men and men who identified as Latino race/ethnicity had lower odds of being persistent smokers compared to non-smokers. CONCLUSIONS Despite efforts to reduce smoking among people living with HIV (PLWH), a substantial subset of men continued to smoke during their two years in the study. Findings suggest that primary partners who also smoke and low income were the strongest predictors of sustained smoking behaviors among HIV-positive men. Additional research is needed to better understand how to increase motivation and support for smoking cessation among PLWH and their primary partners, while attending to how socioeconomic status may inhibit access to and the sustained impact of existing smoking cessation programs.
Collapse
Affiliation(s)
- Kristi E Gamarel
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, USA.
| | | | - Amy A Conroy
- Department of Medicine, University of California, San Francisco, USA
| | | | - Nadra Lisha
- Department of Medicine, University of California, San Francisco, USA
| | - Jonelle M Taylor
- Department of Medicine, University of California, San Francisco, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, USA
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco, USA
| |
Collapse
|
13
|
Balfour L, Wiebe SA, Cameron WD, Sandre D, Pipe A, Cooper C, Angel J, Garber G, Holly C, Dalgleish TL, Tasca GA, MacPherson PA. An HIV-tailored quit-smoking counselling pilot intervention targeting depressive symptoms plus Nicotine Replacement Therapy. AIDS Care 2016; 29:24-31. [PMID: 27435835 DOI: 10.1080/09540121.2016.1201195] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cardiovascular disease (CVD) rates among people living with HIV/AIDS (PHAs) are high. Rates of cigarette smoking, a leading contributor to CVD among PHAs, are 40-70% (2-3 times higher than the general population). Furthermore, PHAs have high rates of depression (40-60%), a risk factor for smoking cessation relapse. The current pilot study examined the effectiveness of a specifically tailored 5-session smoking cessation counselling programme for PHAs, which addressed depression, in combination with Nicotine Replacement Therapy (NRT) in a cohort of PHA smokers (n = 50). At 6-month follow-up, 28% of participants demonstrated biochemically verified abstinence from smoking. This result compares favourably to other quit-smoking intervention studies, particularly given the high percentage of HIV+ smokers with depression. At study baseline, 52% of HIV+ smokers scored above the clinical cut-off for depression on the Centre for Epidemiological Studies - Depression (CES-D) scale. HIV+ smokers with depression at study baseline demonstrated quantitatively lower depression at 6-month follow-up with a large effect size (d = 1), though it did not reach statistical significance (p = .058). Furthermore, those with depression were no more likely to relapse than those without depression (p = .33), suggesting that our counselling programme adequately addressed this significant barrier to smoking cessation among PHAs. Our pilot study indicates the importance of tailored programmes to help PHAs quit smoking, the significance of addressing depressive symptoms, and the need for tailored counselling programmes to enhance quit rates among PHAs.
Collapse
Affiliation(s)
- Louise Balfour
- a Department of Psychology , The Ottawa Hospital , Ottawa , ON , Canada.,b Department of Psychology , The University of Ottawa , Ottawa , ON , Canada.,c The Ottawa Hospital Research Institute , Ottawa , ON , Canada.,d Department of Medicine , The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute , Ottawa , ON , Canada
| | - Stephanie A Wiebe
- a Department of Psychology , The Ottawa Hospital , Ottawa , ON , Canada.,b Department of Psychology , The University of Ottawa , Ottawa , ON , Canada.,c The Ottawa Hospital Research Institute , Ottawa , ON , Canada
| | - William D Cameron
- e Division of Infectious Diseases , The Ottawa Hospital, Ottawa Hospital Research Institute, Faculty of Medicine, University of Ottawa , Ottawa , ON , Canada
| | - Daniella Sandre
- a Department of Psychology , The Ottawa Hospital , Ottawa , ON , Canada.,b Department of Psychology , The University of Ottawa , Ottawa , ON , Canada.,c The Ottawa Hospital Research Institute , Ottawa , ON , Canada
| | - Andrew Pipe
- f The University of Ottawa Heart Institute , Ottawa , ON , Canada.,g Ottawa Hospital Research Institute , Ottawa , ON , Canada
| | - Curtis Cooper
- e Division of Infectious Diseases , The Ottawa Hospital, Ottawa Hospital Research Institute, Faculty of Medicine, University of Ottawa , Ottawa , ON , Canada
| | - Jonathan Angel
- e Division of Infectious Diseases , The Ottawa Hospital, Ottawa Hospital Research Institute, Faculty of Medicine, University of Ottawa , Ottawa , ON , Canada
| | - Gary Garber
- h Faculty of Medicine , University of Ottawa, Ottawa Hospital Research Institute , Ottawa , ON , Canada
| | - Crystal Holly
- a Department of Psychology , The Ottawa Hospital , Ottawa , ON , Canada.,b Department of Psychology , The University of Ottawa , Ottawa , ON , Canada.,c The Ottawa Hospital Research Institute , Ottawa , ON , Canada
| | - Tracy L Dalgleish
- i Greenbelt Family Health Team , Nepean , ON , Canada.,j Ottawa Couple and Family Institute , Ottawa , ON , Canada
| | - Giorgio A Tasca
- a Department of Psychology , The Ottawa Hospital , Ottawa , ON , Canada.,b Department of Psychology , The University of Ottawa , Ottawa , ON , Canada.,k Department of Psychology , Carleton University , Ottawa , ON , Canada
| | - Paul A MacPherson
- e Division of Infectious Diseases , The Ottawa Hospital, Ottawa Hospital Research Institute, Faculty of Medicine, University of Ottawa , Ottawa , ON , Canada
| |
Collapse
|
14
|
Shelley D, Tseng TY, Gonzalez M, Krebs P, Wong S, Furberg R, Sherman S, Schoenthaler A, Urbina A, Cleland CM. Correlates of Adherence to Varenicline Among HIV+ Smokers. Nicotine Tob Res 2016; 17:968-74. [PMID: 26180221 DOI: 10.1093/ntr/ntv068] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Low rates of adherence to smoking cessation pharmacotherapy may limit the effectiveness of treatment. However, few studies have examined adherence in smoking cessation trials thus, there is a limited understanding of factors that influence adherence behaviors. This brief report analyzes correlates of adherence to varenicline among people living with HIV/AIDS. METHODS Study participants were recruited from three HIV care centers in New York City and enrolled in a three-arm randomized controlled pilot study in which all subjects received varenicline. At the 1-month study visit, there were no significant differences in adherence by study condition, therefore we combined treatment arms to examine correlates of adherence (n = 127). We used pill counts to assess varenicline adherence, defined as taking at least 80% of the prescribed dose. We conducted a multivariate path analysis to assess factors proposed by the information-motivation-behavioral skills model to predict adherence. RESULTS Only 56% of smokers were at least 80% adherent to varenicline at 1 month. Adherence-related information, self-efficacy, a college degree, and non-Hispanic white race/ethnicity were associated with increased varenicline adherence. In path analysis, information and motivation were associated with increased adherence self-efficacy, and adherence self-efficacy was associated with increased adherence, but with marginal significance. These associations with adherence were no longer significant after controlling for race/ethnicity and education. CONCLUSIONS Further exploration of the role of a modifiable correlates of adherence, such as adherence-related information, motivation and self-efficacy is warranted. Interventions are needed that can address disparities in these and other psychosocial factors that may mediate poor medication adherence.
Collapse
Affiliation(s)
- Donna Shelley
- Department of Population Health, New York University School of Medicine, New York, NY;
| | - Tuo-Yen Tseng
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Mirelis Gonzalez
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Paul Krebs
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Selena Wong
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Robert Furberg
- Center for the Advancement of Health Information Technology, Research Triangle Institute, Raleigh, NC
| | - Scott Sherman
- Department of Population Health, New York University School of Medicine, New York, NY; Behavioral Health Research, St Luke's Roosevelt Hospital, New York, NY
| | | | - Anthony Urbina
- New York University College of Nursing and Center for Drug Use and HIV Research, New York, NY
| | - Charles M Cleland
- New York University College of Nursing and Center for Drug Use and HIV Research, New York, NY
| |
Collapse
|
15
|
Abstract
OBJECTIVE Gastrointestinal disorders are common in HIV-positive patients and, in some cases, may be related to antiretroviral therapy (ART), making it difficult to determine the need for upper gastrointestinal (UGI) endoscopy. The primary aim of this study was to determine whether lymphocyte T CD4 cell counts were correlated with indications for endoscopy in these patients and with endoscopic diagnosis. PATIENTS AND METHODS We prospectively collected data from consecutive HIV-positive patients undergoing UGI endoscopy between 2007 and 2013, and included 265 patients who had been receiving ART for at least 6 months. Parameters studied were demographics, immune parameters, comorbidities, comedications, indications for endoscopy, and endoscopic, pathologic, and microbiologic findings. RESULTS The most frequent indications for UGI endoscopy were gastroesophageal reflux, epigastric pain, and other. Peptic esophagitis, esophageal candidiasis, and normal endoscopy were the most common diagnoses. The prevalence rates of Helicobacter pylori infection and neoplasia were 26.4 and 1.8%, respectively. Patients with CD4+ counts 200 cells/μl or more had significantly lower rates of macrolide and nonmacrolide use, fewer comorbidities, and were less likely to have AIDS than patients with lower counts. They were also more likely to have normal UGI endoscopy and had a higher frequency of H. pylori infection. AIDS status and the presence of comorbidities were independent predictors of endoscopic abnormalities. CONCLUSION UGI endoscopy remains a key diagnostic procedure for HIV-positive patients with UGI symptoms. AIDS and comorbidities are risk factors for the presence of mucosal lesions among HIV-positive patients on ART.
Collapse
|
16
|
Côté J, Cossette S, Ramirez-Garcia P, De Pokomandy A, Worthington C, Gagnon MP, Auger P, Boudreau F, Miranda J, Guéhéneuc YG, Tremblay C. Evaluation of a Web-based tailored intervention (TAVIE en santé) to support people living with HIV in the adoption of health promoting behaviours: an online randomized controlled trial protocol. BMC Public Health 2015; 15:1042. [PMID: 26458508 PMCID: PMC4603806 DOI: 10.1186/s12889-015-2310-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/22/2015] [Indexed: 11/19/2022] Open
Abstract
Background Long-term use of antiretroviral therapy, normal aging, and presence of certain risk factors are associated with metabolic disorders that predispose persons living with HIV to diabetes and cardiovascular diseases. The emergence and progression of these disorders can be prevented by adopting healthy behaviours. Based on the theory of planned behaviour, the Web-based tailored intervention TAVIE en santé was developed. The aim of this study is to evaluate the effectiveness of TAVIE en santé in order to support people living with HIV in the adoption of health promoting behaviours. Methods/Design An online randomized controlled trial with parallel-groups will be conducted across Canada. To participate in this study, people living with HIV must be: ≥ 18 years, able to read/understand French or English, have access to the Internet. A convenience sample of 750 participants will be randomly assigned either to an experimental group (TAVIE en santé, n = 375) or to a control group (websites, n = 375) (1:1 allocation ratio). The TAVIE en santé intervention is composed of seven interactive computer sessions, lasting between 5 and 10 min. The sessions, hosted by a virtual nurse, aim to develop and strengthen skills required for behaviour change. The control group will receive a validated list of five predetermined conventional health-related Websites. The adoption of health behaviour (smoking cessation or physical activity or healthy eating) is the principal outcome. Cognitions (intention, attitude, perceived behavioral control) are the secondary outcomes. Health indicators will also be assessed. All outcomes will be measured with a self-administered online questionnaire and collected three times: at baseline, 3 and 6 months after. The principal analyses will focus on differences between the two trial groups using Intention-to-Treat analysis. Discussion This study will yield new results about the efficacy of Web-based tailored health behaviours change interventions in the context of chronic disease. The TAVIE en santé intervention could constitute an accessible complementary service in support of existing specialized services to support people living with HIV adopt health behaviors. Trial registration NCT02378766, assigned on March 3th 2015.
Collapse
Affiliation(s)
- José Côté
- Research Centre of the Centre Hospitalier de l'Université de Montréal, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada. .,Research Chair in Innovative Nursing Practices, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada. .,Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte-Ste-Catherine, Montréal, H3T 1A8, QC, Canada.
| | - Sylvie Cossette
- Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte-Ste-Catherine, Montréal, H3T 1A8, QC, Canada. .,Research Center of the Montreal Heart Institute, 5000, Bélanger Street, Montréal, H1T 1C8, QC, Canada.
| | - Pilar Ramirez-Garcia
- Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte-Ste-Catherine, Montréal, H3T 1A8, QC, Canada.
| | - Alexandra De Pokomandy
- Faculty of Medecine, McGill University, 3655 Sir William Osler, Montreal, H3G 1Y6, QC, Canada.
| | - Catherine Worthington
- Faculty of Human and Social Development, University of Victoria, 3800 Finnerty Road, Victoria, V8P 5C2, BC, Canada.
| | - Marie-Pierre Gagnon
- Research Centre of the Centre Hospitalier Universitaire de Québec, 2705, boulevard Laurier, Québec, G1V 4G2, QC, Canada. .,Faculty of Nursing Sciences, Université Laval, 1050, avenue de la Médecine Local 3645, Québec, G1V 0A6, QC, Canada.
| | - Patricia Auger
- Research Centre of the Centre Hospitalier de l'Université de Montréal, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada. .,Research Chair in Innovative Nursing Practices, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada.
| | - François Boudreau
- Faculty of Nursing, Université du Québec à Trois-Rivièves, 3351, boul. des Forges, CP 500, Trois-Rivières, G9A 5H7, QC, Canada.
| | - Joyal Miranda
- Ryerson University, 350 Victoria Street, Toronto, M5B 2K3, ON, Canada.
| | - Yann-Gaël Guéhéneuc
- Canada Research Chair on Software Patterns and Patterns of Software, 2500, chemin de Polytechnique, Montréal, H3T 1J4, QC, Canada. .,Department of Computer Engineering, Polytechnique Montréal, 2500, chemin de Polytechnique, Montréal, H3T 1J4, QC, Canada.
| | - Cécile Tremblay
- Research Centre of the Centre Hospitalier de l'Université de Montréal, 900 Saint Denis Street, Montreal, H2X 0A9, QC, Canada. .,Quebec Public Health Laboratory, Sainte-Marie Rd, Sainte-Anne-de-Bellevue, H9X 3R5, QC, Canada. .,Faculty of Medecine, Université de Montréal, 2900, boulevard Édouard-Montpetit, Montréal, H3T 1J4, QC, Canada.
| |
Collapse
|
17
|
Cropsey KL, Jardin B, Burkholder G, Clark CB, Raper JL, Saag M. An Algorithm Approach to Determining Smoking Cessation Treatment for Persons Living With HIV/AIDS: Results of a Pilot Trial. J Acquir Immune Defic Syndr 2015; 69:291-8. [PMID: 26181705 PMCID: PMC4505746 DOI: 10.1097/qai.0000000000000579] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Smoking now represents one of the biggest modifiable risk factors for disease and mortality in people living with HIV (PLHIV). To produce significant changes in smoking rates among this population, treatments will need to be both acceptable to the larger segment of PLHIV smokers and feasible to implement in busy HIV clinics. The purpose of this study was to evaluate the feasibility and effects of a novel proactive algorithm-based intervention in an HIV/AIDS clinic. METHODS PLHIV smokers (N = 100) were proactively identified through their electronic medical records and were subsequently randomized at baseline to receive a 12-week pharmacotherapy-based algorithm treatment or treatment as usual. Participants were tracked in-person for 12 weeks. Participants provided information on smoking behaviors and associated constructs of cessation at each follow-up session. RESULTS The findings revealed that many smokers reported using prescribed medications when provided with a supply of cessation medication as determined by an algorithm. Compared with smokers receiving treatment as usual, PLHIV smokers prescribed these medications reported more quit attempts and greater reduction in smoking. Proxy measures of cessation readiness (eg, motivation, self-efficacy) also favored participants receiving algorithm treatment. CONCLUSIONS This algorithm-derived treatment produced positive changes across a number of important clinical markers associated with smoking cessation. Given these promising findings coupled with the brief nature of this treatment, the overall pattern of results suggests strong potential for dissemination into clinical settings and significant promise for further advancing clinical health outcomes in this population.
Collapse
Affiliation(s)
- Karen L. Cropsey
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology
| | | | - Greer Burkholder
- University of Alabama at Birmingham, Department of Internal Medicine, Division of Infectious Diseases
| | - C. Brendan Clark
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology
| | - James L. Raper
- University of Alabama at Birmingham, Department of Internal Medicine, Division of Infectious Diseases
| | - Michael Saag
- University of Alabama at Birmingham, Department of Internal Medicine, Division of Infectious Diseases
| |
Collapse
|
18
|
de Dios MA, Stanton CA, Cano MÁ, Lloyd-Richardson E, Niaura R. The Influence of Social Support on Smoking Cessation Treatment Adherence Among HIV+ Smokers. Nicotine Tob Res 2015; 18:1126-33. [PMID: 26116086 DOI: 10.1093/ntr/ntv144] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 06/21/2015] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The high prevalence of smoking among people living with HIV is a significant problem. Nonadherence to smoking cessation pharmacotherapy is a barrier for successfully quitting. The current study investigated the extent to which social support variables impact adherence and cessation. METHODS Participants were 444 HIV+ smokers who provided data on nicotine patch adherence, social support, and smoking. We conducted a path analysis to estimate (1) the effects of six social support indicators at baseline on nicotine patch adherence; (2) the effect of patch adherence on 7-day point prevalence smoking at 6-month follow-up; and (3) the indirect effects of social support indicators on 7-day point prevalence smoking at 6-month follow-up via patch adherence. RESULTS The tested model demonstrated good fit as indicated by the comparative fit index, root mean square error of approximation, and weighted root mean square residual (0.94, 0.02, and 0.51, respectively). Path analysis results indicated greater social support network contact was associated with higher levels of nicotine patch adherence (β = .13, P = .02), greater patch adherence was associated with a lower probability of 7-day point prevalence smoking at 6-month follow-up (β = -.47, P < .001) and greater social support network contact (β = -.06, P = .03) had a significant indirect effect on 7-day point prevalence smoking at 6-month follow-up via patch adherence. CONCLUSIONS Findings have implications for smoking cessation interventions that seek to capitalize on the beneficial effects of social support. Such efforts should account for the role that frequency of contact may have on nicotine patch use and other treatment-related mechanisms.
Collapse
Affiliation(s)
- Marcel A de Dios
- MD Anderson Cancer Center, Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, University of Texas, Houston, TX;
| | - Cassandra A Stanton
- Department of Population Sciences, Georgetown University, Washington, DC; Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, Washington, DC
| | - Miguel Ángel Cano
- Department of Epidemiology, College of Public Health and Social Work, Florida International University, Miami, FL
| | | | - Raymond Niaura
- Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Oncology, Georgetown University Medical Center, Washington, DC
| |
Collapse
|
19
|
Ande A, McArthur C, Ayuk L, Awasom C, Achu PN, Njinda A, Sinha N, Rao PSS, Agudelo M, Nookala AR, Simon S, Kumar A, Kumar S. Effect of mild-to-moderate smoking on viral load, cytokines, oxidative stress, and cytochrome P450 enzymes in HIV-infected individuals. PLoS One 2015; 10:e0122402. [PMID: 25879453 PMCID: PMC4399877 DOI: 10.1371/journal.pone.0122402] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 02/21/2015] [Indexed: 01/05/2023] Open
Abstract
Mild-to-moderate tobacco smoking is highly prevalent in HIV-infected individuals, and is known to exacerbate HIV pathogenesis. The objective of this study was to determine the specific effects of mild-to-moderate smoking on viral load, cytokine production, and oxidative stress and cytochrome P450 (CYP) pathways in HIV-infected individuals who have not yet received antiretroviral therapy (ART). Thirty-two human subjects were recruited and assigned to four different cohorts as follows: a) HIV negative non-smokers, b) HIV positive non-smokers, c) HIV negative mild-to-moderate smokers, and d) HIV positive mild-to-moderate smokers. Patients were recruited in Cameroon, Africa using strict selection criteria to exclude patients not yet eligible for ART and not receiving conventional or traditional medications. Those with active tuberculosis, hepatitis B or with a history of substance abuse were also excluded. Our results showed an increase in the viral load in the plasma of HIV positive patients who were mild-to-moderate smokers compared to individuals who did not smoke. Furthermore, although we did not observe significant changes in the levels of most pro-inflammatory cytokines, the cytokine IL-8 and MCP-1 showed a significant decrease in the plasma of HIV-infected patients and smokers compared with HIV negative non-smokers. Importantly, HIV-infected individuals and smokers showed a significant increase in oxidative stress compared with HIV negative non-smoker subjects in both plasma and monocytes. To examine the possible pathways involved in increased oxidative stress and viral load, we determined the mRNA levels of several antioxidant and cytochrome P450 enzymes in monocytes. The results showed that the levels of most antioxidants are unaltered, suggesting their inability to counter oxidative stress. While CYP2A6 was induced in smokers, CYP3A4 was induced in HIV and HIV positive smokers compared with HIV negative non-smokers. Overall, the findings suggest a possible association of oxidative stress and perhaps CYP pathway with smoking-mediated increased viral load in HIV positive individuals.
Collapse
Affiliation(s)
- Anusha Ande
- Division of Pharmacology and Toxicology, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Carole McArthur
- Department of Oral and Craniofacial Science, School of Dentistry, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Leo Ayuk
- Regional Hospital, Box 818, Bamenda, North West Province, Cameroon
| | - Charles Awasom
- Regional Hospital, Box 818, Bamenda, North West Province, Cameroon
| | - Paul Ngang Achu
- Mezam Polyclinic HIV/AIDS Treatment Center, Bamenda, Cameroon
| | - Annette Njinda
- Mezam Polyclinic HIV/AIDS Treatment Center, Bamenda, Cameroon
| | - Namita Sinha
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - P. S. S. Rao
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Marisela Agudelo
- Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Anantha Ram Nookala
- Division of Pharmacology and Toxicology, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Stephen Simon
- Department of Medical Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Anil Kumar
- Division of Pharmacology and Toxicology, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Santosh Kumar
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- * E-mail:
| |
Collapse
|
20
|
Exposing the gaps in awareness, knowledge and estimation of risk for anal cancer in men who have sex with men living with HIV: a cross-sectional survey in Australia. J Int AIDS Soc 2015; 18:19895. [PMID: 25828269 PMCID: PMC4380906 DOI: 10.7448/ias.18.1.19895] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/18/2015] [Accepted: 03/04/2015] [Indexed: 01/07/2023] Open
Abstract
Introduction The incidence of anal cancer is significantly higher in men who have sex with men (MSM) living with HIV when compared to the general population. We aimed to assess their awareness, knowledge and perceived level of personal risk for anal cancer to help inform educational strategies targeting this group. Methods A cross-sectional study of 327 HIV positive MSM in Melbourne, Australia, attending clinical settings (a sexual health centre, tertiary hospital HIV outpatients and high HIV caseload general practices) completed a written questionnaire in 2013/14. Poor knowledge was defined as those who had never heard of anal cancer, or scored 5 or less out of 10 in knowledge questions amongst those who reported ever hearing about anal cancer. Underestimation of risk was defined as considering themselves as having the same or lower risk for anal cancer compared to the general population. Results Of 72% (95% confidence interval (CI): 67–77) who had heard of anal cancer, 47% (95% CI: 41–53) could not identify any risk factors for anal cancer. Of total men surveyed, 51% (95% CI: 46–57) underestimated their risk for anal cancer. Multivariate analysis showed that men who underestimated their risk were older (OR 1.04 (per year increase in age), 95% CI: 1.01–1.07), had poor anal cancer knowledge (OR 2.06, 95% CI: 1.21–3.51), and more likely to have ever had an anal examination (OR 2.41, 95% CI: 1.18–4.93). They were less likely to consult a physician if they had an anal abnormality (OR 0.54, 95% CI: 0.31–0.96), to have had receptive anal sex (OR 0.12, 95% CI: 0.02–0.59) or speak English at home (OR 0.28, 95% CI: 0.09–0.90). Conclusions This survey of MSM living with HIV demonstrated limited awareness, knowledge level and estimation of risk for anal cancer. Further educational and public health initiatives are urgently needed to improve knowledge and understanding of anal cancer risk in MSM living with HIV.
Collapse
|