1
|
Chandran A, Bhondoekhan F, Wilson TE, Milam J, Cohen MH, Adimora AA, Adedimeji A, Cocohoba J, Parish C, Holstad M, Kassaye S, Kempf MC. Intensity of Social Support Matters: A Latent Class Analysis to Identify Levels of Social Support Associated with Optimal Health Outcomes Among Women Living with HIV. AIDS Behav 2022; 26:243-251. [PMID: 34287753 DOI: 10.1007/s10461-021-03377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
Social support is associated with improved HIV care and quality of life. We utilized latent class analysis to identify three classes of baseline emotional and tangible perceived social support, termed "Strong", "Wavering" and "Weak". "Weak" vs. "Strong" perceived social support was associated over time with an 8% decreased risk of optimal antiretroviral therapy (ART) adherence for emotional and 6% decreased risk for tangible perceived social support. Importantly, "Wavering" vs "Strong" social support also showed a decreased risk of ART adherence of 6% for emotional and 3% for tangible support. "Strong" vs. "Weak" perceived support had a similar association with undetectable viral load, but the association for "Strong" vs. "Wavering" support was not statistically significant. Intensity of social support is associated with HIV care outcomes, and strong social support may be needed for some individuals. It is important to quantify the level or intensity of social support that is needed to optimize HIV outcomes.
Collapse
Affiliation(s)
- Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite W6501, Baltimore, MD, 21205, USA.
| | - Fiona Bhondoekhan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite W6501, Baltimore, MD, 21205, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Joel Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mardge H Cohen
- Cook County Health and Hospital System, Chicago, IL, USA
| | - Adaora A Adimora
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adebola Adedimeji
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, USA
| | - Carrigan Parish
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marcia Holstad
- Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Seble Kassaye
- Department of Medicine/Infectious Diseases, Georgetown University, Washington, DC, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
2
|
Budhwani H, Yigit I, Ofotokun I, Konkle-Parker DJ, Cohen MH, Wingood GM, Metsch LR, Adimora AA, Taylor TN, Wilson TE, Weiser SD, Kempf MC, Sosanya O, Gange S, Kassaye S, Turan B, Turan JM. Examining the Relationships Between Experienced and Anticipated Stigma in Health Care Settings, Patient-Provider Race Concordance, and Trust in Providers Among Women Living with HIV. AIDS Patient Care STDS 2021; 35:441-448. [PMID: 34739336 PMCID: PMC8817693 DOI: 10.1089/apc.2021.0096] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Stigma in health care settings can have negative consequences on women living with HIV, such as increasing the likelihood of missed visits and reducing trust in their clinical providers. Informed by prior stigma research and considering knowledge gaps related to the effect of patient-provider race concordance, we conducted this study to assess if patient-provider race concordance moderates the expected association between HIV-related stigma in health care settings and patients' trust in their providers. Moderation analyses were conducted using Women's Interagency HIV Study data (N = 931). We found significant main effects for patient-provider race concordance. Higher experienced stigma was associated with lower trust in providers in all patient-provider race combinations [White-White: B = -0.89, standard error (SE) = 0.14, p = 0.000, 95% confidence interval, CI (-1.161 to -0.624); Black patient-White provider: B = -0.19, SE = 0.06, p = 0.003, 95% CI (-0.309 to -0.062); and Black-Black: B = -0.30, SE = 0.14, p = 0.037, 95% CI (-0.575 to -0.017)]. Higher anticipated stigma was also associated with lower trust in providers [White-White: B = -0.42, SE = 0.07, p = 0.000, 95% CI (-0.552 to -0.289); Black patient-White provider: B = -0.17, SE = 0.03, p = 0.000, 95% CI (-0.232 to -0.106); and Black-Black: B = -0.18, SE = 0.06, p = 0.002, 95% CI (-0.293 to -0.066)]. Significant interaction effects indicated that the negative associations between experienced and anticipated HIV-related stigma and trust in providers were stronger for the White-White combination compared with the others. Thus, we found that significant relationships between HIV-related experienced and anticipated stigma in health care settings and trust in providers exist and that these associations vary across different patient-provider race combinations. Given that reduced trust in providers is associated with antiretroviral medication nonadherence and higher rates of missed clinical visits, interventions to address HIV-related stigma in health care settings may improve continuum of care outcomes.
Collapse
Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | | | - Igho Ofotokun
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | | | | | - Adaora A Adimora
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tonya N Taylor
- Downstate Health Sciences University, Brooklyn, New York, USA
| | - Tracey E Wilson
- Downstate Health Sciences University, Brooklyn, New York, USA
| | - Sheri D Weiser
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | - Seble Kassaye
- Georgetown University, Washington, District of Columbia, USA
| | | | - Janet M Turan
- University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| |
Collapse
|
3
|
CROCKETT KB, ESENSOY TA, JOHNSON MO, NEILANDS TB, KEMPF MC, KONKLE-PARKER D, WINGOOD G, TIEN PC, COHEN M, WILSON TE, LOGIE CH, SOSANYA O, PLANKEY M, GOLUB E, ADIMORA AA, PARISH C, WEISER SD, TURAN JM, TURAN B. Internalized HIV Stigma and Pain among Women with HIV in the United States: The Mediating Role of Depressive Symptoms. AIDS Behav 2020; 24:3482-3490. [PMID: 32418165 PMCID: PMC7669722 DOI: 10.1007/s10461-020-02919-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pain is common in women with HIV, though little research has focused on psychosocial experiences contributing to pain in this population. In the present study we examined whether internalized HIV stigma predicts pain, and whether depressive symptoms mediate this relationship among women with HIV. Data were drawn from the Women's Interagency HIV Study (WIHS), for 1,364 women with HIV who completed three study visits between 2015 and 2016. We used a sequential longitudinal design to assess the relationship between internalized HIV stigma at time 1 on pain at time 3 through depressive symptoms at time 2. Analyses revealed internalized HIV stigma was prospectively associated with greater pain, B = 5.30, 95% CI [2.84, 7.60]. The indirect effect through depressive symptoms supported mediation, B = 3.68, 95% CI [2.69, 4.79]. Depression is a modifiable risk factor that can be addressed to improve pain prevention and intervention for women with HIV.
Collapse
Affiliation(s)
- Kaylee B. CROCKETT
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - T. Alinea ESENSOY
- School of Medicine, University of Alabama at Birmingham, Birmingham AL, USA
| | - Mallory O. JOHNSON
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Torsten B. NEILANDS
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Mirjam-Colette KEMPF
- School of Medicine, University of Alabama at Birmingham, Birmingham AL, USA,Schools of Nursing and Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deborah KONKLE-PARKER
- Department of Medicine/Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gina WINGOOD
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Phyllis C. TIEN
- Department of Medicine, University of California, San Francisco and Medical Service, Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Mardge COHEN
- Department of Medicine, Stroger Hospital of Cook County Bureau of Health and Hospital Systems, Chicago, IL, USA
| | - Tracey E. WILSON
- Department of Community Health Sciences, State University of New York, Downstate Health Sciences University, School of Public Health, Brooklyn, NY, USA
| | - Carmen H. LOGIE
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | - Michael PLANKEY
- Georgetown University Medical Center, Department of Medicine, Division of Infectious Diseases, Washington, DC, USA
| | - Elizabeth GOLUB
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Adaora A. ADIMORA
- Division of Infectious Diseases, University of North Carolina Schools of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carrigan PARISH
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University Miami Research Center, Miami, FL, USA
| | - Sheri D. WEISER
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Janet M. TURAN
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bulent TURAN
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
4
|
Chandran A, Edmonds A, Benning L, Wentz E, Adedimeji A, Wilson TE, Blair-Spence A, Palar K, Cohen M, Adimora A. Longitudinal Associations Between Neighborhood Factors and HIV Care Outcomes in the WIHS. AIDS Behav 2020; 24:2811-2818. [PMID: 32170507 PMCID: PMC7483905 DOI: 10.1007/s10461-020-02830-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Identifying structural determinants affecting HIV outcomes is important for informing interventions across heterogeneous geographies. Longitudinal hierarchical generalized mixed-effects models were used to quantify the associations between changes in certain structural-level factors on HIV care engagement, medication adherence, and viral suppression. Among women living with HIV in the WIHS, ten-unit increases in census-tract level proportions of unemployment, poverty, and lack of car ownership were inversely associated with viral suppression and medication adherence, while educational attainment and owner-occupied housing were positively associated with both outcomes. Notably, increased residential stability (aOR 5.68, 95% CI 2.93, 9.04) was positively associated with HIV care engagement, as were unemployment (aOR: 1.59, 95% CI 1.57, 1.60), lack of car ownership (aOR 1.14, 95% CI 1.13, 1.15), and female-headed households (aOR 1.23, 95% CI 1.22, 1.23). This underscores the importance of understanding neighborhood context, including factors that may not always be considered influential, in achieving optimal HIV-related outcomes.
Collapse
Affiliation(s)
- Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew Edmonds
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eryka Wentz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adebola Adedimeji
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, State University of New York, Downstate Health Sciences University, School of Public Health, Brooklyn, NY, USA
| | - Amanda Blair-Spence
- Department of Medicine, Division of Infectious Disease and Travel Medicine, Georgetown University, Washington, DC, USA
| | - Kartika Palar
- Division of HIV, Infectious Disease and Global Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Mardge Cohen
- Cook County Health and Hospital System, Chicago, IL, USA
| | - Adaora Adimora
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
5
|
Adedimeji A, Shi Q, Haddad L, Holman S, Edmonds A, Weber K, Kassaye S, Karim R, Bolivar H, Reid M, Kempf M, Golub E, Hoover DR, Anastos K. Women from afar: an observational study of demographic characteristics and mortality among foreign-born women living with HIV in the Women's Interagency HIV Study ( WIHS) in the United States 1994-2016. J Int AIDS Soc 2020; 23:e25486. [PMID: 32437092 PMCID: PMC7241263 DOI: 10.1002/jia2.25486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Foreign-born persons comprise ~13% of the US population. Immigrants, especially women, often face a complex set of social and structural factors that negatively impact health outcomes including greater risk of HIV infection. We described socio-demographic, clinical and immunological characteristics and AIDs and non-AIDS death among foreign-born women living with HIV (FBWLWH) participating in the US Women's Interagency HIV Study (WIHS) in the US from 1994 to 2016. We hypothesized that FBW will experience higher AIDS-related mortality compared to US-born women (USBW). METHODS The WIHS is a multicenter prospective observational cohort study of mostly women living with HIV (WLWH). The primary exposure in this analysis, which focused on 3626 WLWH, was self-reported country of birth collapsed into foreign-born and US born. We assessed the association of birthplace with categorized demographic, clinical and immunological characteristics, and AIDS/non-AIDS mortality of WLWH, using chi-squared tests. Proportional hazard models examined the association of birthplace with time from enrolment to AIDS and non-AIDS death. RESULTS Of the 628 FBW, 13% were born in Africa, 29% in the Caribbean and 49% in Latin America. We observed significant differences by HIV status in socio-demographic, clinical and immunological characteristics and mortality. For both AIDS and non-AIDS caused deaths FBW WLWH had lower rates of death. Adjusting for year of study enrolment and other demographic/clinical characteristics mitigated FBW's statistical survival advantage in AIDS deaths Relative Hazard (RH = 0.91 p = 0.53), but did not substantively change the survival advantage in non-AIDS deaths RH = 0.33, p < 0.0001). CONCLUSION Foreign-born WLWH exhibited demographic, clinical and immunological characteristics that are significantly different compared with women born in the US or US territory. After adjusting for these characteristics, the FB WLWH had a significantly lower hazard of non-AIDS but not AIDS mortality compared to women born in the US or a US territory. These findings of non-increased mortality can help inform models of care to optimize treatment outcomes among FBWLWH in the United States.
Collapse
Affiliation(s)
- Adebola Adedimeji
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNYUSA
| | - Qiuhu Shi
- Department of Epidemiology and Community HealthSchool of Health Sciences and PracticeNew York Medical CollegeValhallaNYUSA
| | - Lisa Haddad
- Department of Gynecology and ObstetricsEmory University School of MedicineAtlantaGAUSA
| | - Susan Holman
- State University of New YorkDownstate Medical CenterBrooklynNYUSA
| | - Andrew Edmonds
- Department of EpidemiologyThe University of North Carolina at Chapel HillNCUSA
| | | | - Seble Kassaye
- Department of Infectious DiseasesGeorgetown UniversityWashingtonDCUSA
| | - Roksana Karim
- Division of Disease Prevention, Policy and Global HealthKeck School of MedicineUniversity of Southern CaliforniaLos AngelesCAUSA
| | | | - Michael Reid
- Institute of Global Health SciencesDivision of HIV, Infectious Disease and Global MedicineUniversity of California at San FranciscoCAUSA
| | - Mirjam‐Colette Kempf
- Schools of Nursing, Public Health and MedicineUniversity of Alabama at BirminghamBirminghamALUSA
| | - Elizabeth Golub
- Department of EpidemiologyJohns Hopkins UniversityBaltimoreMDUSA
| | | | - Kathryn Anastos
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNYUSA
- Department of MedicineMontefiore Medical CenterBronxNYUSA
| |
Collapse
|
6
|
Chandran A, Benning L, Musci RJ, Wilson TE, Milam J, Adedimeji A, Parish C, Adimora AA, Cocohoba J, Cohen MH, Holstad M, Kassaye S, Kempf MC, Golub ET. The Longitudinal Association between Social Support on HIV Medication Adherence and Healthcare Utilization in the Women's Interagency HIV Study. AIDS Behav 2019; 23:2014-2024. [PMID: 30311104 PMCID: PMC7331802 DOI: 10.1007/s10461-018-2308-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Social support is associated with HIV-related health outcomes. However, few studies have explored this longitudinally. We assessed psychometric properties of the Medical Outcomes Study's Social Support Survey among women in the Women's Interagency HIV Study, and explored the longitudinal effects of social support on HIV medication adherence (HIV-positive women) and healthcare utilization (HIV-positive and negative women). The 15 questions loaded into two factors, with Cronbach's Alpha > 0.95. Over 3 years, perceived emotional support was associated with optimal medication adherence (OR 1.19, 95% CI 1.10-1.28) and healthcare utilization (OR 1.16, 95% CI 1.05-1.27), and tangible social support with adherence only (OR 1.18, 95% CI 1.08-1.27) when controlling for covariates, including core sociodemographic characteristics and depressive symptoms. Interventions to further understand the drivers of sub-types of social support as well as enhance sustained social support may assist with optimizing care of women with and at risk for HIV.
Collapse
Affiliation(s)
- Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite W6501, Baltimore, MD 21205, USA
| | - Lorie Benning
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rashelle J. Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, SUNY Downstate Medical Center, School of Public Health, Brooklyn, NY, USA
| | - Joel Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Adebola Adedimeji
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx NY, USA
| | - Carrigan Parish
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Adaora A. Adimora
- Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Cocohoba
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, USA
| | | | - Marcia Holstad
- Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Seble Kassaye
- Department of Medicine/Infectious Diseases, Georgetown University, Washington, DC, USA
| | - Mirjam-Colette Kempf
- Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
7
|
Vance DE, Rubin LH, Valcour V, Waldrop-Valverde D, Maki PM. Aging and Neurocognitive Functioning in HIV-Infected Women: a Review of the Literature Involving the Women's Interagency HIV Study. Curr HIV/AIDS Rep 2017; 13:399-411. [PMID: 27730446 DOI: 10.1007/s11904-016-0340-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
HIV-infected women may be particularly vulnerable to certain types of neurocognitive impairments which may be exacerbated by aging and other predictors. Within the context of cognitive reserve, this article examines issues surrounding women as they age with HIV. For this, a review of 12 recent studies (2013-2016) using data from the Women's Interagency HIV Study (WIHS), the largest cohort study comparing HIV-infected and demographically matched uninfected women, is presented that specifically examines neurocognition. In general, HIV-infected women are more vulnerable to developing neurocognitive impairments than uninfected women; other factors that may contribute to these neurocognitive impairments include recent illicit drug use, reading level (educational quality/cognitive reserve), stress, PTSD, insulin resistance, liver fibrosis, and age. Surprisingly, when examined in some analyses, age × HIV interactions were not observed to impact neurocognitive performance, findings largely consistent in the literature; however, longitudinal analyses of these data have yet to be performed which may yield future insights of how cognitive reserve may be compromised over time. Yet, with insulin resistance, liver fibrosis, stress, and other known predictors of poorer neurocognition also occurring more with advanced age, in time, the synergistic effect of age and HIV may be more robust and observable as this population ages.
Collapse
Affiliation(s)
- David E Vance
- School of Nursing, University of Alabama at Birmingham (UAB), Room 2M026, 1701 University Boulevard, Birmingham, AL, 35294-1210, USA.
| | - Leah H Rubin
- Department of Psychiatry, University of Illinois at Chicago, Room 324, MC 913, Chicago, IL, 60612, USA
| | - Victor Valcour
- Department of Neurology, UCSF School of Medicine, 3333 California Street, San Francisco, CA, 94104, USA
| | - Drenna Waldrop-Valverde
- Center for Neurocognitive Studies, Nell Hodgson Woodruff School of Nursing, Emory University, Room 442, 1520 Clifton Road, NE, Atlanta, GA, 30322-4027, USA
| | - Pauline M Maki
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Room 328, MC 913, Chicago, IL, 60612, USA
| |
Collapse
|
8
|
Kelso-Chichetto NE, Plankey M, Abraham AG, Ennis N, Chen X, Bolan R, Cook RL. Association between alcohol consumption trajectories and clinical profiles among women and men living with HIV. Am J Drug Alcohol Abuse 2017. [PMID: 28621562 DOI: 10.1080/00952990.2017.1335317] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alcohol use is common among persons living with HIV (PLWH). It is unclear how alcohol consumption changes over time and if these changes are associated with clinical profiles. OBJECTIVE We aimed to describe the association between longitudinal patterns of alcohol consumption and the clinical profiles of PLWH. METHODS Data from the Women's Interagency HIV Study (n = 1123 women) and Multicenter AIDS Cohort Study (n = 597 men) from 2004 to 2013 were utilized. Group-based trajectory models were used to assess alcohol consumption patterns across 10 years. Generalized estimating equations were used to identify associations between clinical factors and alcohol consumption. All analyses were stratified by sex. RESULTS Four trajectories of alcohol use were identified in women and men (women: abstinent 38%, low: 25%, moderate: 30%, heavy: 7%; men: abstinent 16%, low: 69%, moderate: 9%, heavy: 5%). The Framingham Risk Score (women: adjusted odds ratio [AOR] 1.07, 95% confidence interval [CI] 1.04-1.09), years on ART (women: AOR 1.02, CI 1.00-1.05; men: AOR 1.05, CI 1.01-1.09), suboptimal ART adherence (men: AOR 1.23, CI 1.07-1.42), and unsuppressed viral load (women: AOR 1.82, CI 1.56-2.13; men: AOR 1.36, CI 1.17-1.58) were associated with increased odds for moderate drinking. The Framingham Risk Score (women: AOR 1.10, CI 1.07-1.14; men: AOR 1.12, CI 1.06-1.20), suboptimal adherence (women: AOR 1.25, CI 1.04-1.51), and unsuppressed viral load (women: AOR 1.78, CI 1.42-2.24) were associated with increased odds for heavy drinking. CONCLUSIONS Clinicians should consider screening patients for alcohol consumption, particularly if patients have comorbid medical conditions, suboptimal antiretroviral adherence, and/or detectable viral load.
Collapse
Affiliation(s)
- Natalie E Kelso-Chichetto
- a Department of Epidemiology , Colleges of Public Health and Health Professions and Medicine, University of Florida , Gainesville , FL , USA
| | - Michael Plankey
- b Department of Medicine , Georgetown University Medical Center , Washington , DC , USA
| | - Alison G Abraham
- c Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Nicole Ennis
- d Department of Clinical and Health Psychology , College of Public Health and Health Professions, University of Florida , Gainesville , FL , USA
| | - Xinguang Chen
- a Department of Epidemiology , Colleges of Public Health and Health Professions and Medicine, University of Florida , Gainesville , FL , USA
| | | | - Robert L Cook
- a Department of Epidemiology , Colleges of Public Health and Health Professions and Medicine, University of Florida , Gainesville , FL , USA
| |
Collapse
|
9
|
Kassaye S, Li Y, Huhn G, Peters MG, French AL, Tien PC, Luxon B, Plankey MW. Direct and Indirect Serum Markers of Liver Fibrosis Compared with Transient Elastography among Women in the Women's Interagency HIV Study. ACTA ACUST UNITED AC 2015; 6. [PMID: 26251759 PMCID: PMC4524652 DOI: 10.4172/2155-6113.1000446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to determine the test characteristics of direct and indirect biomarkers for liver fibrosis compared with transient elastography (TE) among a group of human immunodeficiency virus (HIV)-infected and uninfected women with or without Hepatitis C virus (HCV) infection. METHODS Women enrolled in the Women's Interagency HIV Study (WIHS) from Washington DC, San Francisco, and Chicago with a body mass index (BMI)<35 underwent liver stiffness measurement using TE between October, 2010 and September, 2012. Serum samples were tested for hyaluronic acid to calculate the SHASTA and aspartate aminotransferase to platelet ratio index (APRI). Receiver operator characteristics (ROC) of significant liver fibrosis (liver stiffness ≥ 7.1 kPa by TE, correlating with a METAVIR fibrosis score of F2-F4) predicted by SHASTA and APRI were compared. RESULTS Among 308 women, the median age was 48 years, BMI was 25.6, 67% were non-Hispanic black, 27% HCV+, and 78% HIV+. The overall prevalence of significant liver fibrosis was 20%, and among HIV+ women, 22%. Overall, there was no statistically significant difference in the area under ROC curve (AUROC) between SHASTA and APRI relative to significant fibrosis by TE. Among HCV+ women (with or without HIV), the AUROC ranged from 0.70-0.73 for both the SHASTA and APRI compared to TE. Both SHASTA and APRI were associated with significant misclassification with a false negative rate of 33-40% for significant fibrosis compared with TE among women with HCV infection, with or without HIV. CONCLUSION Both the SHASTA and APRI, direct and indirect serum biomarkers of liver fibrosis respectively, are comparable at detection of significant liver fibrosis among women with HCV infection, regardless of HIV status. However, there was a high false negative rate in detection of significant liver fibrosis of up to 40% which is a significant limitation of use of these biomarkers.
Collapse
Affiliation(s)
- Seble Kassaye
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Ying Li
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Gregory Huhn
- CORE Center/Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Marion G Peters
- Department of Medicine, University of California, San Francisco, California, USA
| | - Audrey L French
- CORE Center/Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, California, USA ; Medical Service, Department of Veterans Affairs Medical Center, San Francisco, California, USA
| | - Bruce Luxon
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Michael W Plankey
- Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| |
Collapse
|
10
|
Schwartz JB, Moore KL, Yin M, Sharma A, Merenstein D, Islam T, Golub ET, Tien PC, Adeyemi OM. Relationship of vitamin D, HIV, HIV treatment, and lipid levels in the Women's Interagency HIV Study of HIV-infected and uninfected women in the United States. J Int Assoc Provid AIDS Care 2014; 13:250-9. [PMID: 24668135 DOI: 10.1177/2325957413506748] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Relationships between vitamin D, lipids, HIV infection, and HIV treatment (±antiretroviral therapy [ART]) were investigated with Women's Interagency HIV Study data (n = 1758 middle-aged women) using multivariable regression. Sixty-three percent of women had vitamin D deficiency. Median 25-hydroxyvitamin D (25-OH vitamin D) was highest in HIV-infected + ART-treated women (17 ng/mL; P < .001) and was the same in HIV-uninfected or HIV-infected women without ART (14 ng/mL). Vitamin D levels were lower if efavirenz (EFV) was included in ART (15 versus 19 ng/mL; P < .001). The most common lipid abnormality was high triglycerides (≥200 mg/dL) in HIV-infected + ART-treated women (13% versus 7% of HIV-infected without ART and 5% of HIV-uninfected; P < .001), with a positive relationship between 25-OH vitamin D and triglycerides (95% confidence interval 0.32-1.69; P < .01). No relationships between 25-OH vitamin D and cholesterol were detected. Vitamin D deficiency is common irrespective of HIV status but influenced by HIV treatment. Similarly, vitamin D levels were positively related to triglycerides only in ART-treated HIV-infected women and unrelated to cholesterol.
Collapse
|