Multiomic analysis reveals microbiome-related relationships between cocaine use and metabolites

OBJECTIVE

Over 19 million individuals globally have a cocaine use disorder, a significant public health crisis. Cocaine has also been associated with a pro-inflammatory state and recently with imbalances in the intestinal microbiota as compared to nonuse. The objective of this pilot study was to characterize the gut microbiota and plasma metabolites in people with HIV (PWH) who use cocaine compared with those who do not.

DESIGN

Cross-sectional study.

METHODS

A pilot study in PWH was conducted on 25 cocaine users and 25 cocaine nonusers from the Miami Adult Studies on HIV cohort. Stool samples and blood plasma were collected. Bacterial composition was characterized using 16S rRNA sequencing. Metabolomics in plasma were determined using gas and liquid chromatography/mass spectrometry.

RESULTS

The relative abundances of the Lachnopspira genus, Oscillospira genus, Bifidobacterium adolescentis species, and Euryarchaeota phylum were significantly higher in the cocaine- using PWH compared to cocaine-nonusing PWH. Cocaine-use was associated with higher levels of several metabolites: products of dopamine catabolism (3-methoxytyrosine and 3-methoxytyramine sulfate), phenylacetate, benzoate, butyrate, and butyrylglycine.

CONCLUSIONS

Cocaine use was associated with higher abundances of taxa and metabolites known to be associated with pathogenic states that include gastrointestinal conditions. Understanding key intestinal bacterial functional pathways that are altered due to cocaine use in PWH will provide a better understanding of the relationships between the host intestinal microbiome and potentially provide novel treatments to improve health.

Food Insecurity Is Associated With a Lower Quality of Life Among People Living With HIV (PLWH) and HIV Seronegative Individuals, in the Miami Adult Studies on HIV (MASH) Cohort

Objectives

Food insecurity affects underserved and marginalized populations in the United States, which could lead to a decline in quality of life over time and further worsening health outcomes. This study aims to determine the association between food security and quality of life among people living with and without HIV in Miami, FL.

Methods

This was a cross-sectional analysis of a minority population from the Miami Adult Studies on HIV (MASH) cohort. Demographics, anthropometrics, and fasting blood samples were collected by trained personnel. HIV viral loads (VL, copies/ml) were abstracted from medical records (suppressed viral load < 50 copies/ml) with the participants’ consent. Food security status was assessed using the USDA Household Food Security Module and analyzed as food secure (full) vs. insecure (marginal, low, very low). Quality of Life (QoL) was determined with the Spitzer QoL Index (scores: 0–10). QoL was dichotomized as a high (≥8) or low QoL (<8). All statistical analyses were performed using SPSS 26.

Results

Participants’ mean age was 54.6 ± 7.9 years (N = 1,034), 58% were male, and 61.1% Black; 46.6% were living with HIV and 90.9% had a suppressed viral load. Food insecurity was reported by 48.4% of individuals. Food secure individuals showed a significantly higher QoL score compared to food insecure individuals (8.68 ± 1.57, 7.84 ± 1.89, respectively; p < 0.001). People living with HIV (PLWH) did not have significantly different QoL scores nor food insecurity compared to HIV-uninfected individuals. A linear regression showed that food security was associated with higher QoL after adjusting for age, sex, race, ethnicity, HIV status, BMI, and annual family income (β = 0.64 SE = 0.11, P = 0.001). Logistic regression found that food insecurity was associated with lower odds of having a high QoL after adjusting for age, sex, race and ethnicity, HIV status, BMI, and annual family income (OR: 0.45; 95% CI: 0.33, 0.62; P < 0.001).

Conclusions

Food insecurity negatively affects the quality of life of minorities with and without HIV in the MASH cohort in Miami. Improving the food security of marginalized populations by facilitating their access to high-quality foods could improve their health and quality of life.

Funding Sources

National Institute on Drug Abuse.

Smoking Is Associated With Microbial Translocation in the Miami Adult Studies on HIV (MASH) Cohort

Objectives

The prevalence of cigarette smoking is 2 to 3 times greater among people living with HIV (PLWH) than in the HIV uninfected population. Smoking has also been associated with deleterious effects on the gut leading to potential microbial translocation. Thus, we sought to use CD14 (sCD14) as a surrogate marker of microbial translocation to determine if smoking was associated with changes in microbial translocation.

Methods

A cross-sectional analysis was completed with participants from the Miami Adult Studies on HIV (MASH) cohort. Demographic characteristics and cigarette smoking status were self-reported. Levels of sCD14 were analyzed using ELISA kits in Dr. Sherman's laboratory. HIV serostatus and viral load (VL) were abstracted from medical records with the participants’ consent. Statistical analyses included descriptive statistics, T-test, linear regression for sCD14 levels, and logistic regression to calculate the odds of having an sCD14 level above the sample median (1064.3 ng/mL). All analyses were conducted on SPSS 26.

Results

A total of 470 participants were included in the analysis. The mean age was 53 ± 8 years, 42.8% were females and 64.5% were Black. PLWH accounted for 76.8% of participants and 85.1% had a suppressed VL (<50 copies/mL). Smokers had significantly higher mean sCD14 levels than non-smokers (1025.8 ± 429.0 vs. 1183.4 ± 465.7, respectively; P = 0.002). This relationship remained significant after adjusting for sex, age, BMI, and HIV status (β = 166.70, SE = 52.36, P = 0.002). Also, smoking tended to be associated with 1.6 times the odds of having high sCD14 levels, adjusted for BMI, age, sex, and HIV status (β = 1.6, 95% CI = 1.0–2.6, P = 0.051).

Conclusions

Cigarette smoking appears to contribute to immune activation regards of HIV status which may contribute to microbial translocation, regardless of HIV status. The findings provide further evidence of the deleterious effect of cigarette smoking on physiological functions, including gut health. Further research is needed to determine the long-term effects of smoking on immune activation and microbial translocation.

Funding Sources

Supported by the National Institute on Drug Abuse.

Cannabis Use and Body Composition in People Living with HIV (PLWH) From the Miami Adult Studies on HIV (MASH) Cohort

Objectives

Cannabis is the most prevalently used substance in the United States and among people living with HIV (PLWH). Underserved minorities living with HIV suffer from high rates of obesity. Yet, little is known about the implications of cannabis use on body composition in PLWH. Thus, we sought to determine the association between cannabis use and body composition PLWH.

Methods

In this cross-sectional study, participants were selected from the ongoing Miami Adult Studies on HIV (MASH) cohort. Cannabis use was self-reported and confirmed with urinalysis for cannabis along with other illicit drugs (American Bio Medica Corp, Kinderhook, NY). Participants were selected if they did not use any illicit drugs and excluded if they used illicit drugs other can cannabis. Informed consent, demographics, and anthropometrics were collected by trained personnel. HIV viral load (VL, copies/mL), and CD4+ cells (cells/mL) were abstracted from medical records. Descriptive statistics were used to analyze demographics, cannabis use, overweight (BMI ≥ 25 kg/m2) and VL (suppressed VL &lt; 50 copies/mL). SPSS 26 was used to analyze the linear association between cannabis use and BMI. Logistic regression calculated the odds ratio (OR) of cannabis use and overweight status. Independent sample t-test compared CD4+ cell count and VL between the cannabis-using and non-using groups.

Results

Participants’ mean age was 53.6 ± 8.3 years (n = 346), 42.5% were female, 57.5% were Black, and 73.1% had a BMI ≥ 25 kg/m2 (overweight). Cannabis users accounted for 34.1% of the sample. The frequency of participants with a suppressed VL was 80.3%. No significant differences in CD4+ count or VL between the cannabis users and non-users (p &gt; .05). Cannabis use was associated with a lower BMI adjusted for age, sex, race and ethnicity, CD4+ count, and VL (b = −1.8 SE = 0.83, p = .03). Also, cannabis use was associated with reduced odds of being overweight after adjusting for age, sex, race and ethnicity, CD4+ count, and VL (OR: 0.44, 95% CI: 0.23–0.83; p = 0.01).

Conclusions

The use of cannabis was associated with lower BMI and decreased odds of being overweight or obese. Cannabis use did not significantly affect crucial markers of HIV disease progression (CD4+ count and VL) negatively. Longitudinal research is needed to further assess these associations and determine its medicinal efficacy in weight management.

Funding Sources

NIDA.

Serum Ferritin Is Associated With Elevated ALT Among People Living With HIV and HIV-Seronegative Individuals in the Miami Adult Studies on HIV Cohort

Objectives

It has been shown that people living with HIV (PLWH) are vulnerable to liver inflammation and damage. Elevated serum ferritin has been associated with higher incidence of liver damage. This study examined the relationship between serum ferritin levels and liver damage in PLWH.

Methods

A cross-sectional analysis of data from participants in the Miami Adult Studies on HIV (MASH) cohort. Informed consent, demographics, Alcohol Use Disorder Identification Test (AUDIT) for hazardous drinking (≥8), and fasting blood samples were collected by trained personnel. HIV status, HIV Viral Load (VL, copies/ml) was abstracted from medical charts with the participants’ consent. LabCorp (Burlington, NC) determined serum ferritin and serum alanine aminotransferase (ALT). Opioid use was analyzed by urinalysis (American Bio Medica Corp; Kinderhook, NY). Statistical analyses were performed using SPSS 26 and included T-test, linear and logistic regression. Elevated serum ferritin levels were defined as ≥150 ng/mL and elevated ALT as ≥5 IU/L.

Results

Participants’ mean age was 54.6 ± 7.9 years (n = 1,026), 57.9% were male, and 61.2% wereBack; 46.8% were PLWH, 90.9% had an undetectable viral load. Males had significantly higher ALT (29.6 ± 36.2 vs. 20.8 ± 16.4 IU/L) and serum ferritin (156.1 ± 223.0 vs. 98.7 ± 114.9 ng/mL) than females (P < 0.001). Ferritin (148.3 ± 203.3 vs. 117.5 ± 171.1 ng/mL; P = 0.009), but not ALT (25.6 ± 32.078 vs. 26.1 ± 27.7 IU/L; P > 0.05), was significantly higher in PLWH than HIV-uninfected participants. In a linear model, elevated ALT was positively associated with higher serum ferritin levels after adjusting for sex, age, HIV status, and opioid use (β = 163.75 SE = 14.579, p = 0.001). Individuals with elevated ALT had 4.55 greater odds of having elevated ferritin levels (CI: 3.203–6.460, P < 0.001) after adjusting for age, sex and opioid use.

Conclusions

Alanine aminotransferase seems to be a good predictor of serum ferritin levels in PLWH. Elevated levels of ferritin have been associated with liver inflammation, chronic kidney disease, acute infections, and therefore deleterious health consequences in PLWH that warrant further examination.

Funding Sources

National Institute on Drug Abuse.

Framingham Heart Study (FHS) 10-Year Cardiovascular Risk Is Associated With Marijuana Use in the Miami Adult Studies on HIV (MASH) Cohort

Objectives

Illicit drug use can lead to adverse cardiovascular events; it is an additional risk factor for cardiovascular disease. Thus, we sought to determine the association between CVD and drug use in people living with HIV (PLWH) using the FHS 10-year risk.

Methods

Participants were selected from the MASH cohort. Demographics, anthropometrics, bioimpedance analysis, and fasting blood samples were collected by trained personnel. HIV Viral Load (VL, copies/ml) was abstracted from medical charts. Urine toxicology was used to determine current illicit drug use. Descriptive statistics were used to analyze demographics, HIV status, and VL (undetectable VL &lt; 50 copies/ml). CVD (10-year risk) score was calculated using a formula based on CVD risk factors. An independent sample t-test was used to compare the mean CVD risk score between drug users and non-users. Linear regression was used to find an association between drug users and CVD 10-year risk while controlling for sex and infection status.

Results

Participants’ mean age was 54.6 ± 7.9 years (n = 1034), 58% male and 63.8% Black. About 46.8% were PLWH and 90.9% had an undetectable VL. The average CVD 10-year risk of all participants was 15.1% and 49.6% of participants used illicit substances. A univariate linear regression showed a positive association between FHS 10-year risk and marijuana use (b = 2.260 SE = 1.036, 95% CI: 0.227–4.293; P = 0.029). After adjusting for sex and HIV status the association remained significant (b = 2.322 SE = 1.028, 95% CI: 0.304–4.340; P = 0.024). Comparing the mean 10-year risk between groups, a significant difference between marijuana users and non-users was seen regardless of infection status and age (95% CI: −4.293- −0.227; P = 0.029). Separating by sex, only males showed a significant difference in 10-year risk when comparing marijuana users to non-users irrespective of infection status and age (95% CI: −6.394- −0.8373; P = 0.011). No association was determined between 10-year risk and other substances, including cocaine, fentanyl, and amphetamines.

Conclusions

Marijuana use seems to be a strong predictor of CVD risk in minority populations. However, other substances of abuse did not exhibit a cardiovascular effect regardless of HIV status or sex. Further studies are needed to examine the relationship between the use of marijuana and CVD.

Funding Sources

National Institute on Drug Abuse.

Substance Abuse and BMI Are Associated with Increased Inflammation and Oxidative Stress in Participants of the Miami Adult Studies on HIV (MASH) Cohort

Objectives

Inflammation and oxidative stress are considered important factors in the development of non-communicable diseases with aging. We determined associations between body mass index (BMI), oxidative stress (OS), and inflammation in people living with HIV (PLWH) and un-infected substance users.

Methods

Overweight/obesity (OW/OB) was defined as BMI ≥ 25 and normal weight (NW) as BMI ≤ 24.9 in participants of the MASH cohort. Cocaine use was assessed with questionnaires and urine toxicology. Smoking was assessed with questionnaires. Blood was collected to assess inflammation (high sensitivity C-reactive protein [hsCRP] &gt;3 m/L) by LabCorp, and OS with ARBOR ASSAYS (Ann Arbor, MI) glutathione colorimetric detection kit with %oxidized glutathione above median (&gt;2.33%) as elevated. HIV viral load (VL) was obtained from medical charts. Regressions compared substance-abusing PLWH and un-infected people and controlled for age, sex, HIV status, and BMI.

Results

Mean age of the 605 participants was 54.4 ± 7.4 years, 54.7% male, 70.1% Black; 76% were OW/OB; 73% used cocaine and smoked cigarettes. PLWH comprised 45.5% of the population and 75% had suppressed VL. Regardless of HIV status, OW/OB cocaine users had higher odds for inflammation (OR = 3.1, 95% CI: 1.7–5.6, P &lt; 0.001) and higher OS (OR = 2.0, 95% CI: 1.1–3.4, P = 0.018) than NW cocaine users. OW/OB cocaine + cigarette users also had higher odds for inflammation (OR = 2.6, 95% CI: 1.6–4.2, P = 0.001) and higher OS (OR = 1.9, 95% CI: 1.2–2.9, P = 0.006) than NW cocaine + cigarette users. There were no differences in inflammation or OS between OW/OB cocaine alone or with cigarette use and non-users (P = 0.707). HIV status was not independently associated with inflammation or high OS (P &gt; 0.33).

Conclusions

These results indicated that OW/OB is associated with higher levels of inflammation and oxidative stress than normal weight even when accompanied with cocaine use as well as cocaine + cigarette use. These findings suggest that the use of substances does not increase inflammation or OS beyond overweight/obesity. In addition, in this cohort, with largely suppressed VL, HIV status was not independently associated with greater inflammation or OS. OW/OB is prevalent among PLWH and healthy people and may play an important role in the development of non-communicable diseases.

Funding Sources

National Institute on Drug Abuse.

Predictors of Insulin Resistance and Liver Steatosis in the Miami Adult Studies on HIV (MASH) Cohort

Objectives

Immune activation is central to developing insulin resistance and is implicated in the pathophysiology of liver steatosis. People living with HIV (PLWH) have elevated biomarkers of immune activation, which may play a role in faster development of insulin resistance and liver steatosis. The objective of this study was to examine if HIV status and immune activation are related to insulin resistance and liver steatosis.

Methods

Demographic and anthropometric data on MASH cohort participants were obtained. Insulin resistance was estimated using the triglyceride-glucose (TyG) index from fasting blood. HIV status was abstracted from participants’ medical records. Immune activation biomarkers soluble CD163 (sCD163), sCD27, sCD14, and monocyte chemoattractant protein (MCP-1) measured with multiplex flow cytometry in Dr. Sherman's laboratory. High sensitivity C-Reactive Protein (hsCRP), measure of inflammation, was determined by LabCorp. Liver steatosis was defined as liver fat &gt;3.5% obtained with magnetic resonance elastography scans. Statistics included descriptive analysis, Mann-Whitney tests, multivariate linear, and logistic regressions, controlled for age, sex, and BMI.

Results

Of the 712 participants (age 54.24 ± 7.48 years), 336 were PLWH with suppressed viral load, and 376 were uninfected healthy participants. PLWH had higher levels of sCD27 (P = 0.003) and MCP-1 (P = 0.034) than uninfected participants. Multiple linear regressions showed HIV status and sCD163 were independently associated with higher insulin resistance (HIV status b = 0.130, P = 0.014, sCD163 Multiple logistic regressions showed higher levels of sCD163 (OR = 1.097, 95% CI: 1.01–1.19, P = 0.032) and insulin resistance (OR = 7.126, 95% CI: 2.59–19.58, P &lt; 0.001) were significant predictors of liver steatosis. HIV status, sCD14, sCD27, hsCRP, or MCP-1 were not related to liver steatosis.

Conclusions

These results indicate that HIV infection and sCD163, a marker of immune activation, are independent predictors of insulin resistance, and sCD163 was associated with greater odds of liver steatosis. Lifestyle interventions and anti-inflammatory agents aimed at reducing insulin resistance and immune activation in PLWH may help to reduce the risk of liver steatosis and other co-morbidities.

Funding Sources

Grant Number: U01DA040381.

Obesity Is Associated with Higher Oxidative Stress Among PLWH and Healthy Men, But Not Women, in the Miami Adult Studies on HIV (MASH) Cohort

Objectives

Over-expression of oxidative stress leads to the development of obesity-related complications, including non-communicable diseases in healthy populations. We determined the association between obesity and oxidative stress in people living with HIV (PLWH) and un-infected, healthy individuals.

Methods

Participants were selected from the MASH cohort. Demographics, anthropometrics, bioimpedance analysis, and fasted blood samples were collected by trained personnel. HIV Viral Load (VL, copies/ml) was abstracted from medical charts. Oxidative stress was determined using ARBOR ASSAYS (Ann Arbor, MI) glutathione colorimetric detection kit. Descriptive statistics were used to analyze demographics, HIV status, VL (undetectable VL &lt; 50copies/ml), and obesity (BMI ≥30 kg/m2; body fat % &gt;25 Males and &gt;35 Females) status. Logistic regression was used to find an association between high oxidative stress (% oxidized glutathione [GSSG] defined as % GSSG above the median) and obesity (BMI) in the group of PLWH and the healthy group. Association between body fat %, and high % GSSG was also determined. Linear regression was used to find the association between % GSSG and BMI.

Results

Participants’ mean age was 54.4 ± 7.4 years (n = 738), 55.3% were male and 66.3% Black; 46.7% were PLWH; 90.9% had an undetectable viral load and 47.3% of all participants were obese. A univariate linear regression showed a positive association between BMI and % GSSG among the PLWH (b = 0.066 SE = 0.032, CI: 0.002–0.129; P = 0.043) but not in the healthy group. Logistic regression showed obesity to be a significant predictor for high % GSSG (OR = 1.42, 95% CI:1.06–1.92; P = 0.019) after controlling for age, gender and HIV status. However, when participants were separated by sex, obese male participants were 1.55 times more likely to have high % GSSG (OR = 1.55, 95% CI: 1.025–2.348; P = 0.038) than non-obese males after controlling for age and HIV status. Statistically significant associations were not observed in females, regardless of HIV status.

Conclusions

Obese PLWH and obese healthy participants were more likely to have high oxidative stress than non-obese participants. The increased oxidative stress in males but not in females may provide one of the mechanisms for increased risk for non-communicable diseases such as cardiovascular disease, in males.

Funding Sources

National Institute on Drug Abuse.

Substance Use, Cocaethylene and Obesity in HIV-Infected and Non-Infected Subjects from the Miami Adult Studies in HIV (MASH) Cohort (P10-082-19)

Objectives

Cocaethylene (CE) is a blood metabolite indicating concomitant use of cocaine and alcohol. This combination increases the euphoric effects of cocaine, as well as its longevity in blood. Its toxicity is about 30% greater than that of cocaine or alcohol alone and has plasma half-life 3 to 5 times that of cocaine. CE has been associated with increased non-AIDS related morbidity and mortality, such as heart attacks, liver damage, and increased risk for immediate death. We examined polysubstance use, including the presence of CE and obesity in the MASH Cohort.

Methods

A subset of 74 HIV-infected and 75 non-infected participants (N = 149) from the MASH Cohort were included for this analysis. Demographic characteristics and body mass index (BMI) were obtained through in-person interviews as part of the MASH Cohort's activities. Cocaine, alcohol and opioid use were determined by self-report (30-day use), urine toxicology and blood metabolites; AUDIT-C was also used for alcohol consumption.

Results

Cocaine was used by 48.6% (n = 36) of HIV-infected and 52% (n = 39) of non-infected participants. CE was present in 28.6% (n = 8) of HIV-infected and 20.5% (n = 8) of non-infected participants; most were female (75.0%) and all were Black. BMI of those CE-positive was 35.4 kg/m2. Opioid use among CE-positive subjects was equal in both groups (62.5% each), but opioid use was more prevalent in HIV-infected than non-infected participants (68.9% vs. 54.7% respectively). CE concentrations were directly correlated with AUDIT-C and drinks/week (r = .313 and r = .391, respectively; P < .001). No differences in CE concentration and alcohol consumption were found between HIV-infected and non-infected participants. However, AUDIT-C was significantly higher among CE-positive subjects for both HIV-infected (µ = 3.5 ± 1.8 vs. 1.3 ± 1.6 for CE-positive and negative, respectively; P = .001) and non-infected participants (µ = 4.13 ± 2.9 vs. 1.91 ± 2.2 for CE-positive and negative, respectively; P = .01).

Conclusions

Blood CE shows concurrent use of cocaine and alcohol. In addition, use of opioids and obesity is common among these MASH Cohort participants. Polysubstance use, in combination with obesity, may pose an increased risk for non-AIDS related morbidity and mortality. Longitudinal studies with larger samples are needed.

Funding Sources

National Institute on Drug Abuse 5U01DA040381-03.

Association of TIMP1 Levels and Liver Disease Progression Among HIV/HCV Co-infected, HIV Mono-, HCV Mono-infected, and Healthy Groups from the MASH Cohort (FS09-07-19)

Objectives

Antiretroviral therapy has increased life expectancy for HIV infected patients; however, this population is developing chronic illnesses associated with aging. Liver disease is a major cause of non-AIDS mortality, characterized by progressive fibrosis. Infection with HIV and with Hepatitis C Virus (HCV) promotes liver fibrogenesis. Tissue inhibitor of metalloproteinase-1 (TIMP1), inhibits fibrosis regression and is profibrogenic. Association between TIMP1 and liver disease progression in an aging population of HIV/HCV co-infected, HIV mono-infected, HCV mono-infected, and healthy groups from the Miami Adult Studies on HIV (MASH) cohort in Miami, Florida, was investigated.

Methods

Serum TIMP1 levels were determined by ELISA. A non-invasive estimate of liver fibrosis, FIB-4 score was calculated. Liver fibrosis was defined as FIB-4: Low <1.45, intermediate 1.45 < = FIB-4 < = 3.25, High >3.25. ANOVA with Tukey's test assessed the mean differences of FIB-4 score and TIMP1 level between groups, TIMP1 levels between 3 FIB-4 categories, and the effect of age on FIB-4 and TIMP1. Linear regression predicted the association of FIB-4 score and TIMP-1 level.

Results

Mean age of the cohort was 54.3 ± 8.1 years with no difference between groups. Mean FIB-4 for HIV/HCV co-infected group was the highest among the 4 groups (P < 0.05). Mean TIMP1 for HIV/HCV co-infected group was also the highest among the 4 groups (P < 0.05). FIB-4 and TIMP1 were associated and remained so (β = 0.01, SE = 0.002, P < 0.001) after adjusting for age. Mean TIMP1 for the high FIB-4 category was the highest among the 3 FIB-4 categories (P < 0.05). There was a direct effect of TIMP1 levels on FIB-4 category (P < 0.001). After adjusting for HIV/HCV co-infection (P < 0.001), HIV infection (P < 0.0001), HCV infection (P < 0.002), non-infection (P < 0.001) and age, the relationship between TIMP1 and FIB-4 remained significant. The adjusted TIMP1 mean for HIV/HCV co-infected group was significantly higher compared to HIV infected (P < 0.0001), HCV infected (P < 0.002), and healthy groups (P < 0.0001), regardless of age.

Conclusions

Age is a significant factor of liver diseases progression. Our findings of the highest levels of TIMP1 in HIV/HCV co-infected group, which had the highest liver fibrosis regardless of age, supports the role of TIMP1 as a regulator in the progression of hepatic fibrosis.

Funding Sources

National Institutes on Drug Abuse #5UO1DA040381.

Intakes of Vitamin a and Zinc and Markers of Oxidative Stress in Newly Diagnosed HIV-positive Participants in the MASH Cohort in Miami (P24-016-19)

Objectives

HIV infection is characterized by increased oxidative stress. We examined the association of antioxidant intake with measures of oxidative stress and HIV disease progression in newly diagnosed HIV-infected participants.

Methods

Cross-sectional study of 52 newly-diagnosed HIV-positive participants in the MASH cohort. Blood was drawn for parameters of oxidative stress (oxidized glutathione % and oxidative mitochondrial DNA damage [8-oxo-dG]) and disease stage (CD4- cell counts; HIV-viral load). Questionnaires on demographics and 24-hour dietary recalls and Alcohol Use Disorders Identification Test (AUDIT) were administered. AUDIT scores ≥ 8 was considered hazardous drinking. Dietary intakes of vitamin A and Zinc were calculated. SPSS was used for analyses and Linear Regression Models were estimated.

Results

Participants were 74% male, 75% Black Non-Hispanic, and 21% Hispanics. Mean age was 42.3 ± SD10.2 years, CD4 count was 506.7 ± SD733.4 cells/µLA cross-sectional and HIV viral load was 3.63 ± SD1.23log10 copies/mL. Dietary intake of vitamin A (β = −0.001, SE = 0.0002, P = 0.044) and zinc (β = −0.0004, SE = 0.0002, P = 0.044) were inversely related with mitochondrial DNA damage (8-oxo-dG), after adjusting for education, race, age, gender, and excessive alcohol use. Oxidized glutathione percentage was directly associated with HIV-viral load (β = 0.81, SE = 0.4, P = 0.037) adjusting for age, gender, AUDIT ≥ 8 and BMI in linear regressions.

Conclusions

Lower intake of vitamin A and Zinc were associated with higher oxidative stress and higher HIV viral load. These findings suggest that antioxidant supplementation may be beneficial immediately after receiving a diagnosis of HIV infection as well as during antiretroviral treatment.

Funding Sources

Funded by the National Institute on Drug Abuse and the National Institute of Health.

Lowered Fasting Blood Glucose (FBG) in a Prediabetic Individual with HIV Despite Struggle with Weight Control Management- CASE STUDY (FS17-06-19)

Objectives

HIV infection has previously been associated with malnutrition and wasting; however, with the initiation of antiretroviral therapy (ART), a growing number of people living with HIV (PLWH) are becoming centrally obese, with disproportionate weight accumulation around the abdominal area and fat losses in the rest of their body (periphery face, arms and legs), indicative of lipodystrophy. As a result, some PLWH may struggle simultaneously with central fat accumulation and peripheral losses, trying to balance these 2 opposite effects.

Methods

PB is a 62-year-old, African-American male infected with HIV for 12 years, receiving an NRTI regimen. Participating in the Miami Adult Studies in HIV (MASH) Cohort, PB started a 6-month nutrition intervention targeted to lower diabetes risk in prediabetic PLWH. Baseline body mass index (BMI) was 24.1 kg/m2 and waist circumference (WC) was 36.5 inches. Despite having the initial intention to lose weight, PB gained ∼12.4 lbs just a month after initiation. When questioned about the weight gain, PB revealed that he had started taking an appetite stimulant (Megace) to address the wasting on his periphery, claiming that he looked “sickly”. PB stopped taking Megace after he gained >20 lbs (12.3% Wt∆) in 4 months. BMI at this time was 26.3 kg/m2 and WC was 45.5 inches, reflecting a substantially increased risk for metabolic complications. With WC increasing 9 inches and hip circumference increasing only 2 inches, it is evident that a considerable amount of the weight accumulation occurred around the waist. As can be seen, he among others in his situation, are struggling with conflicting goals by simultaneously trying to reduce central obesity and prevent peripheral losses and wasting, something that may be unique to PLWH.

Results

Despite the participant's difficulties in weight management, his fasting blood glucose (FBG) improved after the 6-month nutrition intervention, with a −14 mg/dL improvement, lowering associated risk for diabetes and cardiometabolic complications.

Conclusions

This improvement in FBG levels suggests that despite the difficulty of effective weight management in these patients, proper glucose values may still be achieved with nutrition counseling and education, thus lowering risk for diabetes and associated complications.

Funding Sources

NIGMS-RISE funding, National Institute on Drug Abuse 5U01DA040381-03 and FIU-Dissertation Funding.

Cocaine Use, Oxidative Stress and Inflammation Among People Living with HIV in the MASH Cohort in Miami (P19-002-19)

Objectives

HIV infection and cocaine use contribute to oxidative stress; persistent oxidative stress leads to rapid rates of glutathione (GSH) consumption. GSH is an abundant intracellular antioxidant and is synthesized from its precursor amino acids. HIV promotes changes in the components of the antioxidant defense system, resulting in GSH depletion and may cause DNA damage, and is associated with chronic inflammatory diseases. Therefore, the aim is to assess oxidative stress, and biomarkers of inflammation in HIV-infected individuals from the Miami Adult Studies on HIV (MASH) cohort, on stable antiretroviral therapy (ART), with controlled HIV viral load.

Methods

A cross-sectional study of participants in the MASH cohort in Miami. Participants were consented and blood was collected for C-reactive protein (CRP), oxidized glutathione and % of reduced to oxidized glutathione (GSH: GSSG). Anthropometrics included body fat measured by the bioimpedance analysis machine.

Results

Mean age was 54.6 ± 6.3 years, 67% were male, and 50% used cocaine, mean BMI was 26.2 ± 3.1, CRP was 7.1 ± 12.4, oxidized glutathione was 34.4 ± 32.4 mmol, and the ratio of GSH: GSSG 4.86 ± 4.7. All participants had undetected viral load and were mainly overweight (70%) with a mean fat% of 28.0 ± 7.1. Cocaine use was strongly related with CRP (r = 401, P = 0.014) and GSH: GSSG (r = −389, P = 0.017) ; BMI was lower with age (r = −0.502, P = 0.024); and fat contain was lower in males (r = −0.474, P = 0.004); males also had significantly higher oxidized glutathione (r = 0.384, P = 0.018); age was inversely correlated with BMI (r = −0.335, P = 0.027). A nutritional supplementation with antioxidants with a longitudinal follow-up of outcomes is in progress.

Conclusions

Our findings suggest that cocaine use is significantly associated with markers of inflammations and oxidative stress in people living with HIV who are already at risk for these conditions, and interventions with antioxidants and detoxification interventions are important for these participants.

Funding Sources

National Institute on Drug Abuse.

Feasibility of a Study on Gut Integrity, Microbial Translocation, Immune Activation and Vitamin D in People Living with HIV (PLWH) Who Use Illegal Drugs (P13-020-19)

Objectives

The purpose of this study was to assess the feasibility of using the Miami Adult Studies on HIV (MASH) cohort to conduct research on markers of gut integrity, MT, immune-activation and inflammation and their relationship to Vitamin D status in this cohort. We hypothesize that drug users infected with HIV, who have vitamin D deficiency or insufficiency, will have higher levels of MT, immune-activation, inflammation and deterioration of the gut integrity than drug users infected with HIV with sufficient Vitamin D levels.

Methods

Ninety HIV-infected drug users and HIV-infected drug non-users were identified from the MASH cohort with IRB approval. Data for this study will be collected at baseline, 6-months and 12-months. Laboratory analyses will include: determination of Lipopolysaccharide for MT, Soluble CD14, Interleukin 6, and Tumor Necrosis Factor alpha to assess immune-activation and inflammation; 25(OH)D levels for Vitamin D status, and Intestinal Fatty Acid Binding Protein as a gut integrity marker. All laboratory analyses will be completed using plasma samples and determined by enzyme-linked immunosorbent assays in the laboratories of the MASH cohort. Dietary and anthropometric data, disease progression and medical history will be collected. The MASH cohort assesses drug use with questionnaires, urine toxicology, and cocaine metabolites.

Results

We hypothesize that drug users infected with HIV, who have vitamin D deficiency or insufficiency, will have higher levels of MT, immune-activation, inflammation and deterioration of the gut integrity than drug users infected with HIV with sufficient Vitamin D levels.

Conclusions

The MASH cohort participants are well-characterized and followed longitudinally enabling access to the participants and their information. This study will provide information to develop adjunct therapies for the management of HIV, gut health and nutrition.

Funding Sources

The National Institute of Drug Abuse provides funding for the MASH cohort.

Metabolic Syndrome (MetS) as a Predictor of Fatty Liver in HIV Infected Adults from the Miami Adult Studies on HIV (MASH) Cohort (FS12-06-19)

Objectives

One of the major comorbidities among people living with HIV (PLWH) is liver disease. MetS is common in this population and may also play a role in the development of liver disease. In order to better understand the mechanisms of liver disease in PLWH, it is important to investigate the relationship between components of MetS and the risk of fatty liver, an early precursor to liver disease. The objective of this study was to determine if the 5 criteria used to diagnose MetS contribute to liver steatosis.

Methods

Crossectional analyses of data from the MASH cohort were analyzed. Waist circumference (WC) and blood pressure (BP) were measured by a research nurse. Serum triglycerides (TRG), glucose (GLU), and HDL were determined in fasting by LabCorp. Liver fat % was estimated with proton density fat fraction using Magnetic Resonance Elastography conducted on a 3T Siemens MAGNETOM Prisma MRI. Liver fat >5% was defined as stage 1 steatosis. Components of MetS were taken from the NCEP ATP III definition of MetS. Spearman correlations and logistic regression were used for analyses.

Results

A total of 324 PLWH aged 53.5 ± 7.5 years were included. Liver fat% was correlated with WC (r = 0.394, P < 0.001), TRG (r = 0.332, P < 0.001), GLU (r = 0.358, P < 0.001), and systolic BP (r = 0.183, P = 0.011), inversely correlated with HDL (r = −0.236, P = 0.001), and trended toward significance with diastolic BP (r = 0.133, P = 0.065). Participants with stage 1 steatosis had a larger WC (41.02in ± 5.3 vs 36.95 ± 5.5, P = 0.001), higher TRG (210.3 mg/dL ± 173.9 vs 121.3 ± 67.9, P = 0.002), and higher GLU (126.1 mg/dL ± 77.7 vs 93.92 ± 50.8, P = 0.001) than those without steatosis. No significant difference was found for HDL cholesterol, SBP, or DBP. A logistic regression model that included all 5 MetS criteria and was controlled for age, gender, and alcohol AUDIT score >8 found that WC (OR 1.11, 95% CI 1.01–1.23, P = 0.030), TRG (OR 1.01, 95% CI 1.00–1.01, P = 0.040), and GLU (OR 1.01, 95% CI 1.00–1.03, P = 0.033) are significant predictors of stage 1 steatosis.

Conclusions

WC, TRG, and GLU, three of the 5 criteria for diagnosing MetS were significant predictors of stage 1 steatosis in PLWH. Future studies investigating the risk of liver disease progression in PLWH need to account for these confounding factors as they explore HIV specific mechanisms for liver disease.

Funding Sources

National Institutes on Drug Abuse #5UO1DA040381.

Preliminary Results on the Effectiveness of a Nutrition Intervention in Lowering Diabetes Risk in Prediabetic People Living with HIV (PLWH) in MASH Cohort (OR36-06-19)

Objectives

The objective of this study is to assess the effectiveness of a 6-month nutrition intervention to improve glycemic parameters and inflammation in prediabetic PLWH on stable ART with undetectable HIV viral load.

Methods

A 6-month randomized, controlled nutrition intervention was conducted in prediabetic PLWH. The study participants for the intervention were recruited from the Miami Adult Studies for HIV (MASH) cohort at the FIU-Borinquen Research Clinic. Upon their consent, the participants were randomized into the intervention group or the control group. Participants randomized in the intervention group met once a month for approximately 1 hour where they received medical nutrition therapy, nutrition counseling and nutrition education; participants randomized into the control group received educational material at baseline. Blood was drawn at baseline and at 6-month to measure fasting blood glucose (FBG) and high sensitivity C-reactive protein (hs-CRP).

Results

A total of 38 participants were recruited and randomized into either the intervention group (n = 20) or the control group (n = 18). We found that the FBG for the 6-month follow-up for the intervention group was significantly lower than the baseline FBG values of the same study group (paired t-test; P = 0.031). No significant difference was found in the control group between the baseline and 6-month fasting blood glucose values (P = 0.068). Moreover, no significant difference was found in pre/post C-reactive protein (CRP) levels in the intervention or control group (paired t-test; P = 0.404 and P = 0.117 respectively). There was a significant difference in CRP levels at baseline (P = 0.028) between the study groups but no difference at the 6-month follow up (Mann Whitney U test: P = 0.430).

Conclusions

The results from this intervention support the notion that a nutrition intervention is effective in prediabetic PLWH to lower diabetes risk by significantly lowering fasting blood glucose and may be implemented into larger scale interventions; however, no significant changes was seen in hs-CRP values between the 2 groups.

Funding Sources

National Institute of General Medical Sciences (NIGMS): Research Initiative for Scientific Enhancement (RISE), Biomedical Research Initiative (BRI) Grant, National Institute on Drug Abuse 5U01DA040381-03 and FIU-Dissertation Funding.

Using a knowledge, attitudes and practices survey to supplement findings of an outbreak investigation: cholera prevention measures during the 1991 epidemic in Peru

BACKGROUND

To assess the effectiveness of the cholera prevention activities of the Peruvian Ministry of Health, we conducted a knowledge, attitudes, and practices (KAP) survey in urban and rural Amazon communities during the cholera epidemic in 1991.

METHODS

We surveyed heads of 67 urban and 61 rural households to determine diarrhoea rates, sources of cholera prevention information, and knowledge, attitudes, and practices regarding ten cholera prevention measures.

RESULTS

Twenty-five per cent of 482 urban and 11% of 454 rural household members had diarrhoea during the first 3-4 months of the epidemic. Exposure to mass media education was greater in urban areas, and education through interpersonal communication was more prevalent in rural villages. Ninety-three per cent of rural and 67% of urban respondents believed they could prevent cholera. The mean numbers of correct responses to ten knowledge questions were 7.8 for urban and 8.2 for rural respondents. Practices lagged behind knowledge and attitudes (mean correct response to ten possible: urban 4.9, rural 4.6). Seventy-five per cent of respondents drank untreated water and 91% ate unwashed produce, both of which were identified as cholera risk factors in a concurrently conducted case-control study.

CONCLUSIONS

The cholera prevention campaign successfully educated respondents, but did not cause many to adopt preventive behaviours. Direct interpersonal education by community-based personnel may enhance the likelihood of translating education into changes in health behaviours. Knowledge, attitudes, and practices surveys conducted with case-control studies during an epidemic can be an effective method of refining education/control programmes.

Severe life-threatening cholera associated with blood group O in Peru: implications for the Latin American epidemic

A household survey in 1991, at the onset of the Latin American cholera epidemic, investigated high attack rates in Trujillo, Peru, and determined the association between blood group O and severe cholera. Of 463 persons in 69 households, 173 (37%) reported diarrhea, 21% required rehydration therapy, and 4% were hospitalized; these treatment requirements greatly exceeded estimates based on other populations. Elevated vibriocidal or antitoxic antibody titers were present in 52% of 321 from whom serum was obtained; 73% were blood group O. Blood group O was strongly associated with severe cholera: Infected persons had more diarrheal stools per day than persons of other blood groups, were more likely to report vomiting and muscle cramps, and were almost eight times more likely to require hospital treatment. Since prevalence of blood group O in Latin America may be the world's highest, estimates of treatment requirements should be increased to prevent unnecessary deaths.

Epidemic cholera in the Amazon: the role of produce in disease risk and prevention

Epidemic cholera struck Peru in January 1991 and spread within a month to the Amazon headwaters. A case-control study was done in the Amazonian city of Iquitos, Peru. Cholera-like illness was associated with eating unwashed fruits and vegetables (odds ratio [OR] = 8.0; 95% confidence limits [CL] = 2.2, 28.9) and drinking untreated water (OR = 2.9; 95% CL = 1.3, 6.4). Consumption of a drink made from toronja, a citrus fruit, was protective against illness (OR = 0.4; 95% CL = 0.2, 0.7). Illness was inversely associated with the quantity of toronja drink consumed (P < .01). Produce has not previously been convincingly documented as a risk factor for cholera; this study underscores the importance of washing produce before eating it. Acidic juices, such as toronja drink (pH 4.1), inhibit vibrio growth and may make contaminated water safer. Wild citrus fruits such as toronja are abundant, cheap, and popular in the Amazon region. Promoting the consumption of toronja drink may be a useful cholera prevention strategy in this region.

Epidemic cholera in the Amazon: the challenge of preventing death

Epidemic cholera struck Peru in January 1991, and spread rapidly. The national cholera case-fatality rate (CFR) was less than 1% in the first six months of the epidemic, but in some rural areas, the CFR exceeded 10%. We investigated cholera mortality in the rural Amazon region, an area with a CFR of 6.3%. We conducted a case-control study, comparing 29 decedents with 61 survivors of recent cholera-like diarrheal illness in 12 villages with a combined CFR of 13.5%. Of 29 decedents, 28 (96%) died in the village or en route to a health facility. Death occurred within 36 hours of illness onset for 83% of the decedents. In 11 (92%) villages, the first or second recognized case was fatal. Death was associated with receiving treatment only at home (odds ratio indeterminate; 95% confidence interval 3.5, indeterminate). Treatment with oral rehydration salts (ORS) was not protective against death for patients who received treatment only at home. Treatment with homemade sugar-salt solution (SSS) was also not protective; fewer than one-third of respondents knew the correct SSS recipe. Most decedents experienced multiple barriers to health care. Cholera victims died rapidly and early in village outbreaks, and few patients had access to health care. Provision of threatened villages with ORS supplies and education in their use before cholera strikes is essential to reducing cholera mortality in this region.

Waterborne transmission of epidemic cholera in Trujillo, Peru: lessons for a continent at risk

The epidemic of cholera that began in Peru in January, 1991, marked the first such epidemic in South America this century. Subsequently, over 533,000 cases and 4700 deaths have been reported from nineteen countries in that hemisphere. We investigated the epidemic in Trujillo, the second largest city in Peru. Trujillo's water supply was unchlorinated and water contamination was common. Suspect cholera cases were defined as persons presenting to a health facility with acute diarrhoea between Feb 1, and March 31, 1991. We studied a cohort of 150 patients who had been admitted to hospital and conducted a matched case-control study with 46 cases and 65 symptom-free and serologically uninfected controls; we also carried out a water quality study. By March 31, 1991, 16,400 cases of suspected cholera (attack rate 2.6%), 6673 hospital admissions, and 71 deaths (case-fatality rate 0.4%) had been reported in the province of Trujillo. 79% of stool cultures of patients with diarrhoea presenting to a single hospital yielded Vibrio cholerae O1. In the case-control study, drinking unboiled water (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.3-7.3), drinking water from a household water storage container in which hands had been introduced into the water (4.2, 1.2-14.9), and going to a fiesta (social event) (3.6, 1.1-11.1) were associated with illness. The water quality study showed progressive contamination during distribution and storage in the home: faecal coliform counts were highest in water from household storage containers and lowest in city well water. V cholerae O1, biotype El Tor, serotype Inaba, was isolated from three city water samples. Cholera control measures in Trujillo should focus on treatment of water and prevention of contamination during distribution and in the home. Trujillo's water and sanitation problems are common in South America; similar control measures are needed throughout the continent to prevent spread of epidemic cholera.