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Ribeiro A, Trevizol A, Oluwoye O, McPherson S, McDonell MG, Briese V, Miguel AC, Fratzinger RC, Laranjeira RR, Alonso AL, Karasin AL, Ribeiro M, Madruga CS. HIV and syphilis infections and associated factors among patients in treatment at a Specialist Alcohol, Tobacco, and Drugs Center in São Paulo's "Cracolândia". TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2021; 42:1-6. [PMID: 32215539 DOI: 10.1590/2237-6089-2018-0081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 04/28/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION This study describes the epidemiological scenario of human immunodeficiency virus (HIV) and syphilis at the biggest specialist drug addiction center in Brazil. The great challenge is to find strategies to reduce the impact of inequality and discrimination and develop policies to protect individuals living with - or at risk of - infections. METHODS During the period from January 1 to May 31, 2016, a cross-sectional study was conducted on which all patients (N = 806) seeking inpatient treatment were enrolled. A structured diagnostic interview and rapid tests were conducted initially, and diagnoses were confirmed by tests conducted at a venereal disease research laboratory (VDRL). RESULTS HIV and syphilis rates were 5.86% and 21.9%, respectively. Women were nearly 2.5 times more likely to have syphilis. HIV infection was associated with unprotected sex (odds ratio [OR]: 3.27, p = 0.003, 95% confidence interval [95%CI]: 1.51-7.11), and suicidal ideation (OR: 6.63, p = 0.001, 95%CI: 3.37-14.0). Although only 1.86% reported injecting drugs at any point during their lifetimes, this variable was associated with both HIV and syphilis. Elevated rates of HIV and syphilis were observed in the context of this severe social vulnerability scenario. CONCLUSION The risk factors identified as associated with HIV and syphilis should be taken into consideration for implementation of specific prevention strategies including early diagnosis and treatment of sexually transmitted infections (STI) to tackle the rapid spread of STIs in this population.
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Affiliation(s)
- Ariadne Ribeiro
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Centro de Referência em Álcool Tabaco e Outras Drogas (CRATOD), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Alisson Trevizol
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Oladunni Oluwoye
- Initiative for Research and Education to Advance Community Health, Washington State University Health Sciences, Washington State University, Spokane, WA, USA
| | - Sterling McPherson
- Department of Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane WA, USA
| | - Michael G McDonell
- Initiative for Research and Education to Advance Community Health, Washington State University Health Sciences, Washington State University, Spokane, WA, USA
| | - Viviane Briese
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Centro de Referência em Álcool Tabaco e Outras Drogas (CRATOD), São Paulo, SP, Brazil
| | - André C Miguel
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Rosana C Fratzinger
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Ronaldo R Laranjeira
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Ana L Alonso
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Ana L Karasin
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Marcelo Ribeiro
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Centro de Referência em Álcool Tabaco e Outras Drogas (CRATOD), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
| | - Clarice S Madruga
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil .,Instituto Nacional de Ciência e Tecnologia para Polítias do Álcool e Outras Drogas (INCT-INPAD), UNIFESP, São Paulo, SP, Brazil
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Vernaglia TVC, Leite TH, Faller S, Pechansky F, Kessler FHP, Cruz MS, Group BC. The female crack users: Higher rates of social vulnerability in Brazil. Health Care Women Int 2017; 38:1170-1187. [PMID: 28825524 DOI: 10.1080/07399332.2017.1367001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Female crack users who sought treatment are a hard to find part of the population. We studied sociodemographic and behavioral characteristics of crack users undergoing treatment in psychosocial care centers for alcohol and other drugs in six Brazilian cities. We carried out a cross-sectional study of 816 crack users and collected data with the Addiction Severity Index. Women were more likely to be in vulnerable situations: had worst levels of education, were not receiving money enough to their basic needs; more likely to be HIV positive (10.1%), to report sexual abuse (34%), and to be separated from their children (20%).
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Affiliation(s)
| | | | - Sibele Faller
- c Department of Psychiatry and Legal Medicine , Federal University of Rio Grande do Sul (UFRS) , Brazil
| | - Flavio Pechansky
- d Center for Drug and Alcohol Research , Federal University of Rio Grande do Sul (UFRGS) , Brazil
| | - Felix Henrique Paim Kessler
- c Department of Psychiatry and Legal Medicine , Federal University of Rio Grande do Sul (UFRS) , Brazil.,e Porto Alegre Clinical Hospital , Brazil
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An Exploratory Study to Assess Individual and Structural Level Barriers Associated With Poor Retention and Re-engagement in Care Among Persons Living With HIV/AIDS. J Acquir Immune Defic Syndr 2017; 74 Suppl 2:S113-S120. [PMID: 28079721 DOI: 10.1097/qai.0000000000001242] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Retention in care is the most challenging step along the HIV care continuum. Many patients who engage in care and achieve viral suppression have care interruptions, characterized by moving in and out of care ("churn"). Poor retention has clinical consequences and contributes to new HIV transmissions, but how to predict or prevent it remains elusive. This study sought to understand the relationship between individual- and structural-level barriers, and poor retention for persons living with HIV/AIDS in Atlanta, GA. METHODS We administered a survey, through interviews, with HIV-infected patients continuously retained in care for 6 years ("continuously retained," n = 32) and patients with recent gaps in care ("unretained" n = 27). We assessed individual-level protective factors for successful engagement (self-efficacy, resilience, perceived social support, and disclosure), risk factors for poor engagement (substance use, mental illness, and stigma), and structural/systemic-level barriers (financial and housing instability, transportation, food insecurity, communication barriers, and incarceration history). Chi-square and Mann-Whitney U tests were used to compare the 2 populations. RESULTS Both continuously retained and unretained populations had high rates of prior viral suppression but few unretained patients were virologically suppressed upon return to care (11%). Younger age, crack cocaine use, food insecurity, financial instability, housing instability, and phone number changes in the past year were significantly more likely to be present in the unretained population. CONCLUSIONS Our findings suggest the need for targeted risk assessment tools to predict the highest-risk patients for poor retention whereby public health interventions can be directed to those individuals.
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Burch AE, Rash CJ, Petry NM. Cocaine-using substance abuse treatment patients with and without HIV respond well to contingency management treatment. J Subst Abuse Treat 2017; 77:21-25. [PMID: 28476266 DOI: 10.1016/j.jsat.2017.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 11/17/2022]
Abstract
HIV is common among individuals with substance use disorders, but relatively few studies have examined the impact of HIV status on response to substance abuse treatment. This secondary analysis compared patients seeking treatment for cocaine use with and without HIV in terms of substance use treatment outcomes. Primary treatment outcomes included treatment retention, longest duration of abstinence, and percent of negative samples; both substance use outcomes reflect abstinence from cocaine, alcohol and opioids concurrently. Participants (N=432) were enrolled in randomized clinical trials comparing contingency management (CM) to standard care, and 32 (7%) reported being positive for HIV. Overall, CM improved both treatment retention (average of 8.2weeks compared to 6.0weeks in the standard care condition) and longest duration of abstinence (average of 5.8weeks compared to 2.8weeks in the standard care condition). HIV status was not associated with treatment outcomes as a main effect, nor did it have an interaction effect with treatment condition. These results suggest a benefit of CM in substance abuse treatment irrespective of HIV status.
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Affiliation(s)
- Ashley E Burch
- East Carolina University, East 5th Street, 104 Rawl Building, Greenville, NC 27858-4353, United States.
| | - Carla J Rash
- University of Connecticut, School of Medicine (MC 3944), 263 Farmington Ave., Farmington, CT 06030-3944, United States.
| | - Nancy M Petry
- University of Connecticut, School of Medicine (MC 3944), 263 Farmington Ave., Farmington, CT 06030-3944, United States.
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Ompad DC, Giobazolia TT, Barton SC, Halkitis SN, Boone CA, Halkitis PN, Kapadia F, Urbina A. Drug use among HIV+ adults aged 50 and older: findings from the GOLD II study. AIDS Care 2016; 28:1373-7. [PMID: 27145363 DOI: 10.1080/09540121.2016.1178704] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Understanding the nexus of aging, HIV, and substance use is key to providing appropriate services and support for their aging, HIV seropositive patients. The proportion of PLWHA aged 50 and older is growing due to a variety of factors like decreases in mortality due to highly active retroviral therapy and non-negligible HIV incidence. We describe prevalence of alcohol, tobacco, and other drug use and participation in substance use treatment and 12-step programs among 95 HIV-positive patients aged 50 and older engaged in care. Most (73.7%) smoked cigarettes in their lifetime and 46.3% were current smokers. Most were at medium (81.1%) or high risk (13.7%) for an alcohol use disorder. With respect to illicit drug use, 48.4% had used marijuana, cocaine, crack, methamphetamines, heroin, and/or prescription opiates without a prescription in the last 12 months; 23.2% met criteria for drug dependence. Marijuana was the most commonly reported illicit drug (32.6%) followed by cocaine and crack (10.5% each), heroin and prescription opiates (7.4% each), and methamphetamines (6.3%). Among those who had not used drugs in the past 12 months, 36.7% had been in a substance use treatment program and 26.5% had participated in a 12-step program in their lifetime; 8.2% were currently in treatment and 16.3% were currently participating in a 12-step program. Among those who had used an illicit drug in the past 12 months, 37.0% had never been in treatment, 34.8% had been in treatment in their lifetime, and 28.3% were currently in treatment. With respect to 12-step programs, 27.3% of those meeting dependence criteria had never participated, 45.5% had participated in their lifetimes, and 27.3% were currently participating. Our findings suggest that older adults in HIV care settings could benefit from Screening, Brief Intervention, and Referral to Treatment interventions and/or integrated services for substance abuse and medical treatment.
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Affiliation(s)
- Danielle C Ompad
- a College of Global Public Health, New York University , New York , NY , USA.,b Center for Health, Identity, Behavior, and Prevention Studies, New York University , New York , NY , USA.,c Center for Drug Use and HIV Research , Rory Meyers College of Nursing, New York University , New York , NY , USA
| | - Tatiana T Giobazolia
- b Center for Health, Identity, Behavior, and Prevention Studies, New York University , New York , NY , USA
| | - Staci C Barton
- b Center for Health, Identity, Behavior, and Prevention Studies, New York University , New York , NY , USA
| | - Sophia N Halkitis
- b Center for Health, Identity, Behavior, and Prevention Studies, New York University , New York , NY , USA
| | - Cheriko A Boone
- b Center for Health, Identity, Behavior, and Prevention Studies, New York University , New York , NY , USA.,f Department of Sociomedical Sciences , Columbia University, Mailman School of Public Health , New York , NY , USA.,g School of Social Work , Columbia University , New York , NY , USA
| | - Perry N Halkitis
- a College of Global Public Health, New York University , New York , NY , USA.,b Center for Health, Identity, Behavior, and Prevention Studies, New York University , New York , NY , USA.,c Center for Drug Use and HIV Research , Rory Meyers College of Nursing, New York University , New York , NY , USA.,d Department of Population Health , Langone Medical Center, New York University , New York , NY , USA.,e Department of Applied Psychology , Steinhardt School of Culture, Education, and Human Development, New York University , New York , NY , USA
| | - Farzana Kapadia
- a College of Global Public Health, New York University , New York , NY , USA.,b Center for Health, Identity, Behavior, and Prevention Studies, New York University , New York , NY , USA.,c Center for Drug Use and HIV Research , Rory Meyers College of Nursing, New York University , New York , NY , USA.,d Department of Population Health , Langone Medical Center, New York University , New York , NY , USA
| | - Antonio Urbina
- h Mount Sinai Institute for Advanced Medicine , New York , NY , USA
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Dickson-Gomez J, Bodnar G, Petroll A, Johnson K, Glasman L. HIV Treatment for Alcohol and Non-Injection Drug Users in El Salvador. QUALITATIVE HEALTH RESEARCH 2015; 25:1719-1732. [PMID: 25595149 PMCID: PMC5027900 DOI: 10.1177/1049732314568322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Since the mid-1990 s, many developing countries have introduced and expanded the availability of combination antiretroviral therapy (cART) to persons living with HIV (PLH). However, AIDS-related mortality continues to be high particularly among drug users. In this article, we present results from in-depth interviews with 13 HIV medical providers and 29 crack cocaine and alcohol using PLH in El Salvador. Providers endorsed negative attitudes toward substance using PLH and warned PLH that combining cART with drugs and alcohol would damage their livers and kidneys resulting in death. Upon diagnosis, PLH received little information about HIV treatment and many suffered depression and escalated their drug use. PLH reported suspending cART when they drank or used drugs because of providers' warnings. Substance using PLH were given few strategies and resources to quit using drugs. Messages from medical providers discourage drug users from initiating or adhering to antiretroviral therapy (ART) and may contribute to treatment abandonment.
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Affiliation(s)
| | - Gloria Bodnar
- Fundación Antidrogas de El Salvador, Santa Tecla, El Salvador
| | - Andy Petroll
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kali Johnson
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laura Glasman
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, Bozack AK, Caban M, Rourke SB. Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review. Am J Public Health 2015; 106:e1-e23. [PMID: 26562123 DOI: 10.2105/ajph.2015.302905] [Citation(s) in RCA: 235] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Accumulating evidence suggests responses to HIV that combine individual-level interventions with those that address structural or contextual factors that influence risks and health outcomes of infection. Housing is such a factor. Housing occupies a strategic position as an intermediate structural factor, linking "upstream" economic, social, and cultural determinants to the more immediate physical and social environments in which everyday life is lived. The importance of housing status for HIV prevention and care has been recognized, but much of this attention has focused on homeless individuals as a special risk group. Analyses have less often addressed community housing availability and conditions as factors influencing population health or unstable, inadequate, or unaffordable housing as a situation or temporary state. A focus on individual-level characteristics associated with literal homelessness glosses over social, economic, and policy drivers operating largely outside any specific individual's control that affect housing and residential environments and the health resources or risk exposures such contexts provide. OBJECTIVES We examined the available empirical evidence on the association between housing status (broadly defined), medical care, and health outcomes among people with HIV and analyzed results to inform future research, program development, and policy implementation. SEARCH METHODS We searched 8 electronic health and social science databases from January 1, 1996, through March 31, 2014, using search terms related to housing, dwelling, and living arrangements and HIV and AIDS. We contacted experts for additional literature. SELECTION CRITERIA We selected articles if they were quantitative analyses published in English, French, or Spanish that included at least 1 measure of housing status as an independent variable and at least 1 health status, health care, treatment adherence, or risk behavior outcome among people with HIV in high-income countries. We defined housing status to include consideration of material or social dimensions of housing adequacy, stability, and security of tenure. DATA COLLECTION AND ANALYSIS Two independent reviewers performed data extraction and quality appraisal. We used the Cochrane Risk of Bias Tool for randomized controlled trials and a modified version of the Newcastle Ottawa Quality Appraisal Tool for nonintervention studies. In our quality appraisal, we focused on issues of quality for observational studies: appropriate methods for determining exposure and measuring outcomes and methods to control confounding. RESULTS Searches yielded 5528 references from which we included 152 studies, representing 139,757 HIV-positive participants. Most studies were conducted in the United States and Canada. Studies examined access and utilization of HIV medical care, adherence to antiretroviral medications, HIV clinical outcomes, other health outcomes, emergency department and inpatient utilization, and sex and drug risk behaviors. With rare exceptions, across studies in all domains, worse housing status was independently associated with worse outcomes, controlling for a range of individual patient and care system characteristics. CONCLUSIONS Lack of stable, secure, adequate housing is a significant barrier to consistent and appropriate HIV medical care, access and adherence to antiretroviral medications, sustained viral suppression, and risk of forward transmission. Studies that examined the history of homelessness or problematic housing years before outcome assessment were least likely to find negative outcomes, homelessness being a potentially modifiable contextual factor. Randomized controlled trials and observational studies indicate an independent effect of housing assistance on improved outcomes for formerly homeless or inadequately housed people with HIV. Housing challenges result from complex interactions between individual vulnerabilities and broader economic, political, and legal structural determinants of health. The broad structural processes sustaining social exclusion and inequality seem beyond the immediate reach of HIV interventions, but changing housing and residential environments is both possible and promising.
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Affiliation(s)
- Angela A Aidala
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Michael G Wilson
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Virginia Shubert
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - David Gogolishvili
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Jason Globerman
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Sergio Rueda
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Anne K Bozack
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Maria Caban
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
| | - Sean B Rourke
- Angela A. Aidala is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. Michael G. Wilson is with the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Virginia Shubert is with Shubert Botein Policy Associates, New York, NY. At the time of this study, David Gogolishvili, Jason Globerman, Sergio Rueda, and Sean B. Rourke were with the Ontario HIV Treatment Network, Toronto, ON, Canada. Anne K. Bozack is with the Department of Environmental Health Sciences, Mailman School of Public Health. Maria Caban is with the Department of Research and Evaluation, BOOM!Health, New York, NY
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Bertrand SJ, Hu C, Aksenova MV, Mactutus CF, Booze RM. HIV-1 Tat and cocaine mediated synaptopathy in cortical and midbrain neurons is prevented by the isoflavone Equol. Front Microbiol 2015; 6:894. [PMID: 26441850 PMCID: PMC4561964 DOI: 10.3389/fmicb.2015.00894] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/17/2015] [Indexed: 02/05/2023] Open
Abstract
Illicit drugs, such as cocaine, are known to increase the likelihood and severity of HIV-1 associated neurocognitive disorders (HAND). In the current studies synaptic integrity was assessed following exposure to low concentrations of the HIV-1 viral protein Tat 1-86B, with or without cocaine, by quantifying filamentous actin (F-actin) rich structures (i.e., puncta and dendritic spines) on neuronal dendrites in vitro. In addition, the synapse-protective effects of either R-Equol (RE) or S-Equol (SE; derivatives of the soy isoflavone, daidzein) were determined. Individually, neither low concentrations of HIV-1 Tat (10 nM) nor low concentrations of cocaine (1.6 μM) had any significant effect on F-actin puncta number; however, the same low concentrations of HIV-1 Tat + cocaine in combination significantly reduced dendritic synapses. This synaptic reduction was prevented by pre-treatment with either RE or SE, in an estrogen receptor beta dependent manner. In sum, targeted therapeutic intervention with SE may prevent HIV-1 + drug abuse synaptopathy, and thereby potentially influence the development of HAND.
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Affiliation(s)
- Sarah J Bertrand
- Laboratory Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina Columbia, SC, USA
| | - Calvin Hu
- Laboratory Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina Columbia, SC, USA
| | - Marina V Aksenova
- Laboratory Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina Columbia, SC, USA
| | - Charles F Mactutus
- Laboratory Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina Columbia, SC, USA
| | - Rosemarie M Booze
- Laboratory Program in Behavioral Neuroscience, Department of Psychology, University of South Carolina Columbia, SC, USA
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Abstract
Individuals who are homeless or living in marginal conditions have an elevated burden of infection with HIV. Existing research suggests the HIV/AIDS pandemic in resource-rich settings is increasingly concentrated among members of vulnerable and marginalized populations, including homeless/marginally-housed individuals, who have yet to benefit fully from recent advances in highly-active antiretroviral therapy (HAART). We reviewed the scientific evidence investigating the relationships between inferior housing and the health status, HAART access and adherence and HIV treatment outcomes of people living with HIV/AIDS (PLWHA.) Studies indicate being homeless/marginally-housed is common among PLWHA and associated with poorer levels of HAART access and sub-optimal treatment outcomes. Among homeless/marginally-housed PLWHA, determinants of poorer HAART access/adherence or treatment outcomes include depression, illicit drug use, and medication insurance status. Future research should consider possible social- and structural-level determinants of HAART access and HV treatment outcomes that have been shown to increase vulnerability to HIV infection among homeless/marginally-housed individuals. As evidence indicates homeless/marginally-housed PLWHA with adequate levels of adherence can benefit from HAART at similar rates to housed PLWHA, and given the individual and community benefits of expanding HAART use, interventions to identify HIV-seropositive homeless/marginally-housed individuals, and engage them in HIV care including comprehensive support for HAART adherence are urgently needed.
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Skalski LM, Sikkema KJ, Heckman TG, Meade CS. Coping styles and illicit drug use in older adults with HIV/AIDS. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2013; 27:1050-1058. [PMID: 23438250 DOI: 10.1037/a0031044] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The prevalence of HIV infection in older adults is increasing; by 2015, over half of adults living with HIV/AIDS in the United States will be over 50. This study describes the prevalence of drug use and examines psychosocial predictors of drug use in a sample of HIV-infected adults aged 50 and older. Participants were 301 HIV-positive older adults enrolled in a clinical trial of a coping intervention aimed to reduce their depressive symptoms. One-quarter used illicit drugs in the past 60 days (48% any cocaine, 48% weekly marijuana, 44% any other drugs) with an average of 36 days for marijuana and 15 days for cocaine. After controlling for demographics, self-destructive avoidance was positively associated and spiritual coping was negatively associated with drug use. These findings suggest that assessment of drug abuse should be a routine part of care for older patients in HIV clinics. Furthermore, interventions designed to increase spiritual coping and decrease self-destructive avoidance may be particularly efficacious for HIV-infected older adults.
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Affiliation(s)
| | - Kathleen J Sikkema
- Department of Psychology and Neuroscience, and Global Health Institute, Duke University
| | - Timothy G Heckman
- Department of Geriatric Medicine/Gerontology, Ohio University College of Osteopathic Medicine
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