1
|
Palfai TP, Kratzer MPL, Taylor JL, Otis JD, Winter MR. Addressing Pain and Heavy Drinking among Patients in HIV-Care: A Pilot Study of an Integrated Telehealth Intervention. AIDS Behav 2025; 29:1930-1943. [PMID: 39998790 DOI: 10.1007/s10461-025-04660-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2025] [Indexed: 02/27/2025]
Abstract
Chronic pain is common among people living with HIV (PLWH) who engage in heavy drinking and both pain and heavy drinking influence quality of life, functioning, and HIV-outcomes. The purpose of this study was to: (1) test the acceptability and feasibility of a cognitive behavioral telehealth intervention (INTV) to reduce pain and heavy drinking among PLWH, (2) evaluate methods to implement a randomized controlled efficacy trial, and (3) provide preliminary information about its potential value. Forty-eight PLWH with chronic pain who engaged in heavy drinking were recruited from HIV-health clinics and social media. Following baseline assessment, participants were randomized to INTV or treatment-as-usual control (CTL). Participants completed outcome assessments at 3- and 6-months post-baseline. Results indicated that participants experienced high levels of satisfaction and showed strong intervention engagement. Over 85% of follow-up visits were completed across the two time-points. Condition comparisons showed small to moderate effects of the intervention on pain severity at 3-months (f2 = 0.05) but not at 6-months (f2 = 0.01). Effect sizes were consistent with less heavy episodic drinking for those in the INTV across timepoints (3-month aIRR = 0.72, 95% CI: [0.22, 2.41], 6-month aIRR = 0.71, 95% CI: [0.17, 2.96]) but only at 3-months for drinking quantity (3-month aIRR = 0.77, 95% CI: [0.29, 2.04]; 6-month aIRR = 1.00, 95% CI: [0.43, 2.29]). Results indicate that this is a feasible and acceptable approach for reducing chronic pain and heavy drinking among PLWH and that study methods may be useful for conducting a future efficacy trial. TRN: NCT03982433; Date of registration: 5/14/2019.
Collapse
Affiliation(s)
- Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA, 02215, USA.
| | - Maya P L Kratzer
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA, 02215, USA
| | - Jessica L Taylor
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
| | - John D Otis
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA, 02215, USA
| | - Michael R Winter
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
2
|
Gasik RE, Smith EA, Skeen SJ, Tokarz S, Clum G, Felker-Kantor E, Theall KP. Using Geographic Momentary Assessment to Explore Spatial Environment Influences on Wellbeing in People With HIV. AIDS Behav 2025; 29:342-355. [PMID: 39465467 PMCID: PMC11739190 DOI: 10.1007/s10461-024-04527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2024] [Indexed: 10/29/2024]
Abstract
Place-based socio-economic and racial inequities contribute to health disparities among people with HIV (PWH). We used geographic ecological momentary assessment (GEMA) methodologies to explore the interplay between psychosocial outcomes in daily diaries and community spatial measures among PWH in New Orleans. PWH (N = 69) were recruited from a clinic-based cohort study. Micro-longitudinal data were collected via smartphone-based daily diaries and geospatial tracking over 14 days. First, correlations were run between diary derived outcomes (e.g., feeling safe in current location, stress), and spatial measures (e.g., violent crime, alcohol outlets, and vacant lots) within a half-mile buffer around each diary point to understand the real time associations between mood and space. Next, we fit multilevel models, controlling for between-person effects, to assess within-person associations between accumulative spatial daily violence exposure (50m, 100m and 200m buffers), and measures of daily mood and coping. Violent crime, alcohol outlets and vacant lots were inversely correlated with feeling safe and positively correlated with perceived ease of obtaining drugs. Vacant lots were positively associated with stress and inversely correlated with positive mood. Within individuals, higher daily accumulated violence exposure was associated with increased rumination at the 50m buffer level, decreased trust in oneself and others at the 100m buffer, and decreased ratio of positive/negative mood at all buffers. Our results emphasize the intricate interplay between mental wellness, coping mechanisms, and spatial measures in PWH. Future research and interventions for PWH should consider how spatial factors may influence PWH in terms of mental health and care engagement.
Collapse
Affiliation(s)
- Rayna E Gasik
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | - Ethan A Smith
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Simone J Skeen
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Psychology, Hunter College, City University of New York, New York, NY, USA
| | - Stephanie Tokarz
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Gretchen Clum
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Erica Felker-Kantor
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Katherine P Theall
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| |
Collapse
|
3
|
Miller EA, McGinnis KA, Edelman EJ, Feinberg T, Gordon KS, Kerns RD, Marshall BDL, Patterson JA, McRae M. Pain, Substance Use Disorders, Mental Health, and Buprenorphine Treatment among Patients With and Without HIV. AIDS Behav 2024; 28:3994-4004. [PMID: 39264485 PMCID: PMC11586311 DOI: 10.1007/s10461-024-04494-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 09/13/2024]
Abstract
Treatment of opioid use disorder (OUD) with buprenorphine improves outcomes and mortality among people with HIV (PWH). However, engagement is low and is influenced by comorbidities. We examined the impact of patterns of co-occurring pain, substance use disorders (SUDs), and mental health diagnoses on buprenorphine initiation and retention in PWH. The Veterans Aging Cohort Study contained 7,875 patients (2,702 PWH and 5,173 without HIV) with new OUD clinical encounters (2008-2017). Buprenorphine initiation and retention were derived from prescription data. We identified patterns of co-occurring diagnoses (via ICD codes) and assessed the effects of class membership on both outcomes using latent class analysis and regression analyses. The mean age of patients was 55, 98% were male, 58% Black, 8% Hispanic, and only 8% initiated buprenorphine within 12 months of OUD diagnosis. Four classes of co-occurring diagnoses were identified: "Few Co-occurring Diagnoses" (42.3%); "Multiple Pain Conditions" (21.3%); "Pain + SUD" (18.4%) and "Pain + SUD + Mental Health" (18.0%). Patients in the "Pain + SUD" class and "Pain + SUD + Mental Health" class were significantly less likely to initiate buprenorphine and had 59% and 45% lower odds, respectively, of initiating buprenorphine compared with patients in the "Few Co-occurring Diagnoses" class; this effect did not vary by HIV status. Buprenorphine retention was not significantly associated with HIV status or class membership. However, Black Veterans were less likely to initiate or be retained in buprenorphine treatment. Higher comorbidity burden was negatively associated with buprenorphine initiation but not with retention. More research is warranted to determine other factors that may influence treatment retention.
Collapse
Affiliation(s)
- Emily A Miller
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | | | - E Jennifer Edelman
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Termeh Feinberg
- Kelly Government Solutions, Silver Spring, MD, USA
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
- Center for Medical Informatics, Yale University School of Medicine, New Haven, CT, USA
| | - Kirsha S Gordon
- VA Connecticut Healthcare System, West Haven, CT, USA
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Robert D Kerns
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Julie A Patterson
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
| | - MaryPeace McRae
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA.
- , 410 North 12th Street, Richmond, VA, 23298, USA.
| |
Collapse
|
4
|
Palfai TP, Winter MR, Magane KM, Heeren TC, Bernier LB, Murray GE, Saitz R, Kim TW, Stein MD. Pain and unhealthy alcohol use among people living with HIV: A prospective cohort study. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:2089-2098. [PMID: 39317678 PMCID: PMC11884506 DOI: 10.1111/acer.15447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 08/03/2024] [Accepted: 08/31/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Unhealthy alcohol use is prevalent among people living with HIV/AIDS (PLWH) and contributes to impaired functioning, diminished quality of life, and poorer HIV outcomes. Common cooccurring conditions such as chronic pain may be associated with negative outcomes both directly and through its influence on unhealthy drinking itself. However, there is relatively little known about how pain influences unhealthy drinking among PLWH over time. The current study examined whether pain was associated with indices of unhealthy alcohol use, namely heavy drinking and alcohol use disorder (AUD) assessed 12 months later. METHODS The study sample (n = 207) was from the Boston Alcohol Research Collaboration on HIV/AIDS (ARCH) Cohort, a prospective cohort of PLWH with a history of illicit substance or unhealthy alcohol use. We conducted logistic regression analyses to examine the associations between pain and both heavy drinking and AUD status (DSM-5 criteria) (yes/no) over time. In secondary analyses, we examined whether pain was associated with greater AUD severity and whether pain interference was associated with heavy drinking and AUD outcomes. RESULTS We found that pain at baseline was associated with greater odds of AUD [aOR = 2.29 (95% CI: 1.13, 4.64), p = 0.02] but not heavy drinking [aOR = 0.91 (95% CI: 0.44, 1.88), p = 0.79] at 12 months. Pain was also associated with more severe AUD. Analyses of pain interference showed similar results. CONCLUSIONS Pain is prospectively associated with higher odds of AUD among PLWH with a substance/unhealthy alcohol use history. Providers should routinely address pain among PLWH to improve AUD outcomes.
Collapse
Affiliation(s)
- Tibor P. Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Michael R. Winter
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Kara M. Magane
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Timothy C. Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Lauren B. Bernier
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Grace E. Murray
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Theresa W. Kim
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Michael D. Stein
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
5
|
Skeen SJ, Tokarz S, Gasik RE, Solano CM, Smith EA, Sagoe MB, Hudson LV, Steele K, Theall KP, Clum GA. A Trauma-Informed, Geospatially Aware, Just-in-Time Adaptive mHealth Intervention to Support Effective Coping Skills Among People Living With HIV in New Orleans: Development and Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47151. [PMID: 37874637 PMCID: PMC10630874 DOI: 10.2196/47151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/27/2023] [Accepted: 09/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND In 2020, Greater New Orleans, Louisiana, was home to 7048 people living with HIV-1083 per 100,000 residents, 2.85 times the US national rate. With Louisiana routinely ranked last in indexes of health equity, violent crime rates in Orleans Parish quintupling national averages, and in-care New Orleans people living with HIV surviving twice the US average of adverse childhood experiences, accessible, trauma-focused, evidence-based interventions (EBIs) for violence-affected people living with HIV are urgently needed. OBJECTIVE To meet this need, we adapted Living in the Face of Trauma, a well-established EBI tailored for people living with HIV, into NOLA GEM, a just-in-time adaptive mobile health (mHealth) intervention. This study aimed to culturally tailor and refine the NOLA GEM app and assess its acceptability; feasibility; and preliminary efficacy on care engagement, medication adherence, viral suppression, and mental well-being among in-care people living with HIV in Greater New Orleans. METHODS The development of NOLA GEM entailed identifying real-time tailoring variables via a geographic ecological momentary assessment (GEMA) study (n=49; aim 1) and place-based and user-centered tailoring, responsive to the unique cultural contexts of HIV survivorship in New Orleans, via formative interviews (n=12; aim 2). The iOS- and Android-enabled NOLA GEM app leverages twice-daily GEMA prompts to offer just-in-time, in-app recommendations for effective coping skills practice and app-delivered Living in the Face of Trauma session content. For aim 3, the pilot trial will enroll an analytic sample of 60 New Orleans people living with HIV individually randomized to parallel NOLA GEM (intervention) or GEMA-alone (control) arms at a 1:1 allocation for a 21-day period. Acceptability and feasibility will be assessed via enrollment, attrition, active daily use through paradata metrics, and prevalidated usability measures. At the postassessment time point, primary end points will be assessed via a range of well-validated, domain-specific scales. Care engagement and viral suppression will be assessed via past missed appointments and self-reported viral load at 30 and 90 days, respectively, and through well-demonstrated adherence self-efficacy measures. RESULTS Aims 1 and 2 have been achieved, NOLA GEM is in Beta, and all aim-3 methods have been reviewed and approved by the institutional review board of Tulane University. Recruitment was launched in July 2023, with a target date for follow-up assessment completion in December 2023. CONCLUSIONS By leveraging user-centered development and embracing principles that elevate the lived expertise of New Orleans people living with HIV, mHealth-adapted EBIs can reflect community wisdom on posttraumatic resilience. Sustainable adoption of the NOLA GEM app and a promising early efficacy profile will support the feasibility of a future fully powered clinical trial and potential translation to new underserved settings in service of holistic survivorship and well-being of people living with HIV. TRIAL REGISTRATION ClinicalTrials.gov NCT05784714; https://clinicaltrials.gov/ct2/show/NCT05784714. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47151.
Collapse
Affiliation(s)
- Simone J Skeen
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
- Center for Community-Engaged Artificial Intelligence, Tulane University, New Orleans, LA, United States
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Stephanie Tokarz
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Rayna E Gasik
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Chelsea McGettigan Solano
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Ethan A Smith
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Momi Binaifer Sagoe
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Lauryn V Hudson
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Kara Steele
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Katherine P Theall
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Gretchen A Clum
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| |
Collapse
|
6
|
Madkour AS, Felker-Kantor E, Welsh DA, Molina PE, Theall KP, Ferguson T. Lifetime Alcohol Use Trajectories and Health Status Among Persons Living with HIV (PLWH). J Stud Alcohol Drugs 2022; 83:695-703. [PMID: 36136440 PMCID: PMC9523753 DOI: 10.15288/jsad.21-00303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/20/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE We characterized lifetime drinking trajectories among persons living with HIV (PLWH) and examined how trajectories are related to health. METHOD Adults (ages 20-71) were recruited between 2015 and 2017 for a cohort study examining the impact of alcohol use on geriatric comorbidities in PLWH in New Orleans. The New Orleans Alcohol Use in HIV (NOAH) Study (n = 356; 68.8% male) included in-person interviews, anthropometric measurements, and biospecimen collection. Average monthly drinks per decade of life was derived from participants' reported average quantity and frequency of alcoholic beverages for each decade. Health indicators included CD4 count, viral load, health-related quality of life, frailty, comorbidities, body mass index, heavy drinking, anxiety, depression, and posttraumatic stress disorder. Participants also reported lifetime experiences with homelessness and incarceration. Latent curve modeling was applied in MPlus to derive lifetime drinking trajectories. Latent trajectory parameters were modeled as predictors of physical, mental, and social health, controlling for demographics. RESULTS Alcohol consumption increased significantly between the teen years and midlife (31-40), declining thereafter through ages 50-60. Significant interindividual differences were observed in all trajectory parameters. Persons with higher starting points of alcohol consumption showed worse mental health (depression and anxiety) and social experiences (homelessness and incarceration history) at study baseline. A steeper increase in volume of alcohol consumption after ages 10-20 was associated with worse health-related quality of life, greater frailty and comorbidities, and greater odds of current heavy drinking. CONCLUSIONS Understanding lifetime alcohol consumption patterns is important in addressing physical and mental health among adult PLWH.
Collapse
Affiliation(s)
- Aubrey Spriggs Madkour
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Erica Felker-Kantor
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - David A. Welsh
- Section of Pulmonary/Critical Care, School of Medicine, Louisiana State University, New Orleans, Louisiana
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, New Orleans, Louisiana
| | - Patricia E. Molina
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, New Orleans, Louisiana
- Department of Physiology, School of Medicine, Louisiana State University, New Orleans, Louisiana
| | - Katherine P. Theall
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Tekeda Ferguson
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, New Orleans, Louisiana
- Department of Epidemiology, School of Public Health, Louisiana State University, New Orleans, Louisiana
| |
Collapse
|
7
|
Zifodya JS, Ferguson TF, Siggins RW, Brashear MM, Kantrow SP, Nelson S, Shellito JE, Molina PE, Welsh DA. Cross sectional analysis of the effect of alcohol on pulmonary function in a cohort of men and women living with HIV. Alcohol 2022; 101:45-51. [PMID: 35306109 PMCID: PMC9117518 DOI: 10.1016/j.alcohol.2022.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/01/2022] [Accepted: 03/10/2022] [Indexed: 11/21/2022]
Abstract
People living with HIV (PLWH) are at increased risk for noncommunicable diseases such as lung disease in part due to opportunistic infections including pneumonia. HIV infection is associated with increased prevalence of impaired lung function and abnormal gas exchange. Alcohol use disorder (AUD) is exceedingly common in PLWH and is associated with higher risk of pneumonia in PLWH. Alcohol use may lead to lung damage through several mechanisms. Data on the long-term effect of AUD on pulmonary function in PLWH are sparse and conflicting. To evaluate this relationship, we conducted a cross-sectional analysis of adult PLWH in care in Louisiana. We hypothesized that chronic alcohol use would be associated with subsequent pulmonary dysfunction in a dose-dependent fashion. All participants performed standardized spirometry on study entry. In total, 350 participants with acceptable spirometry were included in this analysis. Thirty-one percent of participants were female. Women reported less lifetime alcohol use and less smoking; however, they reported more chronic respiratory symptoms. In adjusted models, total lifetime alcohol use was not associated with spirometry measures of pulmonary function. HIV-related variables (CD4 count and viral load) were also not associated with measures of pulmonary function. We then conducted sex-stratified analyses to eliminate residual confounding of sex and similarly found no association of total lifetime alcohol use and pulmonary function. We found no association of AUDIT score or early life alcohol use and pulmonary function. In latent class factor analysis, current heavy alcohol use was associated with lower measures of pulmonary function as compared to former heavy alcohol use. In summary, in this cohort of New Orleanian men and women living with HIV with robust measures of alcohol use, though total lifetime alcohol use and early life alcohol use were not associated with pulmonary function, current heavy alcohol use was associated with impaired pulmonary function.
Collapse
Affiliation(s)
- Jerry S Zifodya
- Department of Medicine, Tulane University School of Medicine; New Orleans, Louisiana, United States.
| | - Tekeda F Ferguson
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, United States; Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Robert W Siggins
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, United States; Department of Physiology, School of Graduate Studies, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Meghan M Brashear
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, United States; Department of Physiology, School of Graduate Studies, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Stephen P Kantrow
- Department of Internal Medicine, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Steve Nelson
- Department of Internal Medicine, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Judd E Shellito
- Department of Internal Medicine, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States; Department of Microbiology, Immunology, and Parasitology, School of Graduate Studies, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Patricia E Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, United States; Department of Physiology, School of Graduate Studies, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - David A Welsh
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, United States; Department of Internal Medicine, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States; Department of Microbiology, Immunology, and Parasitology, School of Graduate Studies, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| |
Collapse
|