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Joshu CE, Calkins KL, Rudolph JE, Xu X, Wentz E, Coburn SB, Kaur M, Pirsl F, Moore RD, Lau B. Lower endoscopy, early-onset, and average-onset colon cancer among Medicaid beneficiaries with and without HIV. AIDS 2024; 38:85-94. [PMID: 37788111 PMCID: PMC10841159 DOI: 10.1097/qad.0000000000003740] [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] [Indexed: 10/05/2023]
Abstract
BACKGROUND Studies suggest a lower colorectal cancer (CRC) risk and lower or similar CRC screening among people with HIV (PWH) compared with the general population. We evaluated the incidence of lower endoscopy and average-onset (diagnosed at ≥50) and early-onset (diagnosed at <50) colon cancer by HIV status among Medicaid beneficiares with comparable sociodemographic factors and access to care. METHODS We obtained Medicaid Analytic eXtract (MAX) data from 2001 to 2015 for 14 states. We included 41 727 243 and 42 062 552 unique individuals with at least 7 months of continuous eligibility for the endoscopy and colon cancer analysis, respectively. HIV and colon cancer diagnoses and endoscopy procedures were identified from inpatient and other nondrug claims. We used Cox proportional hazards regression models to assess endoscopy and colon cancer incidence, controlling for age, sex, race/ethnicity, calendar year and state of enrollment, and comorbidities conditions. RESULTS Endoscopy and colon cancer incidence increased with age in both groups. Compared with beneficiaries without HIV, PWH had an increased hazard of endoscopy; this association was strongest among those 18-39 years [hazard ratio: 1.85, 95% confidence interval (95% CI) 1.77-1.92] and attenuated with age. PWH 18-39 years also had increased hazard of early-onset colon cancer (hazard ratio: 1.66, 95% CI:1.05-2.62); this association was attenuated after comorbidity adjustment. Hazard ratios were null among all beneficiaries less than 50 years of age. PWH had a lower hazard of average-onset colon cancer compared with those without HIV (hazard ratio: 0.79, 95% CI: 0.66-0.94). CONCLUSION PWH had a higher hazard of endoscopy, particularly at younger ages. PWH had a lower hazard of average-onset colon cancer. Early-onset colon cancer was higher among the youngest PWH but not associated with HIV overall.
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Affiliation(s)
- Corinne E Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Oncology, Johns Hopkins University School of Medicine
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
| | - Keri L Calkins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Mathematica, Ann Arbor, Michigan
| | | | - Xiaoqiang Xu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eryka Wentz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Sally B Coburn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Maneet Kaur
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Filip Pirsl
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Richard D Moore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Oncology, Johns Hopkins University School of Medicine
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Elf JL, Horn K, Abroms L, Stanton CA, Cohn AM, Spielberg F, Gray T, Harvey E, Debnam C, Kierstead L, Levy ME, Castel A, Monroe A, Niaura R. Prevalence and Correlates of Cardiovascular, Pulmonary, Cancer, and Mental Health Comorbidities Among Adults With HIV Who Smoke. J Assoc Nurses AIDS Care 2023; 34:363-375. [PMID: 37378565 PMCID: PMC10803179 DOI: 10.1097/jnc.0000000000000416] [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] [Indexed: 06/29/2023]
Abstract
ABSTRACT Using data from the D.C. Cohort Longitudinal HIV Study, we examined (a) diagnosed mental health and (b) cardiovascular, pulmonary, or cancer (CPC) comorbidity among adults with HIV who smoked. Among 8,581 adults, 4,273 (50%) smoked; 49% of smokers had mental health, and 13% of smokers had a CPC comorbidity. Among smokers, non-Hispanic Black participants had a lower risk for mental health (prevalence ratio [PR]: 0.69; 95% confidence interval [CI] [0.62-0.76]) but a higher risk for CPC (PR: 1.17; 95% CI [0.84-1.62]) comorbidity. Male participants had a lower risk for mental health (PR: 0.88; 95% CI [0.81-0.94]) and CPC (PR: 0.68; 95% CI [0.57-0.81]) comorbidity. All metrics of socioeconomic status were associated with a mental health comorbidity, but only housing status was associated with a CPC comorbidity. We did not find any association with substance use. Gender, socioeconomic factors, and race/ethnicity should inform clinical care and the development of smoking cessation strategies for this population.
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Affiliation(s)
| | | | | | | | - Amy M. Cohn
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | - Tiffany Gray
- George Washington University, Washington, D.C., USA
| | | | - Charles Debnam
- Deputy Chief Executive Officer of Community Wellness Alliance, Washington, D.C., USA
| | | | | | | | - Anne Monroe
- George Washington University, Washington, D.C., USA
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Przybyla S, Ashare RL, Cioffi L, Plotnik I, Shuter J, Seng EK, Weinberger AH. Substance Use and Adherence to Antiretroviral Therapy among People Living with HIV in the United States. Trop Med Infect Dis 2022; 7:tropicalmed7110349. [PMID: 36355891 PMCID: PMC9697670 DOI: 10.3390/tropicalmed7110349] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
People with HIV (PWH) report substance use at higher rates than HIV-uninfected individuals. The potential negative impact of single and polysubstance use on HIV treatment among diverse samples of PWH is underexplored. PWH were recruited from the Center for Positive Living at the Montefiore Medical Center (Bronx, NY, USA) from May 2017-April 2018 and completed a cross-sectional survey with measures of substance use, antiretroviral therapy (ART) use, and ART adherence. The overall sample included 237 PWH (54.1% Black, 42.2% female, median age 53 years). Approximately half of the sample reported any current substance use with 23.1% reporting single substance use and 21.4% reporting polysubstance use. Polysubstance use was more prevalent among those with current cigarette smoking relative to those with no current smoking and among females relative to males. Alcohol and cannabis were the most commonly reported polysubstance combination; however, a sizeable proportion of PWH reported other two, three, and four-substance groupings. Single and polysubstance use were associated with lower ART adherence. A thorough understanding of substance use patterns and related adherence challenges may aid with targeted public health interventions to improve HIV care cascade goals, including the integration of substance use prevention into HIV treatment and care settings.
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Affiliation(s)
- Sarahmona Przybyla
- Department of Community Health and Health Behavior, State University of New York, Buffalo, NY 14214, USA
- Correspondence: ; Tel.: +1-716-829-6750
| | - Rebecca L. Ashare
- Department of Psychology, State University of New York, Buffalo, NY 14214, USA
| | - Loriann Cioffi
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, USA
| | - Isabella Plotnik
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, USA
| | - Jonathan Shuter
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Elizabeth K. Seng
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY 10461, USA
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4
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Tedaldi E, Armon C, Li J, Mahnken J, Simoncini G, Palella F, Carlson K, Buchacz K. A Heavy Burden: Preexisting Physical and Psychiatric Comorbidities and Differential Increases Among Male and Female Participants After Initiating Antiretroviral Therapy in the HIV Outpatient Study, 2008-2018. AIDS Res Hum Retroviruses 2022; 38:519-529. [PMID: 35451335 DOI: 10.1089/aid.2021.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Attention to non-AIDS comorbidities is increasingly important in the HIV care and management in the United States. We sought to assess comorbidities before and after antiretroviral therapy (ART) initiation among persons with HIV (PWH). Using the 2008-2018 HIV Outpatient Study (HOPS) data, we assessed changes in prevalence of physical and psychiatric comorbidities, by sex, among participants initiating ART. Cox proportional hazards models were fit to investigate factors associated with the first documented occurrence of key comorbidities, adjusting for demographics and other covariates, including insurance type, CD4+ cell count, ART regimen, and smoking status. Among 1,236 participants who initiated ART (median age 36 years, CD4 cell count 375 cells/mm3), 79% were male, 66% non-white, 44% publicly insured, 53% ever smoked, 33% had substance use history, and 22% had body mass index ≥30 kg/m2. Among females, the percentages with at least one condition were: at ART start, 72% had a physical and 42% a psychiatric comorbidity, and after a median of 6.1 years of follow-up, these were 87% and 63%, respectively. Among males, the percentages with at least one condition were: at ART start, 61% had a physical and 32% a psychiatric comorbidity, and after a median of 4.6 years of follow-up, these were 82% and 53%, respectively. In multivariable Cox proportional hazards analyses, increasing age and higher viral loads (VL) were associated with most physical comorbidities, and being a current/former smoker and higher VL were associated with all psychiatric comorbidities analyzed. HOPS participants already had a substantial burden of physical and psychiatric comorbidities at the time of ART initiation. With advancing age, PWH who initiate ART experience a clinically significant increase in the burden of chronic non-HIV comorbidities that warrants continued surveillance, prevention, and treatment.
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Affiliation(s)
- Ellen Tedaldi
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Carl Armon
- Cerner Corporation, Kansas City, Missouri, USA
| | - Jun Li
- Division of HIV/AIDS Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Gina Simoncini
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Frank Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Kate Buchacz
- Division of HIV/AIDS Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kovacs L, Kress TC, Belin de Chantemèle EJ. HIV, Combination Antiretroviral Therapy, and Vascular Diseases in Men and Women. JACC Basic Transl Sci 2022; 7:410-421. [PMID: 35540101 PMCID: PMC9079796 DOI: 10.1016/j.jacbts.2021.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 12/01/2022]
Abstract
Thanks to the advent of combination antiretroviral therapy (cART), people living with human immunodeficiency virus (HIV) (PLWH) experienced a marked increase in life expectancy but are now at higher risk for cardiovascular disease (CVD), the current leading cause of death in PLWH on cART. Although HIV preponderantly affects men over women, manifestations of HIV-related CVD differ by sex with women experiencing greater risks than men. Despite extensive investigation, the etiopathology of CVD, notably the respective contribution of viral infection and cART, remain ill-defined. However, both viral infection and cART have been reported to contribute to endothelial dysfunction, the precursor and major cause of atherosclerosis-associated CVD, through mechanisms involving endothelial cell activation, inflammation, and oxidative stress, all leading to reduced nitric oxide bioavailability. Therefore, preserving endothelial function in PLWH on cART should be a main target to reduce CVD morbidity and mortality, notably in females.
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Key Words
- CVD, cardiovascular disease
- FMD, flow-mediated dilatation
- HF, heart failure
- HIV
- HIV, human immunodeficiency virus
- MI, myocardial infarction
- NO, nitric oxide
- PAD, peripheral artery disease
- PH, pulmonary hypertension
- PLWH, people living with HIV
- cART, combination antiretroviral therapy
- cIMT, carotid intima-media thickness
- combination antiretroviral therapy
- endothelial dysfunction
- sex differences
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Affiliation(s)
- Laszlo Kovacs
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Taylor C Kress
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Eric J Belin de Chantemèle
- Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.,Division of Cardiology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta Georgia, USA
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6
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Coburn SB, Dionne-Odom J, Alcaide ML, Moran CA, Rahangdale L, Golub ET, Massad LS, Seidman D, Michel KG, Minkoff H, Murphy K, Brown TT, Visvanathan K, Lau B, Althoff KN. The Association Between HIV Status, Estradiol, and Sex Hormone Binding Globulin Among Premenopausal Women in the Women's Interagency HIV Study. J Womens Health (Larchmt) 2022; 31:183-193. [PMID: 35041528 PMCID: PMC8864429 DOI: 10.1089/jwh.2021.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Characterizing estradiol among women with HIV may have implications for breast cancer and cardiovascular disease risk but has not been adequately explored. We quantified differences in total (E2), free (FE2) estradiol, and sex hormone binding globulin (SHBG) by HIV and viral suppression status. Methods: Women from a substudy (2003-2006) within the Women's Interagency HIV Study (IRB approved at each participating site) were included if they reported: a period in the last six months, were not pregnant/breastfeeding, no oophorectomy, and no exogenous hormone use in the prior year. Serum was collected on days 2-4 of the menstrual cycle. We assessed differences in biomarkers at 25th, 50th, and 75th percentiles by HIV and viral suppression status using weighted quantile regression. Results: Among 643 women (68% with HIV) median age was 37 years. All E2 percentiles were significantly (p < 0.05) lower in women with suppressed viral load versus women without HIV (4-10 pg/mL). The 25th and 50th percentile of E2 were 4-5 pg/mL lower in women with unsuppressed viral load compared to women without HIV (p < 0.05). The 25th and 50th percentile of SHBG was significantly higher in women with unsuppressed viral load compared to women without HIV (10 and 12 nmol/L, respectively). There were no consistent differences in estradiol or SHBG by suppression status. Conclusions: There were no differences in FE2 but significantly lower E2 and higher SHBG among women with HIV versus without HIV. Further research is merited in a large contemporary sample to clarify the clinical implications of these findings.
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Affiliation(s)
- Sally B. Coburn
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.,Address correspondence to: Sally B. Coburn, PhD, MPH, Department of Epidemiology, Johns Hopkins University, 615 N Wolfe Street, No. E7008, Baltimore, MD 21205, USA
| | - Jodie Dionne-Odom
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maria L. Alcaide
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Caitlin A. Moran
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lisa Rahangdale
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Leslie Stewart Massad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dominika Seidman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Katherine G. Michel
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Georgetown University Medical Center, Georgetown University, Washington, District of Columbia, USA
| | - Howard Minkoff
- Department of Obstetrics and Gynecology, Maimonides Medical Center and SUNY Downstate, Brooklyn, New York, USA
| | - Kerry Murphy
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, USA
| | - Todd T. Brown
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
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7
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Prevalence and Risks of Depression and Substance Use Among Adults Living with HIV in the Asia-Pacific Region. AIDS Behav 2022; 26:3862-3877. [PMID: 35668223 PMCID: PMC9170121 DOI: 10.1007/s10461-022-03714-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/01/2022]
Abstract
Despite the mental health and substance use burden among people living with HIV (PLHIV) in the Asia-Pacific, data on their associations with HIV clinical outcomes are limited. This cross-sectional study of PLHIV at five sites assessed depression and substance use using PHQ-9 and ASSIST. Among 864 participants, 88% were male, median age was 39 years, 97% were on ART, 67% had an HIV viral load available and < 1000 copies/mL, 19% had moderate-to-severe depressive symptoms, and 80% had ever used at least one substance. Younger age, lower income, and suboptimal ART adherence were associated with moderate-to-severe depressive symptoms. Moderate-to-high risk substance use, found in 62% of users, was associated with younger age, being male, previous stressors, and suboptimal adherence. Our findings highlight the need for improved access to mental health and substance use services in HIV clinical settings.
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Jones TPW, Lampe FC, Arenas-Pinto A, Smith C, McDonnell J, Haddow L, Johnson M, Yousef E, Lascar M, Maria Geretti A, Sherr L, Collins S, Phillips AN, Rodger AJ. Alcohol, smoking, recreational drug use and association with virological outcomes among people living with HIV: cross-sectional and longitudinal analyses. HIV Med 2021; 23:209-226. [PMID: 34634176 PMCID: PMC9293433 DOI: 10.1111/hiv.13156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/23/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES There is increasing evidence to suggest that people living with HIV (PLWH) have significant morbidity from alcohol, recreational drug use and cigarette smoking. Our aim was to report associations of these factors with antiretroviral therapy (ART) non-adherence, viral non-suppression and subsequent viral rebound in PLWH. METHODS The Antiretroviral Sexual Transmission Risk and Attitudes (ASTRA) study recruited PLWH attending eight outpatient clinics in England between February 2011 and December 2012. Data included self-reported excessive drinking (estimated consumption of > 20 units of alcohol/week), alcohol dependency (CAGE score ≥ 2 with current alcohol consumption), recreational drug use (including injection drug use in the past 3 months), and smoking status. Among participants established on ART, cross-sectional associations with ART non-adherence [missing ≥2 consecutive days of ART on ≥2 occasions in the past three months] and viral-non suppression [viral load (VL) > 50 copies/mL] were assessed using logistic regression. In participants from one centre, longitudinal associations with subsequent viral rebound (first VL > 200 copies/mL) in those on ART with VL ≤ 50 copies/mL at baseline were assessed using Cox regression during a 7-year follow-up. RESULTS Among 3258 PLWH, 2248 (69.0%) were men who have sex with men, 373 (11.4%) were heterosexual men, and 637 (19.6%) were women. A CAGE score ≥ 2 was found in 568 (17.6%) participants, 325 (10.1%) drank > 20 units/week, 1011 (31.5%) currently smoked, 1242 (38.1%) used recreational drugs and 74 (2.3%) reported injection drug use. In each case, prevalence was much more common among men than among women. Among 2459 people on ART who started at least 6 months previously, a CAGE score ≥ 2, drinking > 20 units per week, current smoking, injection and non-injection drug use were all associated with ART non-adherence. After adjusting for demographic and socioeconomic factors, CAGE score ≥ 2 [adjusted odds ratio (aOR) = 1.52, 95% confidence interval (CI): 1.09-2.13], current smoking (aOR = 1.58, 95% CI: 1.10-2.17) and injection drug use (aOR = 2.11, 95% CI: 1.00-4.47) were associated with viral non-suppression. During follow-up of a subset of 592 people virally suppressed at recruitment, a CAGE score ≥ 2 [adjusted hazard ratio (aHR) = 1.66, 95% CI: 1.03-2.74], use of 3 or more non-injection drugs (aHR = 1.82, 95% CI: 1.12-3.57) and injection drug use (aHR = 2.73, 95% CI: 1.08-6.89) were associated with viral rebound. CONCLUSIONS Screening and treatment for alcohol, cigarette and drug use should be integrated into HIV outpatient clinics, while clinicians should be alert to the potential for poorer virological outcomes.
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Affiliation(s)
| | - Fiona C Lampe
- Research Department of Infection & Population, University College London, London, UK
| | | | - Colette Smith
- Research Department of Infection & Population, University College London, London, UK
| | - Jeff McDonnell
- Research Department of Infection & Population, University College London, London, UK
| | - Lewis Haddow
- Research Department of Infection & Population, University College London, London, UK
| | | | - Elaney Yousef
- Brighton and Sussex University Hospitals, Brighton, UK
| | | | - Anna Maria Geretti
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Lorraine Sherr
- Research Department of Infection & Population, University College London, London, UK
| | | | - Andrew N Phillips
- Research Department of Infection & Population, University College London, London, UK
| | - Alison J Rodger
- Research Department of Infection & Population, University College London, London, UK
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9
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Zifodya JS, Triplette M, Shahrir S, Attia EF, Akgun KM, Soo Hoo GW, Rodriguez-Barradas MC, Wongtrakool C, Huang L, Crothers K. A cross-sectional analysis of diagnosis and management of chronic obstructive pulmonary disease in people living with HIV: Opportunities for improvement. Medicine (Baltimore) 2021; 100:e27124. [PMID: 34664836 PMCID: PMC8448060 DOI: 10.1097/md.0000000000027124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/16/2021] [Indexed: 10/29/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is common in people living with HIV (PLWH). We sought to evaluate the appropriateness of COPD diagnosis and management in PLWH, comparing results to HIV-uninfected persons.We conducted a cross-sectional analysis of Veterans enrolled in the Examinations of HIV-Associated Lung Emphysema study, in which all participants underwent spirometry at enrollment and reported respiratory symptoms on self-completed surveys. Primary outcomes were misdiagnosis and under-diagnosis of COPD, and the frequency and appropriateness of inhaler prescriptions. Misdiagnosis was defined as having an International Classification of Diseases (ICD)-9 diagnosis of COPD without spirometric airflow limitation (post-bronchodilator forced expiratory volume in 1-second [FEV1]/Forced vital capacity [FVC] < 0.7). Under-diagnosis was defined as having spirometry-defined COPD without a prior ICD-9 diagnosis.The analytic cohort included 183 PLWH and 152 HIV-uninfected participants. Of 25 PLWH with an ICD-9 diagnosis of COPD, 56% were misdiagnosed. Of 38 PLWH with spirometry-defined COPD, 71% were under-diagnosed. In PLWH under-diagnosed with COPD, 85% reported respiratory symptoms. Among PLWH with an ICD-9 COPD diagnosis as well as in those with spirometry-defined COPD, long-acting inhalers, particularly long-acting bronchodilators (both beta-agonists and muscarinic antagonists) were prescribed infrequently even in symptomatic individuals. Inhaled corticosteroids were the most frequently prescribed long-acting inhaler in PLWH (28%). Results were overall similar amongst the HIV-uninfected.COPD was frequently misdiagnosed and under-diagnosed in PLWH, similar to uninfected-veterans. Among PLWH with COPD and a likely indication for therapy, long-acting inhalers were prescribed infrequently, particularly guideline-concordant, first-line long-acting bronchodilators. Although not a first-line controller therapy for COPD, inhaled corticosteroids were prescribed more often.
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Affiliation(s)
- Jerry S. Zifodya
- Department of Medicine, Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Matthew Triplette
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Shahida Shahrir
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Engi F. Attia
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
| | - Kathleen M. Akgun
- Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, CT
- Yale University School of Medicine, New Haven, CT
| | - Grant W. Soo Hoo
- Department of Medicine, Pulmonary, Critical Care and Sleep Section, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Maria C. Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Administration Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Cherry Wongtrakool
- Department of Medicine, Atlanta Veterans Administration Medical Center & Emory University School of Medicine, Atlanta, GA
| | - Laurence Huang
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA
| | - Kristina Crothers
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
- Veterans Administration Puget Sound Health Care System, Seattle, WA
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10
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Sheira LA, Frongillo EA, Hahn J, Palar K, Riley ED, Wilson TE, Adedimeji A, Merenstein D, Cohen M, Wentz EL, Adimora AA, Ofotokun I, Metsch L, Turan JM, Tien PC, Weiser SD. Relationship between food insecurity and smoking status among women living with and at risk for HIV in the USA: a cohort study. BMJ Open 2021; 11:e054903. [PMID: 34489299 PMCID: PMC8422493 DOI: 10.1136/bmjopen-2021-054903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES People living with HIV (PLHIV) in the USA, particularly women, have a higher prevalence of food insecurity than the general population. Cigarette smoking among PLHIV is common (42%), and PLHIV are 6-13 times more likely to die from lung cancer than AIDS-related causes. This study sought to investigate the associations between food security status and smoking status and severity among a cohort of predominantly low-income women of colour living with and without HIV in the USA. DESIGN Women enrolled in an ongoing longitudinal cohort study from 2013 to 2015. SETTING Nine participating sites across the USA. PARTICIPANTS 2553 participants enrolled in the Food Insecurity Sub-Study of the Women's Interagency HIV Study, a multisite cohort study of US women living with HIV and demographically similar HIV-seronegative women. OUTCOMES Current cigarette smoking status and intensity were self-reported. We used cross-sectional and longitudinal logistic and Tobit regressions to assess associations of food security status and changes in food security status with smoking status and intensity. RESULTS The median age was 48. Most respondents were African-American/black (72%) and living with HIV (71%). Over half had annual incomes ≤US$12 000 (52%). Food insecurity (44%) and cigarette smoking (42%) were prevalent. In analyses adjusting for common sociodemographic characteristics, all categories of food insecurity were associated with greater odds of current smoking compared with food-secure women. Changes in food insecurity were also associated with increased odds of smoking. Any food insecurity was associated with higher smoking intensity. CONCLUSIONS Food insecurity over time was associated with smoking in this cohort of predominantly low-income women of colour living with or at risk of HIV. Integrating alleviation of food insecurity into smoking cessation programmes may be an effective method to reduce the smoking prevalence and disproportionate lung cancer mortality rate particularly among PLHIV.
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Affiliation(s)
- Lila A Sheira
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina System, Columbia, South Carolina, USA
| | - Judith Hahn
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Kartika Palar
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Elise D Riley
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
| | - Tracey E Wilson
- Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Daniel Merenstein
- Family Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Mardge Cohen
- Medicine, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Eryka L Wentz
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adaora A Adimora
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Lisa Metsch
- Sociomedical Sciences, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, California, USA
- Department of Veteran Affairs Medical Center, San Francisco, California, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, California, USA
- Center for AIDS Prevention Studies, University of California, San Francisco, California, USA
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11
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Kim SS, Lee SA, Mejia J, Cooley ME, Demarco RF. Pilot Randomized Controlled Trial of a Digital Storytelling Intervention for Smoking Cessation in Women Living With HIV. Ann Behav Med 2021; 54:447-454. [PMID: 31863582 DOI: 10.1093/abm/kaz062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People living with HIV in the USA smoke at a rate nearly three times that of the general population, and Black women are disproportionately affected by HIV infection. PURPOSE This study was conducted to test the preliminary efficacy of a digital storytelling intervention for smoking cessation in U.S. women living with HIV. METHODS Participants in the treatment arm viewed a film in which women living with HIV talk about quitting smoking, and those in the control arm viewed an attention-control film in which women talk about living with HIV infection. Participants in both arms received eight weekly video-call counseling sessions focused on smoking cessation and nicotine patches or gum during the same period. Participants were followed on a monthly basis from quit day for 3 months. RESULTS Of the 53 participants randomized, four withdrew before receiving any intervention, one dropped out during the intervention, and 48 (90.6%) completed the study. No difference was found in the baseline characteristics between the two arms with the exception that the treatment arm had higher nicotine dependence scores [t(1.51) = 2.30, p = .03] than the control arm. Seven day point-prevalence abstinence rates at 3 month follow-up were not found to differ between the two arms. However, the odds of achieving 3 month prolonged abstinence were four times greater (odds ratio = 4.23, 95% confidence interval = 1.10, 16.23) in the treatment arm than the control arm when the analysis was performed with those (n = 49, 92.5%) who received any part of the allotted intervention. CONCLUSIONS A digital storytelling intervention seems to be a valuable strategy to enhance the effect of conventional tobacco dependence treatment for women living with HIV. However, the underlying mechanism of the effect of digital storytelling necessitates further investigations in a large RCT.Clinical Trials Registration No. NCT03289676.
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Affiliation(s)
- Sun S Kim
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Sang A Lee
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Jeannette Mejia
- Department of Psychology, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, USA
| | - Mary E Cooley
- Phyllis F. Cantor Center, Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rosanna F Demarco
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
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12
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Weinberger AH, Pang RD, Seng EK, Levin J, Esan H, Segal KS, Shuter J. Self-control and smoking in a sample of adults living with HIV/AIDS: A cross-sectional survey. Addict Behav 2021; 116:106807. [PMID: 33460989 PMCID: PMC7887055 DOI: 10.1016/j.addbeh.2020.106807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/03/2020] [Accepted: 12/21/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Cigarette smoking prevalences are very high in persons living with HIV (PLWH). Identifying variables among PLWH that are linked to smoking in community samples (e.g., self-control) can inform smoking treatments for PLWH. The current study examined the association of self-reported self-control and smoking (e.g., smoking status, cigarette dependence) in a sample of PLWH. METHODS Adult PLWH were recruited from the Center for Positive Living (Montefiore Medical Center, Bronx, New York, US). All participants completed measures of demographics, cigarette smoking, and self-control. Participants who reported current cigarette smoking completed measures of cigarette dependence; intolerance for smoking abstinence; and motivation, confidence, and desire to quit smoking. RESULTS The overall sample included 285 PLWH (49.1% cigarette users, 55.4% male, 52.7% Black race, 54.8% Latino/a ethnicity). PLWH with current cigarette smoking reported lower self-control than PLWH with no current cigarette smoking (M = 116.88, SD = 17.07 versus M = 127.39, SD = 20.32; t = -4.15, df = 211, p < 0.001). Among PLWH with current cigarette smoking, lower self-control was associated with greater cigarette dependence (ρ = -0.272, p < 0.01), and lower confidence in quitting smoking cigarettes (ρ = 0.214, p < 0.05). Lower self-control was associated with greater overall smoking abstinence intolerance (ρ = -0.221, p < 0.05) and withdrawal intolerance (ρ = -0.264, p < 0.01). DISCUSSION Among a sample of PLWH, lower self-control was related to cigarette smoking (versus no smoking), greater cigarette dependence, lower confidence in quitting smoking, and greater intolerance for smoking abstinence. It may be useful to target self-control among PLWH to increase confidence in quitting and abstinence intolerance with the goal of improving smoking cessation outcomes.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Raina D Pang
- Keck School of Medicine at University of Southern California, Department of Preventive Medicine, Los Angeles, CA, USA
| | - Elizabeth K Seng
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jacob Levin
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Hannah Esan
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Kate S Segal
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Jonathan Shuter
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
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13
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Abstract
OBJECTIVE AND DESIGN People living with HIV (PLH) suffer disproportionately from the chronic diseases exacerbated by smoking tobacco. We performed a systematic review and meta-analysis to establish the relative prevalence of smoking among PLH. METHODS We included observational studies reporting current smoking rates among PLH and comparators without HIV. We searched Medline, EMBASE, LILACS and SciELO from inception to 31 August 2019. We excluded studies that recruited participants with smoking related illness. We used a random effects model to estimate the odds ratio for current smoking in PLH and people without HIV. We used the Newcastle--Ottawa scale to assess methodological bias. We performed subgroup analysis based on sex and WHO region. We quantified heterogeneity with meta-regression and predictive distributions. PROSPERO registration:CRD42016052608. RESULTS We identified 6116 studies and included 37. Of 111 258 PLH compared with 10 961 217 HIV-negative participants pooled odds of smoking were 1.64 [(95% confidence interval, 95% CI: 1.45-1.85) (95% prediction interval: 0.66-4.10, I2 = 98.1%)]. Odds for men and women living with HIV were 1.68 [(95% CI: 1.44-1.95) (95% prediction interval: 0.71-3.98, I2 = 91.1%)] and 2.16 [(95% CI: 1.77-2.63) (95% prediction interval: 0.92-5.07, I2 = 81.7%)] respectively. CONCLUSION PLH are more likely to be smokers than people without HIV. This finding was true in subgroup analyses of men, women and in four of five WHO regions from which data were available. Meta-regression did not explain heterogeneity, which we attribute to the diversity of PLH populations worldwide. Smoking is a barrier to PLH achieving parity in life expectancy and an important covariate in studies of HIV-associated multimorbidity.
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14
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Webel AR, Schexnayder J, Cioe PA, Zuñiga JA. A Review of Chronic Comorbidities in Adults Living With HIV: State of the Science. J Assoc Nurses AIDS Care 2021; 32:322-346. [PMID: 33595986 PMCID: PMC8815414 DOI: 10.1097/jnc.0000000000000240] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT People living with HIV are living longer, high-quality lives; however, as they age, this population is at increased risk for developing chronic comorbidities, including cardiovascular disease, certain types of cancer (e.g., lung, anal, and liver), and diabetes mellitus. The purpose of this state-of-the-science review is to provide an evidence-based summary on common physical comorbidities experienced by people living and aging with HIV. We focus on those chronic conditions that are prevalent and growing and share behavioral risk factors that are common in people living with HIV. We will discuss the current evidence on the epidemiology, physiology, prevention strategies, screening, and treatment options for people living with HIV across resource settings.
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Affiliation(s)
- Allison R Webel
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Julie Schexnayder
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Patricia A Cioe
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Julie A Zuñiga
- Allison R. Webel, PhD, RN, FAAN, is Associate Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Associate Editor, Journal of the Association of Nurses in AIDS Care
- Julie Schexnayder, DNP, MPH, ACNP-BC, is a PhD Candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
- Patricia A. Cioe, PhD, RN, is Associate Professor of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Julie A. Zuñiga, RN, PhD, FAAN, is Assistant Professor of Nursing, School of Nursing, University of Texas at Austin, Austin, Texas, USA
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15
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Raggio G, Goodman G, Robbins GK, Looby SE, Labbe A, Psaros C. Developing a pilot lifestyle intervention to prevent cardiovascular disease in midlife women with HIV. HIV Res Clin Pract 2021; 22:1-13. [PMID: 33616022 DOI: 10.1080/25787489.2021.1883957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Background: Women with HIV (WWH) are at elevated risk for cardiovascular disease (CVD) compared to men with HIV. Lifestyle interventions, like the Diabetes Prevention Program (DPP), may reduce CVD risk, but most fail to address barriers to healthy behaviors facing WWH. OBJECTIVE Objective: To inform the adaptation of the DPP for midlife WWH, pilot the modified intervention, and assess feasibility, acceptability, and implementation barriers. METHODS Methods: Interviews were conducted with cisgender, English-speaking WWH ages 40-59 to assess intervention preferences. The adapted DPP was piloted and evaluated. CVD knowledge, CVD risk perception, quality of life, and physical activity were assessed pre- and post-intervention. RESULTS Results: Eighteen WWH completed interviews. Adaptations included reducing the number of sessions and adding HIV, CVD, stress, aging, menopause, and smoking content. Of 14 women contacted for the pilot, seven completed a baseline, five attended group sessions, and five completed a post-treatment assessment. Attendance barriers included transportation access and costs. Satisfaction was moderate; informal exit interviews indicated that women would recommend the program. CVD knowledge, perceived risk, and physical activity increased, and fatigue and mental health improved. Content on nutrition, aging, HIV, and stress was seen as most useful; suggested changes included group exercises and additional content on recipes, HIV management, and aging. CONCLUSIONS Conclusions: Midlife WWH reported benefits from our adapted intervention. Increases in CVD knowledge and perceived CVD risk suggest improved awareness of the impact of lifestyle behaviors. Retention was adequate; socioeconomic barriers were common. Intervention feasibility and acceptability may be improved via remote access and further content customization.
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Affiliation(s)
- Greer Raggio
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,National Center for Weight and Wellness, Washington, DC, USA
| | - Georgia Goodman
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Gregory K Robbins
- Division of Infectious Diseases, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Sara E Looby
- Metabolism Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, MA, USA
| | - Allison Labbe
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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16
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Ale BM, Amahowe F, Nganda MM, Danwang C, Wakaba NN, Almuwallad A, Ale FBG, Sanoussi A, Abdullahi SH, Bigna JJ. Global burden of active smoking among people living with HIV on antiretroviral therapy: a systematic review and meta-analysis. Infect Dis Poverty 2021; 10:12. [PMID: 33579391 PMCID: PMC7881452 DOI: 10.1186/s40249-021-00799-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/21/2021] [Indexed: 12/14/2022] Open
Abstract
Background Although the high burden of both active smoking and human immunodeficiency virus (HIV) is clearly known, the relationship between them is still not well characterized. Therefore, we estimated the global prevalence of active smoking in people living with HIV (PLHIV) on antiretroviral therapy (ART) and investigated the association between exposure to active smoking and risk for suboptimal adherence to ART. Main text: We searched PubMed, Embase, and Web of Science to identify articles published until September 19, 2019. Eligible studies reported the prevalence of active smoking in PLHIV on ART or investigated the association between active smoking and ART adherence; or enough data to compute these estimates. We used a random-effects model to pool data and quantified heterogeneity (I2). The global prevalence of active smoking was 36.1% (95% CI: 33.7–37.2; 329 prevalence data; 462 104 participants) with substantial heterogeneity. The prevalence increased with level of country income; from 10.1% (95% CI: 6.8–14.1) in low-income to 45.2% (95% CI: 42.7–47.7) in high-income countries; P < 0.0001. With regards to the Joint United Nations Programme on HIV/AIDS (UNAIDS) regions, the prevalence was higher in West and Central Europe and North America 45.4% (42.7–48.1) and lowest in the two UNAIDS regions of sub-Saharan Africa: Eastern and Southern Africa 10.7% (95% CI: 7.8–14.0) and West and Central Africa 4.4% (2.9–6.3); P < 0.0001. Globally, we estimated that there were 4 110 669 PLHIV on ART who were active smokers, among which the highest number was from Eastern and Southern Africa (35.9%) followed by Asia and the Pacific (25.9%). Active smoking was significantly associated with suboptimal ART adherence: pooled odds ratio 1.57 (95% CI: 1.37–1.80; I2 = 56.8%; 19 studies; 48 450 participants); even after considering adjusted estimates: 1.67 (95% CI: 1.39–2.01; I2 = 53.0%; 14 studies). Conclusions This study suggests a high prevalence of active smoking in PLHIV on ART and an association between active smoking and ART suboptimal adherence. As such, healthcare providers and policy makers should focus on adopting and implementing tobacco harm reduction strategies in HIV care, especially in sub-Saharan Africa known as epicenter of HIV pandemic with highest number of active tobacco smoking among PLHIV on ART. ![]()
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Affiliation(s)
| | | | - Motto Malea Nganda
- Department of Clinical Science and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Célestin Danwang
- Epidemiology and Biostatistics Unit, Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | | | - Ateeq Almuwallad
- Applied Medical Sciences College, Jazan University, Jazan, Saudi Arabia.,Center for Trauma Science, Queen Mary University of London, London, UK
| | | | - Alamou Sanoussi
- Transition Support Program Department, Advocate Good Samaritan Hospital, Downers Grove, IL, USA
| | | | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon
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17
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Impact of Perceived Cardiovascular Risk on Cardiovascular Disease Prevention Behaviors in People With and Without HIV Infection. J Acquir Immune Defic Syndr 2020; 83:513-521. [PMID: 31914003 DOI: 10.1097/qai.0000000000002290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND People living with HIV (PLHIV) are at elevated risk of developing atherosclerotic cardiovascular disease (ASCVD). PLHIV do not engage in recommended levels of ASCVD prevention behaviors, perhaps due to a reduced perception of risk for ASCVD. We examined how HIV status influences knowledge, beliefs, and perception of risk for ASCVD and ASCVD prevention behaviors. METHODS AND RESULTS We conducted a mixed-methods study of 191 PLHIV and demographically similar HIV-uninfected adults. Participants completed self-reported surveys on CVD risk perceptions, adherence to CVD medication (aspirin, antihypertensives, and lipid-lowering medication) and 3 dietary intake interviews. All wore an accelerometer to measure physical activity. A subset of PLHIV (n = 38) also completed qualitative focus groups to further examine the influence of HIV on knowledge, perception of risk for ASCVD, and behavior. PARTICIPANTS They were approximately 54 (±10) years, mostly men (n = 111; 58%), and African American (n = 151, 83%) with an average 10-year risk of an ASCVD event of 10.4 (±8.2)%. PLHIV were less likely to engage in physical activity (44% vs 65%, P < 0.05), and HIV status was associated with 43 fewer minutes of physical activity per week (P = 0.004). Adherence to ASCVD medications was better among PLHIV (P < 0.001). Diet composition was similar between groups (P > 0.05). HIV status did not influence ASCVD risk perceptions (P > 0.05) and modestly influenced physical activity and smoking. CONCLUSIONS Although perceptions of ASCVD risk modestly influence some behaviors, additional barriers and insufficient cues to action result in suboptimal physical activity, dietary intake, and smoking rates. However, PLHIV have high adherence to ASCVD medications, which can be harnessed to reduce their high burden of ASCVD.
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18
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Sabin CA, Kunisaki KM, Bagkeris E, Post FA, Sachikonye M, Boffito M, Anderson J, Mallon P, Williams I, Vera JH, Johnson M, Babalis D, Winston A. Respiratory symptoms and chronic bronchitis in people with and without HIV infection. HIV Med 2020; 22:11-21. [PMID: 32892488 DOI: 10.1111/hiv.12955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/29/2020] [Accepted: 08/05/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES High rates of respiratory symptoms and chronic bronchitis (CB) are reported in people with HIV infection (PWH). We investigated the prevalence of respiratory symptoms and CB in PWH and HIV-negative people in the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study. METHODS Assessment of respiratory symptoms and CB was undertaken using the modified form of the St. George's Respiratory Questionnaire for chronic obstructive pulmonary disease (COPD). Univariate (χ2 tests, Mann-Whitney U tests and Spearman's rank correlation) and multivariable (linear and logistic regression) analyses were performed to consider associations of respiratory symptoms with demographic, lifestyle and HIV-related parameters, and with depressive symptoms and quality of life. RESULTS Among the 619 participants, respiratory Symptom scores were higher in older and younger PWH compared to older HIV-negative people, with median (interquartile range) scores of 17.7 (6.2, 39.5), 17.5 (0.9, 30.0) and 9.0 (0.9, 17.5), respectively (P = 0.0001); these differences remained significant after confounder adjustment. Sixty-three participants (10.2%) met the criteria for CB [44 (14.0%) older PWH, 14 (9.2%) younger PWH, and five (3.3%) older HIV-negative people; P = 0.002], with these differences also remaining after adjustment for confounding variables, particularly smoking status [older vs. younger PWH: odds ratio (OR) 4.48 (95% confidence interval (CI) 1.64, 12.30); P = 0.004; older PWH vs. HIV-negative people: OR 4.53 (95% CI 1.12, 18.28); P = 0.03]. Respiratory symptoms and CB were both associated with greater depressive symptom scores and poorer quality of life. No strong associations were reported between CB and immune function, HIV RNA or previous diagnosis of any AIDS event. CONCLUSIONS Respiratory symptoms and CB are more common in PWH than in demographically and lifestyle-similar HIV-negative people and are associated with poorer mental health and quality of life.
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Affiliation(s)
- C A Sabin
- Institute for Global Health, UCL, London, UK
| | - K M Kunisaki
- Minneapolis Veterans Affairs Health Care System, and University of Minnesota, Minneapolis, MN, USA
| | - E Bagkeris
- Institute for Global Health, UCL, London, UK
| | - F A Post
- Caldecot Centre, King's College Hospital, London, UK
| | - M Sachikonye
- UK Community Advisory Board (UK-CAB), London, UK
| | - M Boffito
- St. Stephen's Centre, Chelsea and Westminster Hospital, London, UK
| | - J Anderson
- Homerton University Hospital, London, UK
| | - Pwg Mallon
- HIV Molecular Research Group, School of Medicine, University College Dublin, Dublin, Ireland
| | - I Williams
- Institute for Global Health, UCL, London, UK
| | - J H Vera
- Elton John Centre, Brighton and Sussex University Hospital, Brighton, UK.,Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - M Johnson
- Ian Charleson Day Centre, Royal Free NHS Trust, London, UK
| | - D Babalis
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - A Winston
- Department of Infectious Disease, Imperial College London, London, UK
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19
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Parcesepe AM, Lancaster K, Edelman EJ, DeBoni R, Ross J, Atwoli L, Tlali M, Althoff K, Tine J, Duda SN, Wester CW, Nash D. Substance use service availability in HIV treatment programs: Data from the global IeDEA consortium, 2014-2015 and 2017. PLoS One 2020; 15:e0237772. [PMID: 32853246 PMCID: PMC7451518 DOI: 10.1371/journal.pone.0237772] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/02/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Substance use is common among people living with HIV and has been associated with suboptimal HIV treatment outcomes. Integrating substance use services into HIV care is a promising strategy to improve patient outcomes. METHODS We report on substance use education, screening, and referral practices from two surveys of HIV care and treatment sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. HIV care and treatment sites participating in IeDEA are primarily public-sector health facilities and include both academic and community-based hospitals and health facilities. A total of 286 sites in 45 countries participated in the 2014-2015 survey and 237 sites in 44 countries participated in the 2017 survey. We compared changes over time for 147 sites that participated in both surveys. RESULTS In 2014-2015, most sites (75%) reported providing substance use-related education on-site (i.e., at the HIV clinic or the same health facility). Approximately half reported on-site screening for substance use (52%) or referrals for substance use treatment (51%). In 2017, the proportion of sites providing on-site substance use-related education, screening, or referrals increased by 9%, 16%, and 8%, respectively. In 2017, on-site substance use screening and referral were most commonly reported at sites serving only adults (compared to only children/adolescents or adults and children/adolescents; screening: 86%, 37%, and 59%, respectively; referral: 76%, 47%, and 46%, respectively) and at sites in high-income countries (compared to upper middle income, lower middle income or low-income countries; screening: 89%, 76%, 68%, and 45%, respectively; referral: 82%, 71%, 57%, and 34%, respectively). CONCLUSION Although there have been increases in the proportion of sites reporting substance use education, screening, and referral services across IeDEA sites, gaps persist in the integration of substance use services into HIV care, particularly in relation to screening and referral practices, with reduced availability for children/adolescents and those receiving care within resource-constrained settings.
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Affiliation(s)
- Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kathryn Lancaster
- Department of Epidemiology, The Ohio State University, Columbus, Ohio, United States of America
| | - E Jennifer Edelman
- Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Raquel DeBoni
- National Institute of Infectology, Evandro Chagas, Fiocruz, Brazil
| | - Jeremy Ross
- TREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Keri Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Judicaël Tine
- Maladies Infectieuses du Centre Hospitalier, National Universitaire de FANN, Dakar, Senegal
| | - Stephany N Duda
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - C William Wester
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health (VIGH), Nashville, Tennessee, United States of America
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, New York, United States of America
- Department of Epidemiology and Biostatistics, City University of New York, New York, New York, United States of America
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20
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Lam JO, Levine-Hall T, Hood N, Alexeeff SE, Horberg MA, Young-Wolff KC, Sterling SA, Williams A, Weisner C, Satre DD, Silverberg MJ. Smoking and cessation treatment among persons with and without HIV in a U.S. integrated health system. Drug Alcohol Depend 2020; 213:108128. [PMID: 32603975 PMCID: PMC7392076 DOI: 10.1016/j.drugalcdep.2020.108128] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Persons with HIV (PWH) are more likely to smoke and are more susceptible to the harmful effects of smoking than persons without HIV. We examined smoking patterns and use of cessation treatment among PWH and persons without HIV in a U.S. integrated health system. METHODS We identified adults (≥18 years) with HIV and demographically-matched persons without HIV between July 2013 and December 2017. Smoking status and cessation treatment were ascertained from health records. We calculated age-standardized annual prevalence of smoking and evaluated trends using Cochran-Armitage tests and Poisson regression. Factors associated with cessation treatment during the study period, and smoking in the last year of the study, were evaluated by HIV status using multivariable Poisson models. RESULTS The study included 11,235 PWH and 227,320 persons without HIV. Smoking prevalence was higher among PWH across all years but declined for both groups (from 16.6% to 14.6% in PWH and 11.6% to 10.5% in persons without HIV). Among smokers, PWH were more likely to initiate cessation treatment compared to persons without HIV (17.9% vs. 13.3%, covariate-adjusted prevalence ratio of 1.31, 95% CI = 1.15-1.50), with few differences in cessation treatment across subgroups of PWH. In 2017, smoking prevalence remained higher in PWH, especially among those who were younger or who had diagnoses of depression or substance use disorder. CONCLUSION In a setting with access to cessation resources, smoking prevalence decreased both in PWH and persons without HIV. PWH had greater uptake of cessation treatment, which is encouraging for smoking reduction and improved health.
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Affiliation(s)
- Jennifer O. Lam
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland CA, 94612, USA
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland CA, 94612, USA
| | - Nicole Hood
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland CA, 94612, USA
| | - Stacey E. Alexeeff
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland CA, 94612, USA
| | - Michael A. Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, 2101 East Jefferson Street, 3 East, Rockville, MD, 20852, USA
| | - Kelly C. Young-Wolff
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland CA, 94612, USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Stacy A. Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland CA, 94612, USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Andrew Williams
- Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland CA, 94612, USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Derek D. Satre
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland CA, 94612, USA,Department of Psychiatry, Weill Institute for Neurosciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland CA, 94612, USA
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21
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Chichetto NE, Polanka BM, So-Armah KA, Sung M, Stewart JC, Koethe JR, Edelman EJ, Tindle HA, Freiberg MS. Contribution of Behavioral Health Factors to Non-AIDS-Related Comorbidities: an Updated Review. Curr HIV/AIDS Rep 2020; 17:354-372. [PMID: 32314325 PMCID: PMC7363585 DOI: 10.1007/s11904-020-00498-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW We summarize recent literature on the contribution of substance use and depression to non-AIDS-related comorbidities. Discussion of recent randomized clinical trials and implementation research to curtail risk attributed to each behavioral health issue is provided. RECENT FINDINGS Smoking, unhealthy alcohol use, opioid use, and depression are common among PWH and individually contribute to increased risk for non-AIDS-related comorbidities. The concurrence of these conditions is notable, yet understudied, and provides opportunity for linked-screening and potential treatment of more than one behavioral health factor. Current results from randomized clinical trials are inconsistent. Investigating interventions to reduce the impact of these behavioral health conditions with a focus on implementation into clinical care is important. Non-AIDS-defining cancers, cardiovascular disease, liver disease, and diabetes are leading causes of morbidity in people with HIV. Behavioral health factors including substance use and mental health issues, often co-occurring, likely contribute to the excess risk of non-AIDS-related comorbidities.
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Affiliation(s)
- Natalie E Chichetto
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Brittanny M Polanka
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Kaku A So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Minhee Sung
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - John R Koethe
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Centers, Nashville, TN, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Centers, Nashville, TN, USA
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22
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De Socio GV, Pasqualini M, Ricci E, Maggi P, Orofino G, Squillace N, Menzaghi B, Madeddu G, Taramasso L, Francisci D, Bonfanti P, Vichi F, dell'Omo M, Pieroni L. Smoking habits in HIV-infected people compared with the general population in Italy: a cross-sectional study. BMC Public Health 2020; 20:734. [PMID: 32434482 PMCID: PMC7238525 DOI: 10.1186/s12889-020-08862-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background Tobacco use is a leading cause of preventable diseases and death for all individuals, even more so for people living with HIV (PLWH), due to their status of chronic inflammation. To date, in Italy no study was performed to compare smoking habits in PLWH and the general population. We aimed to investigate smoking habits in PLWH, as compared to the general population. Methods Multi-center cross-sectional study. Smoking habits were compared between PLWH and the general population. PLWH were enrolled in the STOPSHIV Study. The comparison group from the general population was derived from a survey performed by the National Statistics Institute (ISTAT), with a stratified random sampling procedure matching 2:1 general population subjects with PLWH by age class, sex, and macro-area of residence. Results The total sample consisted of 1087 PLWH (age 47.9 ± 10.8 years, male 73.5%) and 2218 comparable subjects from the general population. Prevalence of current smokers was 51.6% vs 25.9% (p < 0.001); quitting smoking rate was 27.1% vs. 50.1% (p < 0.001) and the mean number of cigarettes smoked per day was 15.8 vs. 11.9 (p < 0.001), respectively for PLWH and the general population. Smoking and heavy smoking rates amongst PLWH were significantly higher even in subjects who reported diabetes, hypertension and extreme obesity (p < 0.001). Logistic regressions showed that PLWH were more likely current smokers (adjusted Odds Ratio, aOR = 3.11; 95% Confidence Interval (CI) =2.62–3.71; p < 0.001) and heavy smokers (> 20 cigarettes per day) (aOR = 4.84; 95% CI = 3.74–6.27; p < 0.001). PLWH were less likely to have quitted smoking (aOR = 0.36; 95% CI = 0.29–0.46; p < 0.001). Conclusion HIV-infected patients showed a higher rate of current smokers, a larger number of cigarettes smoked and a lower quitting rate than the general population. Our findings emphasize the need for smoking cessation strategies targeting HIV persons.
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Affiliation(s)
- Giuseppe Vittorio De Socio
- Department of Medicine 2, Infectious Diseases Unit, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy. .,Current Address: Azienda Ospedaliera di Perugia, Piazzale Menghini 1, 06129, Perugia, Italy.
| | - Marta Pasqualini
- Department of Political Science, University of Perugia, Perugia, Italy
| | - Elena Ricci
- Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Maggi
- Infectious Diseases Clinic, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giancarlo Orofino
- Division I Infectious and Tropical Diseases, ASL Città di Torino, Turin, Italy
| | - Nicola Squillace
- Infectious Diseases Unit ASST-MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Barbara Menzaghi
- Infectious Diseases Unit, ASST della Valle Olona - Busto Arsizio (VA), Busto Arsizio, Italy
| | - Giordano Madeddu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Lucia Taramasso
- Department of Health Science (DISSAL), Infectious Disease Clinic, University of Genova, Genoa, Italy.,Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Francisci
- Department of Medicine 2, Infectious Diseases Unit, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| | - Paolo Bonfanti
- Infectious Diseases Unit, A. Manzoni Hospital, Lecco, Italy
| | - Francesca Vichi
- Infectious Diseases Unit, Santa Maria Annunziata Hospital, USL Centro, Florence, Italy
| | - Marco dell'Omo
- Department of Medicine, Perugia University, Perugia, Italy
| | - Luca Pieroni
- Current Address: Azienda Ospedaliera di Perugia, Piazzale Menghini 1, 06129, Perugia, Italy
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23
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Nansseu JR, Tounouga DN, Noubiap JJ, Bigna JJ. Changes in smoking patterns after HIV diagnosis or antiretroviral treatment initiation: a global systematic review and meta-analysis. Infect Dis Poverty 2020; 9:35. [PMID: 32295634 PMCID: PMC7160973 DOI: 10.1186/s40249-020-00644-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 03/03/2020] [Indexed: 01/01/2023] Open
Abstract
Background Tobacco consumption is more life-threatening in people living with human immunodeficiency virus (HIV) than within the general population; therefore, people living with HIV (PLWH) should be highly motivated to take action towards quitting smoking at or after HIV diagnosis. The aim of this systematic review with meta-analysis was to investigate changes in smoking habits among PLWH over time. Main text We considered prospective and retrospective cohort studies including PLWH aged 15 years and above, which have measured the prevalence of tobacco smoking (current, former or never) at study initiation and completion, and published between January 1, 2000 and April 15, 2018 without language or geographical restriction. We searched PubMed, EMBASE, Web of Science, Africa Journal Online, and Global Index Medicus. We used a random-effects model to pool data. Nine studies were included. The proportion of current and former smokers decreased slightly over time, around 2.5 and 3.8%, respectively. However, the proportion of never smokers decreased sharply by 22.5%, and there were 2.1 and 1.5% PLWH who shifted from never and former smoking to current smoking, respectively. On the other hand, 10.5% PLWH shifted from current to former smoking, 7.1% tried to quit tobacco consumption but failed, and 10.1% stayed in the “never smoking” category over time. Conclusions PLWH seem not to change positively their smoking habits towards quitting tobacco consumption. There is urgent need to increase actions aimed at helping this vulnerable population to quit tobacco consumption, including individually tailored therapeutic education, psychosocial and pharmacologic supports.
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Affiliation(s)
- Jobert Richie Nansseu
- Department of Public Health, Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Yaoundé, Cameroon.,Department for the Control of Disease, Epidemics and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Dalhia Noelle Tounouga
- Department of Public Health, Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Yaoundé, Cameroon
| | - Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, PO Box 1274, Yaoundé, Cameroon. .,School of Public Health, Faculty of Medicine, University of Paris Sud XI, Le Kremlin Bicêtre, France.
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24
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Ruppert AM, Lavolé A, Makinson A, Le Maître B, Cadranel J. [How to reduce lung cancer mortality among people living with HIV?]. Rev Mal Respir 2020; 37:267-274. [PMID: 32197931 DOI: 10.1016/j.rmr.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/28/2019] [Indexed: 11/26/2022]
Abstract
Lung cancer is the leading cause of cancer related death among people living with HIV (PLHIV). Tobacco exposure is higher among PLHIV (38.5%) and mainly explains the increased risk of lung cancer. To reduce lung cancer mortality, two approaches need to be implemented: lung cancer screening with low-dose thoracic CT scan and smoking cessation. Low dose CT scan is feasible in PLHIV. The false positive rate is not higher than in the general population, except for cases with CD4 <200/mm3. The impact on survival remains to be assessed. Despite the high prevalence, smoking cessation research among PLHIV is scarce. Very low quality data from 11 studies showed that more intensive smoking cessation interventions were effective in achieving short-term abstinence. A single randomized phase 3 trial showed the superiority of varenicline compared to placebo in long-term smoking cessation. The maximum benefit of reducing lung cancer mortality should be obtained by combining smoking cessation and lung cancer screening.
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Affiliation(s)
- A-M Ruppert
- GRC n°04, Theranoscan, faculté de médecine P&M Curie, Sorbonne université, hôpital Tenon (AP-HP), 4, rue de la Chine, 75252 Paris, France; Service de pneumologie, unité de tabacologie, hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - A Lavolé
- GRC n°04, Theranoscan, faculté de médecine P&M Curie, Sorbonne université, hôpital Tenon (AP-HP), 4, rue de la Chine, 75252 Paris, France; Service de pneumologie, unité de tabacologie, hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A Makinson
- Département des maladies infectieuses et unité, InsermU1175, université et CHU de Montpellier, Montpellier, France
| | - B Le Maître
- Unité de coordination de tabacologie, CHU de Caen, Caen, France
| | - J Cadranel
- GRC n°04, Theranoscan, faculté de médecine P&M Curie, Sorbonne université, hôpital Tenon (AP-HP), 4, rue de la Chine, 75252 Paris, France; Service de pneumologie, unité de tabacologie, hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
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25
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Weinberger AH, Seng EK, Ditre JW, Willoughby M, Shuter J. Perceived Interrelations of Pain and Cigarette Smoking in a Sample of Adult Smokers Living With HIV/AIDS. Nicotine Tob Res 2020; 21:489-496. [PMID: 29394402 DOI: 10.1093/ntr/nty021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/25/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Persons living with HIV/AIDS (PLWH) have very high prevalences of both cigarette smoking and pain, yet little is known about the relationship between smoking and pain for PLWH. This study examined the factor structure, reliability, and validity of a measure of perceived interrelations of pain and smoking in a sample of PLWH. METHODS Participants in this study were 108 current cigarette smoking PLWH (64.8% reporting current pain) in the Bronx, NY. Participants completed assessments of demographics, smoking behaviors, and pain. Interrelations of pain and smoking were measured using the 9-item Pain and Smoking Inventory (PSI). The dimensionality of the PSI was evaluated using Horn's Parallel Analysis and exploratory factor analysis. Internal consistency was evaluated using Cronbach's alpha, and validity analyses evaluated the relationship between the PSI and demographics, HIV clinical characteristics, smoking, and pain in the total sample. RESULTS A single-factor structure was the best fit for the PSI. The internal consistency of the PSI total score was excellent in the total sample (α = 0.94) and among participants with pain (α = 0.93). The PSI total score was significantly higher for PLWH who smoke and had current pain versus no current pain. Among smokers with HIV and pain, higher PSI scores were associated with higher pain interference, pain severity, and certain neuropathic pain symptoms (ie, numbness and pain to touch). CONCLUSIONS Among a sample of PLWH, the PSI appeared to be a reliable and valid instrument as a one-factor measure to assess perceived interrelations among pain and cigarette smoking. IMPLICATIONS Even though PLWH have very high prevalences of both pain and cigarette smoking, little is known about the relationship between pain and smoking for PLWH. This study is the first to examine a measure of the perceived interrelations of pain and smoking in a sample of PLWH. The measure was reliable and valid, and higher scores, reflecting that higher perceived interrelations of pain and smoking, were associated with more intense pain and pain interference. Learning more about pain and smoking among PLWH will help to better target smoking interventions to this key subgroup of smokers.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Elizabeth K Seng
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.,The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY
| | | | - Jonathan Shuter
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.,AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY
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26
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De Socio GV, Maggi P, Ricci E, Orofino G, Squillace N, Menzaghi B, Madeddu G, Di Biagio A, Francisci D, Bonfanti P, Vichi F, Schiaroli E, Santoro C, Guastavigna M, dell'Omo M. Smoking Habits in Human Immunodeficiency Virus-Infected People from Italy: A Cross-Sectional Analysis of the STOPSHIV Cohort. AIDS Res Hum Retroviruses 2020; 36:19-26. [PMID: 31502468 DOI: 10.1089/aid.2019.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
In a nationwide Italian sample of people living with HIV (PLWH), the prevalence of smoking, nicotine dependence, propensity to stop smoking, and cardiovascular profile were investigated. The nicotine dependence by Fagerström test and the propensity to stop according to the stages of change were evaluated. Associations between smoking habits and patients' characteristics were analyzed using an unconditional logistic regression model. Among 1,087 PLWH (age 47.9 ± 10.8 years, men 73.5%), the prevalence of current smokers was 51.6%. The median of Fagerström test was 4 (interquartile range 2-6); 60.1% of the smokers were in precontemplation, 17.6% in contemplation, 18.7% in preparation, and 3.6% in action. In a logistic multivariate model, current smoking was associated with male sex, being divorced/widowed, Caucasian ethnicity, dyslipidemia, atherosclerotic cardiovascular disease risk, psychiatric comorbidity, hepatitis C virus infection, and alcohol abuse. Low high-density lipoprotein cholesterol level was associated with high nicotine dependence. More than 50% of PLWH were current smokers, one-third of them showed a high or very high degree of dependence. Our findings draw attention to the need of smoking cessation strategies for PLWH.
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Affiliation(s)
- Giuseppe Vittorio De Socio
- Department of Medicine 2, Infectious Diseases Clinic, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| | - Paolo Maggi
- Infectious Diseases Clinic, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Elena Ricci
- Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Orofino
- Division I of Infectious and Tropical Diseases, ASL Città di Torino, Torino, Italy
| | - Nicola Squillace
- Infectious Diseases Unit ASST-MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona-Busto Arsizio, Busto Arsizio, Italy
| | - Giordano Madeddu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Antonio Di Biagio
- Infectious Diseases, San Martino Policlinico Hospital Genoa, Genoa, Italy
| | - Daniela Francisci
- Department of Medicine 2, Infectious Diseases Clinic, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| | - Paolo Bonfanti
- Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy
| | - Francesca Vichi
- Infectious Diseases Unit, Santa Maria Annunziata Hospital, USL Centro, Florence, Italy
| | - Elisabetta Schiaroli
- Department of Medicine 2, Infectious Diseases Clinic, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| | - Carmen Santoro
- Infectious Disease Clinic, University of Bari, Bari, Italy
| | - Marta Guastavigna
- Division I of Infectious and Tropical Diseases, ASL Città di Torino, Torino, Italy
| | - Marco dell'Omo
- Department of Medicine, Perugia University, Perugia, Italy
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27
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Floridia M, Ravizza M, Masuelli G, Tassis B, Savasi VM, Liuzzi G, Sansone M, Simonazzi G, Franceschetti L, Meloni A, Vimercati A, Guaraldi G, Pinnetti C, Dalzero S, Tamburrini E. Prevalence, Correlates and Outcomes of Smoking in Pregnant Women with HIV: A National Observational Study in Italy. Subst Use Misuse 2020; 55:1165-1172. [PMID: 32100603 DOI: 10.1080/10826084.2020.1729204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Few studies have evaluated in pregnant women with HIV the prevalence of smoking and its associations with maternal and neonatal outcomes. Objectives: to assess the prevalence of smoking among women with HIV in early pregnancy and the association between smoking and pregnancy outcomes in this particular population. Methods: We used data from a multicenter observational study to define the prevalence of smoking in women with HIV in early pregnancy, and the role of smoking status and intensity as risk factors for adverse maternal and neonatal outcomes. Main outcome measures were fetal growth restriction [FGR], preterm delivery [PD] and low birthweight [LB], evaluated in univariate and multivariate analyses. Results: The overall (2001-2018) prevalence of reported smoking (at least one cigarette/day) was 25.6% (792/3097), with a significant decrease in recent years (19.0% in 2013-2018). Women who smoked were less commonly African, had lower body mass index, older age, a longer history of HIV infection and higher CD4 counts. In univariate analyses, smokers were significantly more likely to have PD, LB, FGR and detectable HIV viral load at third trimester. Multivariable analyses confirmed for smokers a significantly higher risk of LB (adjusted odds ratio [AOR]: 1.69, 95%CI 1.22-2.34) and FGR (AOR 1.88, 95%CI 1.27-2.80), while the associations with detectable HIV and PD were not maintained. Conclusions: The common prevalence of smoking among pregnant women with HIV and its association with adverse outcomes indicates that smoking cessation programs in this population may have a significant impact on neonatal and maternal health.
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Affiliation(s)
- Marco Floridia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marina Ravizza
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - Giulia Masuelli
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Beatrice Tassis
- Department of Obstetrics and Gynecology "L. Mangiagalli," Fondazione IRCCS "Ca' Granda" - Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Maria Savasi
- Department of Obstetrics and Gynaecology, Luigi Sacco Hospital and University of Milan, Milan, Italy
| | - Giuseppina Liuzzi
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Matilde Sansone
- Department of Neurosciences, Reproductive and Dentistry Science, University Federico II, Naples, Italy
| | - Giuliana Simonazzi
- Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi and University of Bologna, Bologna, Italy
| | - Laura Franceschetti
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | - Alessandra Meloni
- Division of Gynaecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Antonella Vimercati
- Department of Biomedical and Human Oncological Science (DIMO), 2nd Unit of Obstetrics and Gynaecology, University of Bari, Bari, Italy
| | - Giovanni Guaraldi
- Department of Medical Specialties, Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Carmela Pinnetti
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Serena Dalzero
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - Enrica Tamburrini
- Department of Infectious Diseases, Catholic University and Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Kilibarda B, Baros S, Foley K, Milovanovic M, Mravcik V. Smoking among stigmatized populations in Serbia. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1604844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Biljana Kilibarda
- Institute of Public Health of Serbia, Serbia, Belgrade
- Department of Addictology, First Faculty of Medicine, Charles University and General Teaching Hospital in Prague, Czech Republic, Prague
| | | | - Kristie Foley
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Minja Milovanovic
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Viktor Mravcik
- Department of Addictology, First Faculty of Medicine, Charles University and General Teaching Hospital in Prague, Czech Republic, Prague
- National Monitoring Centre for drugs and addiction, the Office of the Government of the Czech Republic, Czech Republic, Prague
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29
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Lindayani L, Yeh CY, Ko WC, Ko NY. High smoking prevalence among HIV-positive individuals: a systematic review and meta-analysis. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1652364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Linlin Lindayani
- Department of Nursing, Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat, Bandung, Indonesia
| | - Chun-Yin Yeh
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Kagabo R, Kim J, Zubieta JK, Kleinschmit K, Okuyemi K. Association between smoking, and hospital readmission among inpatients with psychiatric illness at an academic inpatient psychiatric facility, 2000-2015. Addict Behav Rep 2019; 9:100181. [PMID: 31193775 PMCID: PMC6542740 DOI: 10.1016/j.abrep.2019.100181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Smoking rates are up to 2–4 times higher among individuals with mental illness. Hospital readmissions for patients with psychiatric illness within a year of discharge are also high, and there is limited evidence of associations between smoking and these readmissions. Methods This study was a secondary data analysis using clinical data of psychiatric inpatients with initial admissions between the years 2000 and 2015. Following a descriptive analysis, logistic regression models were fitted to explore relationships between smoking and psychiatric hospital readmission within 30 days and a year of discharge. Results A total of 5439 patients with average age of 30.18 ± 15.97 were identified. Of this number, 47.0% were current smokers and 53.0% were never smokers. Within 30 days of discharge, 11% of the current smokers were readmitted compared to 9% of never smokers. The primary diagnoses with highest proportion of smokers were, opioid or substance use disorders (80.0%), schizophrenia (70.7%), alcohol dependence (68.2%), and bipolar disorders (50.8%). About 31% of current smokers were readmitted within one year of discharge compared to 26% of never smokers. Adjusted odds ratios for readmission within 1-year of discharge were, bipolar disorders (1.41, p = 0.01), schizophrenia (2.33, p < 0.001), and opioid/substance dependence (1.55, p = 0.01). Conclusion Significant relationships exist between smoking and readmission for patients with psychiatric illness. Smokers are more likely to be readmitted within 30 days or one year after discharge. Interaction of smoking and certain specific diagnoses significantly increases readmission. Smoking rates are high among people with psychiatric illness. Significant associations exist between smoking and readmission for psychiatric patients. Smokers are more likely to be readmitted within 30 days or one year of discharge. Interaction of smoking and some psychiatric diagnoses increases readmission chances.
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Affiliation(s)
- Robert Kagabo
- Department of Family & Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way Ste, A, Salt Lake City, UT 84108, United States of America
| | - Jaewhan Kim
- Department of Health Promotion and Education, University of Utah College of Health, 250 S 1850 E, Salt Lake City, UT 84112, United States of America
| | - Jon-Kar Zubieta
- Department of Psychiatry, University of Utah School of Medicine, 501 Chipeta Way, Salt Lake City, UT 84108, United States of America
| | - Kristi Kleinschmit
- Department of Psychiatry, University of Utah School of Medicine, 501 Chipeta Way, Salt Lake City, UT 84108, United States of America
| | - Kolawole Okuyemi
- Department of Family & Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way Ste, A, Salt Lake City, UT 84108, United States of America
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31
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Weinberger AH, Seng EK, Shuter J. Racial/ethnic differences in perceived risks and benefits of quitting smoking in a sample of African American and Hispanic adults living with HIV/AIDS: A preliminary study. J Ethn Subst Abuse 2019; 20:171-186. [PMID: 31010385 DOI: 10.1080/15332640.2019.1598906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Persons living with HIV/AIDS (PLWH) report very high prevalences of cigarette smoking, and there are racial/ethnic disparities in smoking consequences and quit outcomes. In this exploratory pilot study, we examined racial/ethnic differences in perceived risks and benefits of quitting cigarette smoking among 97 adult PLWH in the Bronx, New York (Hispanic, 53.6%; African American, 46.4%). Compared to African American PLWH, Hispanic PLWH reported greater endorsement of overall risks and benefits and risks of negative affect, difficulty concentrating, social ostracism, loss of enjoyment, and cravings. It may be useful to incorporate risks and benefits of quitting into smoking treatment for African American and Hispanic PLWH.
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Affiliation(s)
- Andrea H Weinberger
- Yeshiva University, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Elizabeth K Seng
- Yeshiva University, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Jonathan Shuter
- Yeshiva University, Bronx, New York.,Montefiore Medical Center, Bronx, New York
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Esan H, Shuter J, Weinberger AH. The relationship of anxiety and smoking behaviors to medication adherence among cigarette smokers living with HIV. Addict Behav 2019; 90:301-305. [PMID: 30476895 DOI: 10.1016/j.addbeh.2018.10.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION People living with HIV/AIDS [PLWH] who smoke cigarettes report lower medication adherence. The purpose of the current study was to examine the relationship between anxiety and smoking behaviors (e.g., smoking quantity and frequency) and medication adherence in a sample of PLWH who smoke. METHODS PLWH who reported current cigarette smoking and use of antiretroviral medication were recruited from Center for Positive Living at Montefiore Medical Center (New York, US). Participants completed questions about their current smoking behavior, anxiety symptoms, and medication adherence. RESULTS The analytic sample included sixty-eight PLWH who smoked cigarettes (female 48.5%, mean age = 49.1 ± 8.8 years, 52.2% Latino/a). The participants smoked an average of 10.53 (SD = 8.6) cigarettes daily and just over half of participants (55.9%) reported high medication adherence. There was a significant association between greater anxiety symptoms and poorer medication adherence (OR = 1.09, CI = 1.04-1.15, p = .001). Participants with higher anxiety symptoms were more likely to report forgetting to take their medication, forgetting to take medication when leaving on a trip, stopping medication when feeling symptoms are under control, and when feeling hassled about sticking to the treatment plan. Within this sample of current smokers, there were no significant associations between smoking quantity or frequency and medication adherence and no interactive effects of these smoking behaviors and anxiety on medication adherence. DISCUSSION Current cigarette smoking PLWH who reported greater anxiety symptoms were less likely to adhere to their medication than current smoking PLWH who reported fewer anxiety symptoms. PLWH who smoke may benefit from assessment and management of anxiety.
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Weiss JJ, Sanchez L, Hubbard J, Lo J, Grinspoon SK, Fitch KV. Diet Quality Is Low and Differs by Sex in People with HIV. J Nutr 2019; 149:78-87. [PMID: 30624677 PMCID: PMC6351143 DOI: 10.1093/jn/nxy241] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/31/2018] [Indexed: 01/04/2023] Open
Abstract
Background People with HIV (PWH) are at risk for developing metabolic comorbidities driven, in part, by immune activation/inflammation. Little is known about diet quality, a potential modifiable factor in PWH. Objectives This study aimed to explore diet quality in terms of conformance with US dietary guidelines by calculating Healthy Eating Index-2010 (HEI) scores among adults with and without HIV in Boston, MA, and determine associations with HEI and markers of immune activation/inflammation. Methods One-hundred and three HIV-infected [50 women, 53 men; mean ± SD age: 47 ± 7 y; body mass index (BMI, in kg/m2): 26 ± 5] and 38 uninfected adults (17 women, 21 men; age: 46 ± 7 y; BMI: 28 ± 4) were included in this cross-sectional analysis. Participants who completed a 4-d food record from which HEI could be calculated were included. HEI was compared between participants with and without HIV, within HIV-infected participants stratified by sex, and by HIV serostatus and sex. In the HIV group, predictors of HEI were determined in multivariable modeling. Univariate associations with diet quality and inflammation/immune markers were assessed. Results The HEI score was 51.3 in the HIV-infected participants and 57.3 in the HIV-uninfected participants (P = 0.052). In the comparison by HIV serostatus and sex, HIV-infected women had significantly lower HEI (49.2) compared with HIV-infected men (55.7) (P = 0.005) and HIV-uninfected men (61.8) (P = 0.002). Adjusting for potential confounding factors, sex remained an independent predictor of HEI in HIV (P = 0.02). In the HIV group, higher log HEI was associated with lower concentration of the immune activation marker sCD14 (P = 0.009). Conclusions Diet quality tended to be lower in HIV-infected individuals compared with HIV-uninfected individuals and was lower among HIV-infected women compared with HIV-infected men, and HIV-uninfected men. There may also be an association with diet quality and sCD14 in PWH. Future prospective studies are needed to confirm these findings and determine whether improving diet quality is a useful strategy to reduce metabolic abnormalities in this population. This study was registered at clinicaltrials.gov as NCT00455793.
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Affiliation(s)
- Julian J Weiss
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Laura Sanchez
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jane Hubbard
- Translational and Clinical Research Center, Massachusetts General Hospital, Boston, MA
| | - Janet Lo
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Steven K Grinspoon
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Kathleen V Fitch
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA,Address correspondence to KVF (e-mail: )
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Miles DRB, Bilal U, Hutton H, Lau B, Lesko C, Fojo A, McCaul ME, Keruly J, Moore R, Chander G. Tobacco Smoking, Substance Use, and Mental Health Symptoms in People with HIV in an Urban HIV Clinic. J Health Care Poor Underserved 2019; 30:1083-1102. [PMID: 31422990 PMCID: PMC7304241 DOI: 10.1353/hpu.2019.0075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The prevalence of tobacco smoking among people with HIV (PWH) ranges from 40% to 70%. Additionally, tobacco smoking is higher among low-income individuals, yet few studies have examined tobacco smoking in low socioeconomic status PWH. Using data from a cohort of PWH receiving care in an urban HIV clinic, we characterized factors associated with current and former smoking and with initiation/re-initiation and cessation of tobacco use. Among a study sample of 1,607 PWH, the prevalence of current smoking was 46.6% among men and 46.0% among women. Current smoking in men and women was associated with Medicaid insurance status, substance use, and panic symptoms. In women, but not men, hazardous alcohol use decreased the likelihood of quitting smoking and increased the risk of initiation/re-initiation. Smoking interventions for low-income, urban PWH may need to be tailored to address mental health and substance use comorbidities.
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Affiliation(s)
- D. R. Bailey Miles
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Community Physicians, Baltimore, MD
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bryan Lau
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Catherine Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anthony Fojo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mary E. McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeanne Keruly
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Richard Moore
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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36
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Reddy KP, Kong CY, Hyle EP, Baggett TP, Huang M, Parker RA, Paltiel AD, Losina E, Weinstein MC, Freedberg KA, Walensky RP. Lung Cancer Mortality Associated With Smoking and Smoking Cessation Among People Living With HIV in the United States. JAMA Intern Med 2017; 177:1613-1621. [PMID: 28975270 PMCID: PMC5675744 DOI: 10.1001/jamainternmed.2017.4349] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/05/2017] [Indexed: 12/19/2022]
Abstract
Importance Lung cancer has become a leading cause of death among people living with human immunodeficiency virus (HIV) (PLWH). Over 40% of PLWH in the United States smoke cigarettes; HIV independently increases the risk of lung cancer. Objective To project cumulative lung cancer mortality by smoking exposure among PLWH in care. Design Using a validated microsimulation model of HIV, we applied standard demographic data and recent HIV/AIDS epidemiology statistics with specific details on smoking exposure, combining smoking status (current, former, or never) and intensity (heavy, moderate, or light). We stratified reported mortality rates attributable to lung cancer and other non-AIDS-related causes by smoking exposure and accounted for an HIV-conferred independent risk of lung cancer. Lung cancer mortality risk ratios (vs never smokers) for male and female current moderate smokers were 23.6 and 24.2, respectively, and for those who quit smoking at age 40 years were 4.3 and 4.5. In sensitivity analyses, we accounted for nonadherence to antiretroviral therapy (ART) and for a range of HIV-conferred risks of death from lung cancer and from other non-AIDS-related diseases (eg, cardiovascular disease). Main Outcomes and Measures Cumulative lung cancer mortality by age 80 years (stratified by sex, age at entry to HIV care, and smoking exposure); total expected lung cancer deaths, accounting for nonadherence to ART. Results Among 40-year-old men with HIV, estimated cumulative lung cancer mortality for heavy, moderate, and light smokers who continued to smoke was 28.9%, 23.0%, and 18.8%, respectively; for those who quit smoking at age 40 years, it was 7.9%, 6.1%, and 4.3%; and for never smokers, it was 1.6%. Among women, the corresponding mortality for current smokers was 27.8%, 20.9%, and 16.6%; for former smokers, it was 7.5%, 5.2%, and 3.7%; and for never smokers, it was 1.2%. ART-adherent individuals who continued to smoke were 6 to 13 times more likely to die from lung cancer than from traditional AIDS-related causes, depending on sex and smoking intensity. Due to greater AIDS-related mortality risks, individuals with incomplete ART adherence had higher overall mortality but lower lung cancer mortality. Applying model projections to the approximately 644 200 PLWH aged 20 to 64 in care in the United States, 59 900 (9.3%) are expected to die from lung cancer if smoking habits do not change. Conclusions and Relevance Those PLWH who adhere to ART but smoke are substantially more likely to die from lung cancer than from AIDS-related causes.
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Affiliation(s)
- Krishna P. Reddy
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Chung Yin Kong
- Harvard Medical School, Boston, Massachusetts
- Institute for Technology Assessment, Massachusetts General Hospital, Boston
| | - Emily P. Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
| | - Travis P. Baggett
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
| | - Mingshu Huang
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Biostatistics Center, Massachusetts General Hospital, Boston
| | - Robert A. Parker
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Biostatistics Center, Massachusetts General Hospital, Boston
| | | | - Elena Losina
- Harvard Medical School, Boston, Massachusetts
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Milton C. Weinstein
- Harvard Medical School, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kenneth A. Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Rochelle P. Walensky
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
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Weinberger AH, Seng EK, Esan H, Shuter J. Perceived risks and benefits of quitting smoking in a sample of adults living with HIV/AIDS. AIDS Care 2017; 30:564-568. [PMID: 28975812 DOI: 10.1080/09540121.2017.1382678] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Persons living with HIV/AIDS (PLWH) smoke at high prevalences and experience significant smoking-related consequences. In community samples, perceived risks and benefits of quitting smoking are related to quit motivation and outcomes and are more strongly endorsed by women. This study examined perceived risks and benefits of quitting smoking and the relationship between risks and benefits and quit motivation and confidence in male and female PLWH. One hundred seven PLWH who reported current cigarette smoking completed measures of demographics, smoking, perceived risks and benefits of quitting smoking, motivation to quit smoking, and confidence in ability to quit smoking. The highest endorsed risks of quitting smoking were cravings and weight gain and higher endorsement of craving risks was associated with lower confidence in the ability to quit smoking. Women endorsed overall risks and risks related to negative affect more highly than men. Women and men did not differ in their endorsement of the other risks, the benefits of quitting, or the relationship between risks and benefits and quit motivation or confidence. It may be useful for health care professionals to incorporate information about perceived risks and benefits of quitting smoking into treatment when working with PLWH who want to stop smoking.
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Affiliation(s)
- Andrea H Weinberger
- a Ferkauf Graduate School of Psychology , Yeshiva University , Bronx , NY , USA.,b Department of Epidemiology and Population Health , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Elizabeth K Seng
- a Ferkauf Graduate School of Psychology , Yeshiva University , Bronx , NY , USA.,c The Saul R. Korey Department of Neurology , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Hannah Esan
- a Ferkauf Graduate School of Psychology , Yeshiva University , Bronx , NY , USA
| | - Jonathan Shuter
- b Department of Epidemiology and Population Health , Albert Einstein College of Medicine , Bronx , NY , USA.,d AIDS Center and Division of Infectious Diseases , Montefiore Medical Center and the Albert Einstein College of Medicine , Bronx , NY , USA
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