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Ma J, Luu B, Ruderman SA, Whitney BM, Merrill JO, Mixson LS, Nance RM, Drumright LN, Hahn AW, Fredericksen RJ, Chander G, Lau B, McCaul ME, Safren S, O'Cleirigh C, Cropsey K, Mayer KH, Mathews WC, Moore RD, Napravnik S, Christopoulos K, Willig A, Jacobson JM, Webel A, Burkholder G, Mugavero MJ, Saag MS, Kitahata MM, Crane HM, Delaney JAC. Alcohol and drug use severity are independently associated with antiretroviral adherence in the current treatment era. AIDS Care 2024; 36:618-630. [PMID: 37419138 PMCID: PMC10771542 DOI: 10.1080/09540121.2023.2223899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized.
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Affiliation(s)
- J Ma
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B Luu
- Department of Medicine, University of Toronto, Toronto, Canada
| | - S A Ruderman
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B M Whitney
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J O Merrill
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L S Mixson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R M Nance
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - L N Drumright
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - A W Hahn
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R J Fredericksen
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - G Chander
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - B Lau
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - M E McCaul
- Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - S Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - C O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Harvard Medical School, Boston, MA, USA
| | - K Cropsey
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - K H Mayer
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - W C Mathews
- Department of Medicine, University of California, San Diego, CA, USA
| | - R D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - S Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - K Christopoulos
- Department of Medicine, University of California, San Francisco, CA, USA
| | - A Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J M Jacobson
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - A Webel
- Department of Child, Family, and Population Health Nursing, Unviersity of Washington, Seattle, WA, USA
| | - G Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - H M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J A C Delaney
- Department of Medicine, University of Washington, Seattle, WA, USA
- College of Pharmacy, University of Manitoba, Winnipeg, Canada
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Fredericksen RJ, Baker R, Sibley A, Estadt AT, Colston D, Mixson LS, Walters S, Bresett J, Levander XA, Leichtling G, Davy-Mendez T, Powell M, Stopka TJ, Pho M, Feinberg J, Ezell J, Zule W, Seal D, Cooper HLF, Whitney BM, Delaney JAC, Crane HM, Tsui JI. Motivation and context of concurrent stimulant and opioid use among persons who use drugs in the rural United States: a multi-site qualitative inquiry. Harm Reduct J 2024; 21:74. [PMID: 38561753 PMCID: PMC10985853 DOI: 10.1186/s12954-024-00986-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND In recent years, stimulant use has increased among persons who use opioids in the rural U.S., leading to high rates of overdose and death. We sought to understand motivations and contexts for stimulant use among persons who use opioids in a large, geographically diverse sample of persons who use drugs (PWUD) in the rural settings. METHODS We conducted semi-structured individual interviews with PWUD at 8 U.S. sites spanning 10 states and 65 counties. Content areas included general substance use, injection drug use, changes in drug use, and harm reduction practices. We used an iterative open-coding process to comprehensively itemize and categorize content shared by participants related to concurrent use. RESULTS We interviewed 349 PWUD (64% male, mean age 36). Of those discussing current use of stimulants in the context of opioid use (n = 137, 39%), the stimulant most used was methamphetamine (78%) followed by cocaine/crack (26%). Motivations for co-use included: 1) change in drug markets and cost considerations; 2) recreational goals, e.g., seeking stronger effects after heightened opioid tolerance; 3) practical goals, such as a desire to balance or alleviate the effects of the other drug, including the use of stimulants to avoid/reverse opioid overdose, and/or control symptoms of opioid withdrawal; and 4) functional goals, such as being simultaneously energized and pain-free in order to remain productive for employment. CONCLUSION In a rural U.S. cohort of PWUD, use of both stimulants and opioids was highly prevalent. Reasons for dual use found in the rural context compared to urban studies included changes in drug availability, functional/productivity goals, and the use of methamphetamine to offset opioid overdose. Education efforts and harm reduction services and treatment, such as access to naloxone, fentanyl test strips, and accessible drug treatment for combined opioid and stimulant use, are urgently needed in the rural U.S. to reduce overdose and other adverse outcomes.
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Affiliation(s)
| | - R Baker
- Oregon Health & Science University, Portland, USA
| | - A Sibley
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - A T Estadt
- The Ohio State University, Colombus, USA
| | - D Colston
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | | | - J Bresett
- Southern Illinois University School of Medicine, Springfield, USA
| | - X A Levander
- Oregon Health & Science University, Portland, USA
| | | | - T Davy-Mendez
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - M Powell
- University of Washington, Seattle, USA
| | - T J Stopka
- Tufts University School of Medicine, Department of Public Health and Community Medicine, Medford, USA
| | - M Pho
- University of Chicago, Chicago, USA
| | - J Feinberg
- West Virginia University, Morgantown, USA
| | - J Ezell
- Cornell University, Ithaca, USA
| | - W Zule
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - D Seal
- Tulane University, New Orleans, USA
| | | | | | | | - H M Crane
- University of Washington, Seattle, USA
| | - J I Tsui
- University of Washington, Seattle, USA
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Fredericksen RJ, Fitzsimmons E, Drumright LN, Loo S, Dougherty S, Brown S, Pearce J, Nance RM, Whitney BM, Ruderman S, O'Cleirigh C, Cropsey K, Mayer KH, Mugavero MJ, Delaney JAC, Crane HM, Hahn A. Vaporized nicotine use among patients in HIV care who smoke tobacco: perceived health effects and effectiveness as a smoking cessation tool. AIDS Care 2023; 35:1741-1748. [PMID: 36912767 PMCID: PMC10497704 DOI: 10.1080/09540121.2023.2180476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/13/2023] [Indexed: 03/14/2023]
Abstract
Evidence suggests adverse health effects from vaporized nicotine (VN) use, such as electronic "e" cigarettes, and limited efficacy to aid tobacco cessation. People with HIV (PWH) smoke tobacco at higher rates than the general population, with greater morbidity, highlighting the necessity of effective tobacco cessation tools. PWH may be more vulnerable to adverse effects of VN. Using semi-structured 1:1 interviews, we examined health beliefs regarding VN, patterns of use, and perceived effectiveness for tobacco cessation among PWH in HIV care at three geographically diverse U.S. sites. PWH (n = 24) had limited understanding of VN product content or health effects, presuming VN less harmful than tobacco cigarettes (TC). VN failed to adequately replicate the psychoactive effects or desired ritual of smoking TC. Concurrent TC use, and continuous VN use throughout the day, was common. Satiety using VN was elusive, and consumption quantity was difficult to track. VN had limited desirability and durability as a TC cessation tool among the interviewed PWH.
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Affiliation(s)
| | - E Fitzsimmons
- Department of Medicine, University of Washington, Seattle, USA
| | - L N Drumright
- Department of Medicine, University of Washington, Seattle, USA
| | - S Loo
- Fenway Community Health, Boston, USA
| | - S Dougherty
- Department of Medicine, University of Alabama-Birmingham, Birmingham, AL, USA
| | - S Brown
- Department of Medicine, University of Washington, Seattle, USA
| | - J Pearce
- Department of Medicine, University of Washington, Seattle, USA
| | - R M Nance
- Department of Medicine, University of Washington, Seattle, USA
| | - B M Whitney
- Department of Medicine, University of Washington, Seattle, USA
| | - S Ruderman
- Department of Medicine, University of Washington, Seattle, USA
| | | | - K Cropsey
- Fenway Community Health, Boston, USA
| | - K H Mayer
- Fenway Community Health, Boston, USA
| | - M J Mugavero
- Department of Medicine, University of Alabama-Birmingham, Birmingham, AL, USA
| | - J A C Delaney
- Department of Medicine, University of Washington, Seattle, USA
| | - H M Crane
- Department of Medicine, University of Washington, Seattle, USA
| | - A Hahn
- Department of Medicine, University of Washington, Seattle, USA
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Fredericksen RJ, Whitney BM, Trejo E, Nance RM, Fitzsimmons E, Altice FL, Carrico AW, Cleland CM, Del Rio C, Duerr A, El-Sadr WM, Kahana S, Kuo I, Mayer K, Mehta S, Ouellet LJ, Quan VM, Rich J, Seal DW, Springer S, Taxman F, Wechsberg W, Crane HM, Delaney JAC. Individual and poly-substance use and condomless sex among HIV-uninfected adults reporting heterosexual sex in a multi-site cohort. BMC Public Health 2021; 21:2002. [PMID: 34736425 PMCID: PMC8567631 DOI: 10.1186/s12889-021-12026-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/15/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We analyzed the association between substance use (SU) and condomless sex (CS) among HIV-negative adults reporting heterosexual sex in the Seek, Test, Treat, and Retain (STTR) consortium. We describe the impact of SU as well as person/partner and context-related factors on CS, identifying combinations of factors that indicate the highest likelihood of CS. METHODS We analyzed data from four US-based STTR studies to examine the effect of SU on CS using two SU exposures: 1) recent SU (within 3 months) and 2) SU before/during sex. Behavioral data were collected via 1:1 or self-administered computerized interviews. Adjusted individual-study, multivariable relative risk regression was used to examine the relationship between CS and SU. We also examined interactions with type of sex and partner HIV status. Pooled effect estimates were calculated using traditional fixed-effects meta-analysis. We analyzed data for recent SU (n = 6781; 82% men, median age = 33 years) and SU before/during sex (n = 2915; 69% men, median age = 40 years). RESULTS For both exposure classifications, any SU other than cannabis increased the likelihood of CS relative to non-SU (8-16%, p-values< 0.001). In the recent SU group, however, polysubstance use did not increase the likelihood of CS compared to single-substance use. Cannabis use did not increase the likelihood of CS, regardless of frequency of use. Type of sex was associated with CS; those reporting vaginal and anal sex had a higher likelihood of CS compared to vaginal sex only for both exposure classifications (18-21%, p < 0.001). Recent SU increased likelihood of CS among those reporting vaginal sex only (9-10%, p < 0.001); results were similar for those reporting vaginal and anal sex (5-8%, p < 0.01). SU before/during sex increased the likelihood of CS among those reporting vaginal sex only (20%; p < 0.001) and among those reporting vaginal and anal sex (7%; p = 0.002). Single- and poly-SU before/during sex increased the likelihood of CS for those with exclusively HIV-negative partners (7-8%, p ≤ 0.02), and for those reporting HIV-negative and HIV-status unknown partners (9-13%, p ≤ 0.03). CONCLUSION Except for cannabis, any SU increased the likelihood of CS. CS was associated with having perceived HIV-negative partners and with having had both anal/vaginal sex.
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Affiliation(s)
- R. J. Fredericksen
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - B. M. Whitney
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - E. Trejo
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - R. M. Nance
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - E. Fitzsimmons
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - F. L. Altice
- Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510-2283 USA
| | - A. W. Carrico
- Division of Prevention Science and Community Health, University of Miami, 1120 NW 14th St, Miami, FL 33136 USA
| | - C. M. Cleland
- Center for Drug Use and HIV Research, NYU School of Global Public Health, 665 Broadway, 11th Floor, New York, NY 10012 USA
| | - C. Del Rio
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE Room 7011, Atlanta, GA 30322 USA
| | - A. Duerr
- Fred Hutchinson Cancer Research Center, HIV Vaccine Trials Network, Box 358080 (LE 500), Seattle, WA 98109 USA
| | - W. M. El-Sadr
- Mailman School of Public Health, Columbia University, 722 West 168th Street, 13th floor, New York, NY 10032 USA
| | - S. Kahana
- National Institute on Drug Abuse, 6001 Executive Blvd, Rockville, Maryland 20852 USA
| | - I. Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC 20052 USA
| | - K. Mayer
- The Fenway Institute, 1340 Boylston Street, Boston, MA 02215 USA
| | - S. Mehta
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - L. J. Ouellet
- School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL USA
| | - V. M. Quan
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - J. Rich
- Center for Prisoner Health and Human Rights, Immunology Center, The Miriam Hospital, Warren Alpert Medical School, Brown University, 1125 North Main St, Providence, RI 02904 USA
| | - D. W. Seal
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, Suite 2200, New Orleans, LA 70112 USA
| | - S. Springer
- Department of Internal Medicine, School of Medicine, Yale University, 135 College Street, New Haven, CT 06510 USA
| | - F. Taxman
- Center for Advancing Correctional Excellence, Institute of Biohealth Innovation, George Mason University, 4461 Rockfish Creek Lane, Fairfax, VA 22030 USA
| | - W. Wechsberg
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599 USA
| | - H. M. Crane
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - J. A. C. Delaney
- College of Pharmacy, University of Manitoba, Apotex Centre, 750 McDermot Avenue, Winnipeg, Manitoba R3E 0T5 Canada
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Fredericksen RJ, Harding BN, Ruderman SA, McReynolds J, Barnes G, Lober WB, Fitzsimmons E, Nance RM, Whitney BM, Delaney JAC, Mathews WC, Willig J, Crane PK, Crane HM. Patient acceptability and usability of a self-administered electronic patient-reported outcome assessment in HIV care: relationship with health behaviors and outcomes. AIDS Care 2020; 33:1167-1177. [PMID: 33190523 DOI: 10.1080/09540121.2020.1845288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We assessed acceptability/usability of tablet-based patient-reported outcome (PRO) assessments among patients in HIV care, and relationships with health outcomes using a modified Acceptability E-Scale (AES) within a self-administered PRO assessment. Using multivariable linear regression, we measured associations between patient characteristics and continuous combined AES score. Among 786 patients (median age=48; 91% male; 49% white; 17% Spanish-speaking) overall mean score was 26/30 points (SD: 4.4). Mean scores per dimension (max 5, 1=lowest acceptability, 5=highest): ease of use 4.7, understandability 4.7, time burden 4.3, overall satisfaction 4.3, helpfulness describing symptoms/behaviors 4.2, and enjoyability 3.8. Higher overall score was associated with race/ethnicity (+1.3 points/African-American patients (95%CI:0.3-2.3); +1.6 points/Latino patients (95%CI:0.9-2.3) compared to white patients). Patients completing PROs in Spanish scored +2.4 points on average (95%CI:1.6-3.3). Higher acceptability was associated with better quality of life (0.3 points (95%CI:0.2-0.5)) and adherence (0.4 points (95%CI:0.2-0.6)). Lower acceptability was associated with: higher depression symptoms (-0.9 points (95%CI:-1.4 to -0.4)); recent illicit opioid use (-2.0 points (95%CI:-3.9 to -0.2)); multiple recent sex partners (-0.8 points (95%CI:-1.5 to -0.1)). While patients endorsing depression symptoms, recent opioid use, condomless sex, or multiple sex partners found PROs less acceptable, overall, patients found the assessments highly acceptable and easy to use.
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Affiliation(s)
| | | | | | | | - G Barnes
- University of Washington, Seattle, WA, USA
| | - W B Lober
- University of Washington, Seattle, WA, USA
| | | | - R M Nance
- University of Washington, Seattle, WA, USA
| | | | | | - W C Mathews
- University of California at San Diego, San Diego, CA, USA
| | - J Willig
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - P K Crane
- University of Washington, Seattle, WA, USA
| | - H M Crane
- University of Washington, Seattle, WA, USA
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6
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Harding BN, Whitney BM, Nance RM, Ruderman SA, Crane HM, Burkholder G, Moore RD, Mathews WC, Eron JJ, Hunt PW, Volberding P, Rodriguez B, Mayer KH, Saag MS, Kitahata MM, Heckbert SR, Delaney JAC. Anemia risk factors among people living with HIV across the United States in the current treatment era: a clinical cohort study. BMC Infect Dis 2020; 20:238. [PMID: 32197585 PMCID: PMC7085166 DOI: 10.1186/s12879-020-04958-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Anemia is common among people living with HIV infection (PLWH) and is associated with adverse health outcomes. Information on risk factors for anemia incidence in the current antiretroviral therapy (ART) era is lacking. Methods Within a prospective clinical cohort of adult PLWH receiving care at eight sites across the United States between 1/2010–3/2018, Cox proportional hazards regression analyses were conducted among a) PLWH free of anemia at baseline and b) PLWH free of severe anemia at baseline to determine associations between time-updated patient characteristics and development of anemia (hemoglobin < 10 g/dL), or severe anemia (hemoglobin < 7.5 g/dL). Linear mixed effects models were used to examine relationships between patient characteristics and hemoglobin levels during follow-up. Hemoglobin levels were ascertained using laboratory data from routine clinical care. Potential risk factors included: age, sex, race/ethnicity, body mass index, smoking status, hazardous alcohol use, illicit drug use, hepatitis C virus (HCV) coinfection, estimated glomerular filtration rate (eGFR), CD4 cell count, viral load, ART use and time in care at CNICS site. Results This retrospective cohort study included 15,126 PLWH. During a median follow-up of 6.6 (interquartile range [IQR] 4.3–7.6) years, 1086 participants developed anemia and 465 participants developed severe anemia. Factors that were associated with incident anemia included: older age, female sex, black race, HCV coinfection, lower CD4 cell counts, VL ≥400 copies/ml and lower eGFR. Conclusion Because anemia is a treatable condition associated with increased morbidity and mortality among PLWH, hemoglobin levels should be monitored routinely, especially among PLWH who have one or more risk factors for anemia.
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Affiliation(s)
- B N Harding
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA.
| | - B M Whitney
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - R M Nance
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - S A Ruderman
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - H M Crane
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - G Burkholder
- University of Alabama Birmingham, Birmingham, USA
| | - R D Moore
- Johns Hopkins University, Baltimore, USA
| | - W C Mathews
- University of California San Diego, San Diego, USA
| | - J J Eron
- University of North Carolina, Chapel Hill, USA
| | - P W Hunt
- University of California San Francisco, San Francisco, USA
| | - P Volberding
- University of California San Francisco, San Francisco, USA
| | - B Rodriguez
- Case Western Reserve University, Cleveland, USA
| | - K H Mayer
- Fenway Health Institute, Boston, USA
| | - M S Saag
- University of Alabama Birmingham, Birmingham, USA
| | - M M Kitahata
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - S R Heckbert
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - J A C Delaney
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
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7
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Crane HM, Heckbert SR, Drozd DR, Budoff MJ, Delaney JAC, Rodriguez C, Paramsothy P, Lober WB, Burkholder G, Willig JH, Mugavero MJ, Mathews WC, Crane PK, Moore RD, Napravnik S, Eron JJ, Hunt P, Geng E, Hsue P, Barnes GS, McReynolds J, Peter I, Grunfeld C, Saag MS, Kitahata MM. The authors reply. Am J Epidemiol 2014; 180:450. [PMID: 24989243 DOI: 10.1093/aje/kwu167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H M Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - S R Heckbert
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - D R Drozd
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - M J Budoff
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095
| | - J A C Delaney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195
| | - C Rodriguez
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - P Paramsothy
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - W B Lober
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - G Burkholder
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - J H Willig
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - M J Mugavero
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - W C Mathews
- Department of Medicine, School of Medicine, University of California, San Diego, San Diego, CA 92093
| | - P K Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - R D Moore
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205
| | - S Napravnik
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
| | - J J Eron
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
| | - P Hunt
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA 94143
| | - E Geng
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA 94143
| | - P Hsue
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA 94143
| | - G S Barnes
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - J McReynolds
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - I Peter
- Department of Medicine, Mount Sinai Medical Center, New York, NY 10029
| | - C Grunfeld
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA 94143
| | - M S Saag
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - M M Kitahata
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
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Crane HM, Heckbert SR, Drozd DR, Budoff MJ, Delaney JAC, Rodriguez C, Paramsothy P, Lober WB, Burkholder G, Willig JH, Mugavero MJ, Mathews WC, Crane PK, Moore RD, Napravnik S, Eron JJ, Hunt P, Geng E, Hsue P, Barnes GS, McReynolds J, Peter I, Grunfeld C, Saag MS, Kitahata MM. Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts. Am J Epidemiol 2014; 179:996-1005. [PMID: 24618065 DOI: 10.1093/aje/kwu010] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We developed, implemented, and evaluated a myocardial infarction (MI) adjudication protocol for cohort research of human immunodeficiency virus. Potential events were identified through the centralized Centers for AIDS Research Network of Integrated Clinical Systems data repository using MI diagnoses and/or cardiac enzyme laboratory results (1995-2012). Sites assembled de-identified packets, including physician notes and results from electrocardiograms, procedures, and laboratory tests. Information pertaining to the specific antiretroviral medications used was redacted for blinded review. Two experts reviewed each packet, and a third review was conducted if discrepancies occurred. Reviewers categorized probable/definite MIs as primary or secondary and identified secondary causes of MIs. The positive predictive value and sensitivity for each identification/ascertainment method were calculated. Of the 1,119 potential events that were adjudicated, 294 (26%) were definite/probable MIs. Almost as many secondary (48%) as primary (52%) MIs occurred, often as the result of sepsis or cocaine use. Of the patients with adjudicated definite/probable MIs, 78% had elevated troponin concentrations (positive predictive value = 57%, 95% confidence interval: 52, 62); however, only 44% had clinical diagnoses of MI (positive predictive value = 45%, 95% confidence interval: 39, 51). We found that central adjudication is crucial and that clinical diagnoses alone are insufficient for ascertainment of MI. Over half of the events ultimately determined to be MIs were not identified by clinical diagnoses. Adjudication protocols used in traditional cardiovascular disease cohorts facilitate cross-cohort comparisons but do not address issues such as identifying secondary MIs that may be common in persons with human immunodeficiency virus.
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Bird ST, Delaney JAC, Etminan M, Brophy JM, Hartzema AG. Drospirenone and non-fatal venous thromboembolism: is there a risk difference by dosage of ethinyl-estradiol? J Thromb Haemost 2013; 11:1059-68. [PMID: 23574590 DOI: 10.1111/jth.12224] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Previous studies concluded that there was an increased risk of non-fatal venous thromboembolism (VTE) with drospirenone. It is unknown whether the risk is differential by ethinyl-estradiol dosage. OBJECTIVES To assess the risk of VTE with drospirenone and to determine whether drospirenone and ethinyl-estradiol 20 μg (DRSP/EE20) has a lower VTE risk than drospirenone and ethinyl-estradiol 30 μg (DRSP/EE30). METHODS Our cohort included women aged 18-46 years taking drospirenone or levonorgestrel (LNG)-containing combined oral contraceptives (COCs) in the IMS claims database between 2001 and 2009. VTE was defined using ICD-9-CM coding and anticoagulation. The hazard ratio (HR) from Cox proportional hazards models was used to assess the VTE relative risk (RR) with drospirenone compared with levonorgestrel, adjusted by a propensity score used to control for baseline co-morbidity and stratified by EE dosage and user-type (new/current). RESULTS The study included 238 683 drospirenone and 193,495 levonorgestrel users. Among new and current users, a 1.90-fold (95% CI, 1.51-2.39) increased VTE relative risk was observed for drospirenone (18.0 VTE/10,000 women-years) vs. levonorgestrel (8.9 VTE/10,000 women-years). In analysis of new users, DRSP/EE20 had a 2.35-fold (95% CI, 1.44-3.82) VTE RR versus LNG/EE20. New users of DRSP/EE30 observed an increased RR versus LNG/EE30 among women starting to use COCs between 2001 and 2006 (2.51, 95% CI, 1.12-5.64) but not between 2007 and 2009 (0.76, 95% CI, 0.42-1.39), attributable to an increased incidence rate with LNG/EE30 from 2007 to 2009. In direct comparison, DRSP/EE20 had an elevated risk of VTE compared with DRSP/EE30 (RR, 1.55; 95% CI, 0.99-2.41). CONCLUSIONS We observed a modestly elevated risk of VTE with drospirenone, compared with levonorgestrel. The larger VTE incidence rate observed in DRSP/EE20 than in DRSP/EE30 and the increasing VTE incidence rate with levonorgestrel between 2007 and 2009 were unexpected.
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Affiliation(s)
- S T Bird
- Pharmaceutical Outcomes and Policy, College of Pharmacy and Epidemiology, University of Florida, Gainesville, FL 32611, USA.
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Hebert C, Delaney JAC, Hemmelgarn B, Lévesque LE, Suissa S. Benzodiazepines and elderly drivers: a comparison of pharmacoepidemiological study designs. Pharmacoepidemiol Drug Saf 2007; 16:845-9. [PMID: 17563091 DOI: 10.1002/pds.1432] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE Contradictory results were published from two studies in the late 1990s about the effects of long half-life benzodiazepine use on the risk of motor vehicle crashes (MVCs) in the elderly. The use of different study designs could explain the differences observed in these studies. METHODS The results of an unmatched case-control study were compared to those of a case-crossover study using the same prescription claims database to determine whether the current use of benzodiazepines increased the risk of MVCs. RESULTS There were 5579 cases and 12 911 controls identified between the years 1990 and 1993 in the province of Quebec, Canada. The case-control approach demonstrated an increased rate of injurious MVC associated with the current use of long-acting benzodiazepines [odds ratio (OR) 1.45; 95% confidence interval (CI): 1.12-1.88]. The case-crossover approach applied to all cases did not show any association [OR 0.99; 95%CI: 0.83-1.19]. However, among the cases restricted to subjects with four or less prescriptions filled in the previous year, corresponding more to transient exposures, the OR was elevated [OR 1.53; 95%CI: 1.08-2.16]. CONCLUSIONS Differences in study design and analysis may explain some of the discrepancies in previous results. Both study designs provide evidence that long-acting benzodiazepines appear to be associated with an increased risk of MVC.
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Affiliation(s)
- Caroline Hebert
- Division of Clinical Epidemiology, McGill University Health Center, Montreal, Canada
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Delaney JAC, Lévesque LE, Etminan M, Suissa S. Furosemide use and hospitalization for benign prostatic hyperplasia. Can J Clin Pharmacol 2006; 13:e75-80. [PMID: 16489240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Recent studies have shown that furosemide may have anti-inflammatory properties. We explored whether exposure to furosemide would reduce the risk of being hospitalized with prostatism, a marker of benign prostatic hyperplasia. METHODS Using record linkage and the computerized health insurance databases of the province of Québec, Canada, we identified a cohort of men 65 years of age and older within which we conducted a case-control study. Cases were individuals hospitalized with prostatism (ICD-9 code 600) between January 1991 and June 1993, with the index date taken as the date of hospitalisation. Controls were those not having experienced the event during the study period, with an index date selected randomly during their follow-up. Cases and controls were required to have at least 2 (1/2) years of health coverage prior to index date in order to identify risk factors for benign prostatic hyperplasia and establish baseline medical history. We assessed the subjects' exposure to furosemide and various other diuretics in the period 180 to 900 days preceding the index date. Logistic regression was used to evaluate the association between the use of furosemide and hospitalization for prostatism, adjusting for potential confounders. RESULTS The cohort included 8,814 subjects, of which 231 were cases and 8,583 controls. The rate of hospitalization for prostatism was lower for users of furosemide compared to non-users (adjusted rate ratio 0.49; 95% CI: 0.25-0.95). There was no association with the use of thiazide or potassium sparing diuretics (adjusted rate ratio 0.95; 95% CI: 0.65-1.37). Results suggestive of a protective effect associated with corticosteroid use were observed (adjusted rate ratio 0.64; 95% CI: 0.44-0.93). CONCLUSIONS This study supports the hypothesis that furosemide can reduce the risk of hospitalization for prostatism, a marker of benign prostatic hyperplasia.
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Affiliation(s)
- J A C Delaney
- Division of Clinical Epidemiology, Royal Victoria Hospital and the Department of Epidemiology and Biostatistics, McGill University Health Center, Montreal, Canada.
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Abstract
CONTEXT Recent reports suggest an increasing occurrence and severity of Clostridium difficile-associated disease. We assessed whether the use of gastric acid-suppressive agents is associated with an increased risk in the community. OBJECTIVE To determine whether the use of gastric acid-suppressive agents increases the risk of C difficile-associated disease in a community population. DESIGN, SETTING, AND PATIENTS We conducted 2 population-based case-control studies using the United Kingdom General Practice Research Database (GPRD). In the first study, we identified all 1672 cases of C difficile recorded between 1994 and 2004 among all patients registered for at least 2 years in each practice. Each case was matched to 10 controls on calendar time and the general practice. In the second study, a subset of these cases defined as community-acquired, that is, not hospitalized in the prior year, were matched on practice and age with controls also not hospitalized in the prior year. MAIN OUTCOME MEASURES The incidence of C difficile and risk associated with gastric acid-suppressive agent use. RESULTS The incidence of C difficile in patients diagnosed by their general practitioners in the General Practice Research Database increased from less than 1 case per 100,000 in 1994 to 22 per 100,000 in 2004. The adjusted rate ratio of C difficile-associated disease with current use of proton pump inhibitors was 2.9 (95% confidence interval [CI], 2.4-3.4) and with H2-receptor antagonists the rate ratio was 2.0 (95% CI, 1.6-2.7). An elevated rate was also found with the use of nonsteroidal anti-inflammatory drugs (rate ratio, 1.3; 95% CI, 1.2-1.5). CONCLUSIONS The use of acid-suppressive therapy, particularly proton pump inhibitors, is associated with an increased risk of community-acquired C difficile. The unexpected increase in risk with nonsteroidal anti-inflammatory drug use should be investigated further.
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Affiliation(s)
- Sandra Dial
- Division of Critical Care and Respiratory and Clinical Research, Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec.
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Filion KB, Delaney JAC. Cognitive therapy and preventing suicide attempts. JAMA 2005; 294:2847-8; author reply 2848. [PMID: 16352790 DOI: 10.1001/jama.294.22.2847-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
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Affiliation(s)
- Mahyar Etminan
- Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Centre, 687 Pine Ave, West Montreal, Quebec, Canada
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Etminan M, Carleton B, Delaney JAC, Padwal R. Macrolide Therapy forChlamydia pneumoniaein the Secondary Prevention of Coronary Artery Disease: A Meta-Analysis of Randomized Controlled Trials. Pharmacotherapy 2004; 24:338-43. [PMID: 15040646 DOI: 10.1592/phco.24.4.338.33181] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE As recent studies have shown that antibiotic therapy to eradicate Chlamydia pneumoniae may be beneficial in the secondary prevention of coronary artery disease, and studies to date may have lacked statistical power, we conducted a meta-analysis of randomized controlled trials to determine the role of antibiotic therapy in this patient population. DESIGN Systematic review and meta-analysis of randomized controlled trials. PATIENTS A total of 12,032 patients from nine studies. MEASUREMENTS AND MAIN RESULTS We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and abstracts of conference proceedings to identify pertinent studies. The random effects model was used to estimate a pooled relative risk. Heterogeneity was assessed using the bootstrap version of the Q statistic with 1000 replications. In total, we reviewed nine randomized controlled trials enrolling 12,032 patients; six enrolled patients with acute coronary syndrome, two enrolled patients with stable coronary artery disease, and one enrolled a mixed population. Compared with placebo, macrolide therapy was not associated with a significant reduction in any coronary event (relative risk [RR] 0.98, 95% confidence interval [CI] 0.88-1.08), myocardial infarction or angina (RR 0.89, 95% CI 0.68-1.16), or overall mortality (RR 0.95, 95% CI 0.81-1.12). CONCLUSION Our results do not support routine use of antichlamydial therapy for secondary prevention of coronary events.
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Affiliation(s)
- Mahyar Etminan
- Division of Clinical Epidemiology, Royal Victoria Hospital, Montréal, Québec, Canada
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