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Xia C, Chander G, Hutton HE, McCaul ME, Delaney JA, Mayer KH, Jacobson JM, Puryear S, Crane HM, Shapiro AE, Cachay ER, Lau B, Napravnik S, Saag M, Lesko CR. Association of Alcohol Use with COVID-19 Infection and Hospitalization Among People Living with HIV in the United States, 2020. AIDS Behav 2024; 28:1795-1807. [PMID: 38421512 DOI: 10.1007/s10461-024-04301-6] [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] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
Alcohol use was associated with elevated COVID-19 risk in the general population. People with HIV (PWH) have high prevalences of alcohol use. To evaluate the effect of alcohol use on COVID-19 risks among PWH, we estimated the risk of COVID-19 diagnosis and COVID-19-related hospitalization among PWH in routine care at 8 HIV primary care centers that contributed data to the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort according to their alcohol use just prior to the COVID-19 pandemic. The CNICS data repository includes demographic characteristics, clinical diagnoses, and laboratory test results from electronic medical records and other sources. Alcohol use, substance use, and mental health symptoms were self-reported on tablet-based standardized surveys. Alcohol use was categorized according to standard, sex-specific Alcohol Use Disorder Identification Test-Consumption instrument cut-offs. We followed 5,496 PWH (79% male, 48% Black race, median age = 53 years) from March 1, 2020 to December 31, 2020. Relative to PWH with no baseline alcohol use, the adjusted hazard ratio (aHR) of COVID-19 diagnosis was 1.09 (95% confidence interval [CI]: 0.78, 1.51) for lower-risk drinking and 1.19 (95%CI: 0.81, 1.73) for unhealthy drinking. The aHR of COVID-19-related hospitalization was 0.82 (95%CI: 0.33, 1.99) for lower-risk drinking and 1.25 (95%CI: 0.50, 3.09) for unhealthy drinking. Results were not modified by recent cocaine or non-prescribed opioid use, depressive symptoms, or diagnoses of alcohol use disorder. The study suggested a slightly increased, but not statistically significant risk of COVID-19 diagnosis and hospitalization associated with unhealthy alcohol use.
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Affiliation(s)
- Chunyi Xia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Joseph A Delaney
- Division of General Internal Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, 02215, USA
- Department of Global Health and Population, Harvard University T.C. Chan School of Public Health, Boston, MA, 02115, USA
| | - Jeffrey M Jacobson
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Sarah Puryear
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, 94110, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Adrienne E Shapiro
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, Seattle, WA, 98195, USA
| | - Edward R Cachay
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, 92093, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, 27599, USA
| | - Michael Saag
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
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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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Rice LC, Langan MT, Cheng DT, Sheu YS, Peterburs J, Hua J, Qin Q, Rilee JJ, Faulkner ML, Mathena JR, Munro CA, Wand GS, McCaul ME, Desmond JE. Disrupted executive cerebro-cerebellar functional connectivity in alcohol use disorder. Alcohol Clin Exp Res (Hoboken) 2024; 48:33-47. [PMID: 38206281 PMCID: PMC10784638 DOI: 10.1111/acer.15219] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Alcohol use disorder (AUD) affects 283 million people worldwide and its prevalence is increasing. Despite the role of the cerebellum in executive control and its sensitivity to alcohol, few studies have assessed its involvement in AUD-relevant functional networks. The goal of this study is to compare resting-state functional connectivity (FC) patterns in abstinent adults with a history of AUD and controls (CTL). We hypothesized that group differences in cerebro-cerebellar FC would be present, particularly within the frontoparietal/executive control network (FPN). METHODS Twenty-eight participants completed a resting-state functional magnetic resonance imaging (rsfMRI) study. CTL participants had no history of AUD, comorbid psychological conditions, or recent heavy drinking and/or drug use. AUD participants had a history of AUD, with sobriety for at least 30 days prior to data collection. Multivariate pattern analysis, an agnostic, whole-brain approach, was used to identify regions with significant differences in FC between groups. Seed-based analyses were then conducted to determine the directionality and extent of these FC differences. Associations between FC strength and executive function were assessed using correlations with Wisconsin Card Sorting Test (WCST) performance. RESULTS There were significant group differences in FC in nodes of the FPN, ventral attention network, and default mode network. Post hoc analyses predominantly identified FC differences within the cerebro-cerebellar FPN, with AUD showing significantly less FC within the FPN. In AUD, FC strength between FPN clusters identified in the multivariate pattern analysis (MVPA) analysis (Left Crus II, Right Frontal Cortex) was positively associated with performance on the WCST. CONCLUSIONS Our results show less engagement of the FPN in individuals with AUD than in CTL. FC strength within this network was positively associated with performance on the WCST. These findings suggest that long-term heavy drinking alters cerebro-cerebellar FC, particularly within networks that are involved in executive function.
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Affiliation(s)
- Laura C. Rice
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Yi-Shin Sheu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jutta Peterburs
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Institute for Systems Medicine & Department of Human Medicine, MSH Medical School Hamburg, Germany
| | - Jun Hua
- Neurosection, Division of MRI Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Qin Qin
- Neurosection, Division of MRI Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | | | | | | | | | - Gary S. Wand
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary E. McCaul
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John E. Desmond
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lesko CR, Gnang JS, Fojo AT, Hutton HE, McCaul ME, Delaney JA, Cachay ER, Mayer KH, Crane HM, Batey DS, Napravnik S, Christopoulos KA, Lau B, Chander G. Alcohol use and the longitudinal HIV care continuum for people with HIV who enrolled in care between 2011 and 2019. Ann Epidemiol 2023; 85:6-12. [PMID: 37442307 PMCID: PMC10538410 DOI: 10.1016/j.annepidem.2023.07.002] [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: 09/23/2022] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE We described the impact of alcohol use on longitudinal engagement in HIV care including loss to follow-up, durability of viral suppression, and death. METHODS We followed a cohort of 1781 people with HIV from enrolled in care at one of seven US clinics, 2011-2019 through 102 months. We used a multistate, time-varying Markov process and restricted mean time to summarize engagement in HIV care over follow-up according to baseline self-reported alcohol use (none, moderate, or unhealthy). RESULTS Our sample (86% male, 54% White) had median age of 35 years. Over 102 months, people with no, moderate, and unhealthy alcohol use averaged 62.3, 61.1, and 59.5 months virally suppressed, respectively. People who reported unhealthy or moderate alcohol use spent 5.1 (95% confidence intervals (CI): 0.8, 9.3) and 7.6 (95%CI: 3.1, 11.7) more months lost to care than nondrinkers. Compared to no use, unhealthy alcohol use was associated with 3.4 (95%CI: -5.6, -1.6) fewer months in care, not virally suppressed. There were no statistically significant differences after adjustment for demographic and clinical characteristics. CONCLUSIONS Moderate or unhealthy drinking at enrollment in HIV care was associated with poor retention in care. Alcohol use was not associated with time spent virally suppressed.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Jeanine S Gnang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anthony T Fojo
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Heidi E Hutton
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Mary E McCaul
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Joseph A Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Canada; Department of Epidemiology, University of Washington, Seattle, WA
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, University of California San Diego, San Diego, CA
| | | | - Heidi M Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA
| | - D Scott Batey
- School of Social Work, Tulane University, New Orleans, LA
| | - Sonia Napravnik
- School of Medicine, University of North Carolina, Chapel Hill, NC
| | | | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Geetanjali Chander
- School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Medicine, School of Medicine, University of Washington, Seattle, WA
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Pytell JD, Li X, Thompson C, Lesko CR, McCaul ME, Hutton H, Scott Batey D, Cachay E, Mayer KH, Napravnik S, Christopoulos K, Yang C, Crane HM, Chander G, Lau B. The temporal relationship of alcohol use and subsequent self-reported health status among people with HIV. Am J Med Open 2023; 9:100020. [PMID: 37476695 PMCID: PMC10357948 DOI: 10.1016/j.ajmo.2022.100020] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Background Alcohol use among people with HIV is associated with worse HIV treatment outcomes. Its impact on self-reported health status is unclear. Setting Longitudinal cohort of people with HIV engaged in care across 7 clinics participating in the Centers for AIDS Research Network of Integrated Care Systems between January 2011 and June 2014. Methods A total of 5046 participants were studied. A quantile regression model estimated the association of alcohol use levels with subsequent self-reported health status score, accounting for multiple covariates including depressive symptoms. Women, men who have sex with women, and men who have sex with men were analyzed separately. Results Prevalence of heavy alcohol use was 21%, 31%, and 37% among women, men who have sex with women, and men who have sex with men, respectively. Women with heavy alcohol use had a subsequently decreased median self-reported health status score compared to women with no or moderate alcohol use (odds ratio [OR]: 0.76; 95% confidence interval [CI]: 0.58-0.99); this association was not explained by the presence of depressive symptoms. There was no observed association of alcohol use level on subsequent self-reported health status among men who have sex with women. Men who have sex with men reporting no alcohol use had a subsequently decreased median self-reported health status compared to moderate alcohol use (OR: 0.88; 95% CI: 0.80-0.97). Conclusion Heavy alcohol use is associated with worsened self-reported health status at subsequent visits among women with HIV and not men with HIV.
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Affiliation(s)
- Jarratt D. Pytell
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
| | - Ximin Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carol Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine R. Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary E. McCaul
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, MD, USA
| | - Heidi Hutton
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, MD, USA
| | - D. Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward Cachay
- Department of Medicine, University of California, San Diego, CA, USA
| | - Kenneth H. Mayer
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katerina Christopoulos
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Cui Yang
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi M. Crane
- Department of Medicine, UW School of Medicine, University of Washington, Seattle, WA, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan Lau
- Department of Medicine, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lee WJ, Cheng H, Whitney BM, Nance RM, Britton SR, Jordahl K, Lindstrom S, Ruderman SA, Kitahata MM, Saag MS, Willig AL, Burkholder G, Eron JJ, Kovacic JC, Björkegren JLM, Mathews WC, Cachay E, Feinstein MJ, Budoff M, Hunt PW, Moore RD, Keruly J, McCaul ME, Chander G, Webel A, Mayer KH, Delaney JA, Crane PK, Martinez C, Crane HM, Hao K, Peter I. Polygenic risk scores point toward potential genetic mechanisms of type 2 myocardial infarction in people with HIV. Int J Cardiol 2023:S0167-5273(23)00648-4. [PMID: 37149004 DOI: 10.1016/j.ijcard.2023.04.058] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/03/2023] [Accepted: 04/30/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND People with human immunodeficiency virus (HIV) infection (PWH) are at higher risk of myocardial infarction (MI) than those without HIV. About half of MIs in PWH are type 2 (T2MI), resulting from mismatch between myocardial oxygen supply and demand, in contrast to type 1 MI (T1MI), which is due to primary plaque rupture or coronary thrombosis. Despite worse survival and rising incidence in the general population, evidence-based treatment recommendations for T2MI are lacking. We used polygenic risk scores (PRS) to explore genetic mechanisms of T2MI compared to T1MI in PWH. METHODS We derived 115 PRS for MI-related traits in 9541 PWH enrolled in the Centers for AIDS Research Network of Integrated Clinical Systems cohort with adjudicated T1MI and T2MI. We applied multivariate logistic regression analyses to determine the association with T1MI and T2MI. Based on initial findings, we performed gene set enrichment analysis of the top variants composing PRS associated with T2MI. RESULTS We found that T1MI was strongly associated with PRS for cardiovascular disease, lipid profiles, and metabolic traits. In contrast, PRS for alcohol dependence and cholecystitis, significantly enriched in energy metabolism pathways, were predictive of T2MI risk. The association remained after the adjustment for actual alcohol consumption. CONCLUSIONS We demonstrate distinct genetic traits associated with T1MI and T2MI among PWH further highlighting their etiological differences and supporting the role of energy regulation in T2MI pathogenesis.
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Affiliation(s)
- Won Jun Lee
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Haoxiang Cheng
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Bridget M Whitney
- Department of Medicine, University of Washington School of Public Health, Seattle, WA, USA
| | - Robin M Nance
- Department of Medicine, University of Washington School of Public Health, Seattle, WA, USA
| | - Sierra R Britton
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department of Population Health Sciences, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Kristina Jordahl
- Department of Epidemiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Sara Lindstrom
- Department of Epidemiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Stephanie A Ruderman
- Department of Epidemiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Mari M Kitahata
- Department of Medicine, University of Washington School of Public Health, Seattle, WA, USA
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amanda L Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Greer Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph J Eron
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason C Kovacic
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Victor Chang Cardiac Research Institute, Darlinghurst, Australia; St Vincent's Clinical School, University of NSW, Australia
| | - Johan L M Björkegren
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Integrated Cardio Metabolic Centre, Department of Medicine, Karolinska Institutet, Karolinska Universitetssjukhuset, Huddinge, Sweden
| | | | - Edward Cachay
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Matthew J Feinstein
- Department of Medicine, Northwestern University Feinberg School of Medicine, Evanston, IL, USA
| | - Mathew Budoff
- Deparment of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Peter W Hunt
- Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jeanne Keruly
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mary E McCaul
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Geetanjali Chander
- Department of Medicine, University of Washington School of Public Health, Seattle, WA, USA; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Allison Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA; School of Nursing, University of Washington, Seattle, WA, USA
| | | | - Joseph A Delaney
- Department of Medicine, University of Washington School of Public Health, Seattle, WA, USA; College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Paul K Crane
- Department of Medicine, University of Washington School of Public Health, Seattle, WA, USA
| | - Claudia Martinez
- Department of Medicine, Division of Cardiology, University of Miami Miller School of Medicine, Florida, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington School of Public Health, Seattle, WA, USA
| | - Ke Hao
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY, New York, USA.
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7
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Chen PH, Yenokyan K, Fojo AT, Hutton HE, Lesko CR, McCaul ME, Yang C, Cachay ER, Crane HM, Jacobson JM, Kim HN, Kitahata MM, Mayer KH, Moore RD, Napravnik S, Saag M, Lau B, Chander G. Alcohol consumption upon direct-acting antiviral therapy for hepatitis C among persons with human immunodeficiency virus in the United States. Drug Alcohol Depend 2022; 241:109673. [PMID: 36332596 PMCID: PMC9810271 DOI: 10.1016/j.drugalcdep.2022.109673] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Direct-acting antivirals (DAA) are highly effective against hepatitis C virus (HCV) infection among persons with human immunodeficiency virus (PWH). However, alcohol use post-DAA treatment poses a continued threat to the liver. Whether the focus on liver health alone during HCV treatment can impact alcohol consumption is unclear. Therefore, we examined the change in alcohol use among HCV-coinfected PWH who received DAA therapy by non-addiction medical providers. METHODS In our longitudinal clinical cohort study, we identified HCV-coinfected PWH who received interferon-free DAA therapy between January 2014 and June 2019 in the Centers for AIDS Research Network of Integrated Clinical Systems. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) was the alcohol screening instrument. We used mixed-effects logistic regression models to estimate the longitudinal change in alcohol use upon DAA therapy. RESULTS Among 738 HCV-coinfected PWH, 339 (46 %) reported any alcohol use at the end of HCV treatment, including 113 (15 %) with high-risk use (i.e., AUDIT-C ≥3 for women, ≥4 for men). Concurrently, 280 (38 %) PWH noted active drug use, and 357 (48 %) were currently smoking. We observed no changes in the odds of any alcohol or high-risk alcohol use over time with DAA therapy. Findings were similar in the PWH subgroup with a history of alcohol use before DAA treatment. CONCLUSIONS For PWH with HCV, alcohol use did not change following interferon-free DAA treatment by non-addiction medical providers. Thus, clinicians should consider integrating targeted alcohol use interventions into HCV care to motivate reduced alcohol consumption and safeguard future liver health.
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Affiliation(s)
- Po-Hung Chen
- Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | - Karine Yenokyan
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Anthony T Fojo
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edward R Cachay
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, CA 92093, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Jeffrey M Jacobson
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - H Nina Kim
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Mari M Kitahata
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA; Department of Global Health and Population, Harvard University T.C. Chan School of Public Health, Boston, MA 02115, USA
| | - Richard D Moore
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
| | - Michael Saag
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL 35233, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Geetanjali Chander
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
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8
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Luu B, Ruderman S, Nance R, Delaney JAC, Ma J, Hahn A, Heckbert SR, Budoff MJ, Crothers K, Mathews WC, Christopolous K, Hunt PW, Eron J, Moore R, Keruly J, Lober WB, Burkholder GA, Willig A, Chander G, McCaul ME, Cropsey K, O'Cleirigh C, Peter I, Feinstein M, Tsui JI, Lindstroem S, Saag M, Kitahata MM, Crane HM, Drumright LN, Whitney BM. Tobacco smoking and binge alcohol use are associated with incident venous thromboembolism in an HIV cohort. HIV Med 2022; 23:1051-1060. [PMID: 35343038 PMCID: PMC9515244 DOI: 10.1111/hiv.13309] [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: 06/22/2021] [Revised: 01/27/2022] [Accepted: 03/14/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND People with HIV (PWH) are at increased risk of cardiovascular comorbidities and substance use is a potential predisposing factor. We evaluated associations of tobacco smoking and alcohol use with venous thromboembolism (VTE) in PWH. METHODS We assessed incident, centrally adjudicated VTE among 12 957 PWH within the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort between January 2009 and December 2018. Using separate Cox proportional hazards models, we evaluated associations of time-updated alcohol and cigarette use with VTE, adjusting for demographic and clinical characteristics. Smoking was evaluated as pack-years and never, former, or current use with current cigarettes per day. Alcohol use was parameterized using categorical and continuous alcohol use score, frequency of use, and binge frequency. RESULTS During a median of 3.6 years of follow-up, 213 PWH developed a VTE. One-third of PWH reported binge drinking and 40% reported currently smoking. In adjusted analyses, risk of VTE was increased among both current (HR: 1.44, 95% CI: 1.02-2.03) and former (HR: 1.44, 95% CI: 0.99-2.07) smokers compared to PWH who never smoked. Additionally, total pack-years among ever-smokers (HR: 1.10 per 5 pack-years; 95% CI: 1.03-1.18) was associated with incident VTE in a dose-dependent manner. Frequency of binge drinking was associated with incident VTE (HR: 1.30 per 7 days/month, 95% CI: 1.11-1.52); however, alcohol use frequency was not. Severity of alcohol use was not significantly associated with VTE. CONCLUSIONS Current smoking and pack-year smoking history were dose-dependently associated with incident VTE among PWH in CNICS. Binge drinking was also associated with VTE. Interventions for smoking and binge drinking may decrease VTE risk among PWH.
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Affiliation(s)
- Brandon Luu
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | | | - Robin Nance
- University of Washington, Seattle, Washington, USA
| | - Joseph A C Delaney
- University of Washington, Seattle, Washington, USA
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jimmy Ma
- University of Washington, Seattle, Washington, USA
| | - Andrew Hahn
- University of Washington, Seattle, Washington, USA
| | | | | | | | | | | | - Peter W Hunt
- University of California, San Francisco, California, USA
| | - Joseph Eron
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | | | | | - Amanda Willig
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | - Karen Cropsey
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Inga Peter
- Mount Sinai Hospital, New York, New York, USA
| | | | | | | | - Michael Saag
- University of Alabama at Birmingham, Birmingham, Alabama, USA
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9
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Crane HM, Ruderman SA, Whitney BM, Nance RM, Drumright LN, Webel AR, Willig AL, Saag MS, Christopoulos K, Greene M, Hahn AW, Eron JJ, Napravnik S, Mathews WC, Chander G, McCaul ME, Cachay ER, Mayer KH, Landay A, Austad S, Ma J, Kritchevsky SB, Pandya C, Achenbach C, Cartujano-Barrera F, Kitahata M, Delaney JA, Kamen C. Associations between drug and alcohol use, smoking, and frailty among people with HIV across the United States in the current era of antiretroviral treatment. Drug Alcohol Depend 2022; 240:109649. [PMID: 36215811 PMCID: PMC10088427 DOI: 10.1016/j.drugalcdep.2022.109649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/30/2022] [Accepted: 09/23/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine associations between frailty and drug, alcohol, and tobacco use among a large diverse cohort of people with HIV (PWH) in clinical care in the current era. METHODS PWH at 7 sites across the United States completed clinical assessments of patient-reported measures and outcomes between 2016 and 2019 as part of routine care including drug and alcohol use, smoking, and other domains. Frailty was assessed using 4 of the 5 components of the Fried frailty phenotype and PWH were categorized as not frail, pre-frail, or frail. Associations of substance use with frailty were assessed with multivariate Poisson regression. RESULTS Among 9336 PWH, 43% were not frail, 44% were prefrail, and 13% were frail. Frailty was more prevalent among women, older PWH, and those reporting current use of drugs or cigarettes. Current methamphetamine use (1.26: 95% CI 1.07-1.48), current (1.65: 95% CI 1.39-1.97) and former (1.21:95% CI 1.06-1.36) illicit opioid use, and former cocaine/crack use (1.17: 95% CI 1.01-1.35) were associated with greater risk of being frail in adjusted analyses. Current smoking was associated with a 61% higher risk of being frail vs. not frail (1.61: 95% CI 1.41-1.85) in adjusted analyses. CONCLUSIONS We found a high prevalence of prefrailty and frailty among a nationally distributed cohort of PWH in care. This study identified distinct risk factors that may be associated with frailty among PWH, many of which, such as cigarette smoking and drug use, are potentially modifiable.
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Affiliation(s)
- Heidi M Crane
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Stephanie A Ruderman
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Bridget M Whitney
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Robin M Nance
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Lydia N Drumright
- Department of Biobehavioral Nursing and Health Informatics, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Allison R Webel
- Department of Child, Family and Population Health Nursing, University of Washington, Health Sciences Building, Box 357260, 1959 NE Pacific Ave, Seattle, WA, USA.
| | - Amanda L Willig
- Department of Medicine | Division of Infectious Diseases, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294, USA.
| | - Michael S Saag
- Department of Medicine | Division of Infectious Diseases, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294, USA.
| | - Katerina Christopoulos
- School of Medicine, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA.
| | - Meredith Greene
- School of Medicine, University of California San Francisco, 490 Illinois Street, San Francisco, CA 94158, USA.
| | - Andrew W Hahn
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Joseph J Eron
- University of North Carolina, Chapel Hill, CB# 7030, Bioinformatics Building, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599-7030, USA.
| | - Sonia Napravnik
- Department of Epidemiology, 130 Mason Farm Rd, 2101 Bioinformatics Building, Chapel Hill, NC 27599-7215, USA.
| | | | - Geetanjali Chander
- Department of Medicine, 600N. Wolfe Street, Carnegie, Baltimore, MD 21287, USA.
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 3400N. Charles St. Baltimore, MD 21218-2683, USA.
| | - Edward R Cachay
- Owen Clinic, University of California San Diego, UC San Diego Health System, USA.
| | - Kenneth H Mayer
- Fenway Health/The Fenway Institute, 1340 Boylston Street, Boston, MA 02215, USA.
| | - Alan Landay
- Rush University, 1735 W. Harrison St, Chicago, IL 60612, USA.
| | - Steven Austad
- Department of Biology, Campbell Hall, 1300 University Blvd, University of Alabama Birmingham, Birmingham, AL, USA.
| | - Jimmy Ma
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Gerontology & Geriatric Medicine, Stricht Center for Healthy Aging and Alzheimer's Prevention, 475 Vine Street, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Chintan Pandya
- Center for Population Health Information Technology, Wolfe Street, Baltimore, MD 21205, Johns Hopkins University, Baltimore, MD, USA.
| | - Chad Achenbach
- Department of Medicine, Northwestern University Feinberg School of Medicine, 645 N Michigan Ave # 1, Chicago, IL 60611, USA.
| | | | - Mari Kitahata
- Department of Medicine, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA.
| | - Joseph Ac Delaney
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada.
| | - Charles Kamen
- Department of Surgery University of Rochester Medical Center Rochester, NY, USA.
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10
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Lesko CR, Hutton HE, Edwards JK, McCaul ME, Fojo AT, Keruly JC, Moore RD, Chander G. Alcohol Use Disorder and Recent Alcohol Use and HIV Viral Non-Suppression Among People Engaged in HIV Care in an Urban Clinic, 2014-2018. AIDS Behav 2022; 26:1299-1307. [PMID: 34626264 PMCID: PMC8940688 DOI: 10.1007/s10461-021-03487-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 01/28/2023]
Abstract
We estimated joint associations between having history of alcohol use disorder (AUD) (based on prior ICD-9/ICD-10 codes) and recent self-reported alcohol use and viral non-suppression (≥ 1 viral load measurement > 20 copies/mL in the same calendar year as alcohol consumption was reported) among patients on ART enrolled in routine care, 2014-2018, in an urban specialty clinic. Among 1690 patients, 26% had an AUD, 21% reported high-risk alcohol use, and 39% had viral non-suppression. Relative to person-years in which people without AUD reported not drinking, prevalence of viral non-suppression was higher in person-years when people with AUD reported drinking at any level; prevalence of viral non-suppression was not significantly higher in person-years when people with AUD reported not drinking or person-years when people without AUD reported drinking at any level. No level of alcohol use may be "safe" for people with a prior AUD with regard to maintaining viral suppression.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jeanne C Keruly
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Richard D Moore
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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11
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Chander G, Hutton HE, Xu X, Canan CE, Gaver J, Finkelstein J, Lesko CR, McCaul ME, Lau B. Computer delivered intervention for alcohol and sexual risk reduction among women attending an urban sexually transmitted infection clinic: A randomized controlled trial. Addict Behav Rep 2021; 14:100367. [PMID: 34938828 PMCID: PMC8664779 DOI: 10.1016/j.abrep.2021.100367] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 12/18/2022] Open
Abstract
Unhealthy alcohol use is prevalent among women attending STI clinics. We tested whether CBI or CBI-IVR-TM, reduced alcohol use among women in this setting. Neither CBI nor CBI-IVR-TM reduced alcohol use more than control. 2/3 of women had an alcohol use disorder, 65% substance use, 28% depressive symptoms. CBI is insufficient for alcohol reduction in this high severity, high comorbidity setting.
Objective We sought to determine if a computer delivered brief alcohol intervention (CBI) with or without interactive voice response counseling and text messages (CBI-IVR-TM), reduced alcohol use and sexual risk behaviors compared to attention control. Methods We conducted a 3-arm RCT among women (n = 439) recruited from Baltimore City Sexually Transmitted Infection (STI) Clinics. Eligibility included: 1) consumption of >7 drinks per week or 2) ≥2 episodes of heavy episodic drinking or ≥2 episodes of sex under the influence of alcohol in the prior three months. Research assessments conducted at baseline, 3, 6 and 12 months included a 30-day Timeline Followback querying daily alcohol use, drug use, and sexual activity. We used the MINI International Neuropsychiatric Interview-DSM-IV to ascertain drinking severity. Primary alcohol outcomes included: drinking days, heavy drinking days, drinks per drinking day. Secondary sexual risk outcomes included number of sexual partners, days of condomless sex, and days of condomless sex under the influence of drugs and alcohol. Results Median age was 31 (IQR 25–44 years), 88% were African American, 65% reported current recreational drug use, and 26% endorsed depressive symptoms. On the MINI 66% met criteria for alcohol use disorder (49% alcohol dependence, 18% abuse). At follow-up, all three groups reduced drinking days, heavy drinking days, drinks per drinking day and drinks per week with no significant differences between study arms. There was no difference in sexual risk outcomes among the groups. Conclusions Among women attending an urban STI clinic single session CBI with or without IVR and text message boosters was insufficient to reduce unhealthy alcohol use or sexual risk behaviors beyond control. The high severity of alcohol use and the prevalence of mental health symptoms and other substance use comorbidity underscores the importance of developing programs that address not only alcohol use but other determinants of STI risk among women.
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Affiliation(s)
- Geetanjali Chander
- Johns Hopkins University School of Medicine, Department of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States
| | - Heidi E Hutton
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 550 N. Broadway, Baltimore, MD 21205, United States
| | - Xiaoqiang Xu
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 550 N. Broadway, Baltimore, MD 21205, United States
| | - Chelsea E Canan
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21287, United States
| | - Jennifer Gaver
- Johns Hopkins University School of Medicine, Department of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States
| | - Joseph Finkelstein
- Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, New York, NY 10029, United States
| | - Catherine R Lesko
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21287, United States
| | - Mary E McCaul
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, 550 N. Broadway, Baltimore, MD 21205, United States
| | - Bryan Lau
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21287, United States
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12
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McCaul ME, Hutton HE, Cropsey KL, Crane HM, Lesko CR, Chander G, Mugavero MJ, Kitahata MM, Lau B, Saag MS. Decreased Alcohol Consumption in an Implementation Study of Computerized Brief Intervention among HIV Patients in Clinical Care. AIDS Behav 2021; 25:4074-4084. [PMID: 33993353 PMCID: PMC8594281 DOI: 10.1007/s10461-021-03295-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Accepted: 04/29/2021] [Indexed: 12/28/2022]
Abstract
This prospective, nonrandomized implementation study evaluated a computerized brief intervention (CBI) for persons with HIV (PWH) and heavy/hazardous alcohol use. CBI was integrated into two HIV primary care clinics. Eligible patients were engaged in care, ≥ 18 years old, English speaking, endorsed heavy/hazardous alcohol use on the Alcohol Use Disorders Identification Test-C (AUDIT-C). Two 20-min computerized sessions using cognitive behavioral techniques were delivered by a 3-D avatar on touch screen tablets. Of 816 eligible AUDIT-C scores, 537 (66%) resulted in CBI invitation, 226 (42%) of invited patients enrolled, and 176 (78%) of enrolled patients watched at least one session. CBI enrollment was associated with a significant average reduction of 9.1 drinks/week (95% CI - 14.5, - 3.6) 4-12 months post-enrollment. Among those who participated in one or both sessions, average reduction in drinks/week was 11.7 drinks/week (95% CI - 18.8, - 4.6). There was corresponding improvement in AUDIT-C scores. Overall patients reported high levels of intervention satisfaction, particularly among older and Black patients. These promising results point to a practical intervention for alcohol reduction in this vulnerable patient population with elevated rates of heavy/hazardous drinking. Future research should examine strategies to increase initial engagement, strengthen intervention effects to increase the number of patients who achieve non-hazardous drinking, and examine the duration of therapeutic effects.
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Affiliation(s)
- Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 550 N Broadway, Suite 115, Baltimore, MD, 21205, USA.
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 550 N Broadway, Suite 115, Baltimore, MD, 21205, USA
| | - Karen L Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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13
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Crane HM, Nance R, Whitney BM, Ruderman S, Tsui JI, Chander G, McCaul ME, Lau B, Mayer KH, Batey DS, Safren SA, Moore RD, Eron JJ, Napravnik S, Mathews WC, Fredericksen RJ, Hahn AW, Mugavero MJ, Lober WB, Saag MS, Kitahata MM, Delaney JAC. Drug and alcohol use among people living with HIV in care in the United States by geographic region. AIDS Care 2021; 33:1569-1576. [PMID: 33486978 PMCID: PMC9104760 DOI: 10.1080/09540121.2021.1874274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/03/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Substance use in the U.S. varies by geographic region. Opioid prescribing practices and marijuana, heroin, and methamphetamine availability are evolving differently across regions. We examined self-reported substance use among people living with HIV (PLWH) in care at seven sites from 2017-2019 to understand current regional substance use patterns. We calculated the percentage and standardized percentage of PLWH reporting current drug use and at-risk and binge alcohol use by U.S. Census Bureau geographic region and examined associations in adjusted logistic regression analyses. Among 7,686 PLWH, marijuana use was the most prevalent drug (30%), followed by methamphetamine/crystal (8%), cocaine/crack (7%), and illicit opioids (3%). One-third reported binge alcohol use (32%). Differences in percent of current use by region were seen for marijuana (24-41%) and methamphetamine/crystal (2-15%), with more use in the West and Northeast, and binge alcohol use (26-40%). In adjusted analyses, PLWH in the Midwest were significantly less likely to use methamphetamine/crystal (aOR: 0.13;0.06-0.25) or illicit opioids (aOR:0.16;0.05-0.53), and PLWH in the Northeast were more likely to use cocaine/crack (aOR:1.59;1.16-2.17), compared to PLWH in the West. Understanding differences in substance use patterns in the current era, as policies continue to evolve, will enable more targeted interventions in clinical settings among PLWH.
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Affiliation(s)
- Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Robin Nance
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Judith I. Tsui
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Kenneth H. Mayer
- Fenway Institute and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - D Scott Batey
- Department of Social Work, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami FL, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - W Chris Mathews
- Department of Medicine, University of California at San Diego, San Diego, CA, USA
| | | | - Andrew W Hahn
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William B Lober
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Joseph AC Delaney
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Manitoba, Manitoba, Canada
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14
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Lee RS, Zandi PP, Santos A, Aulinas A, Carey JL, Webb SM, McCaul ME, Resmini E, Wand GS. Cross-species Association Between Telomere Length and Glucocorticoid Exposure. J Clin Endocrinol Metab 2021; 106:e5124-e5135. [PMID: 34265046 PMCID: PMC8787853 DOI: 10.1210/clinem/dgab519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Indexed: 12/12/2022]
Abstract
CONTEXT Chronic exposure to glucocorticoids (GCs) or stress increases the risk of medical disorders, including cardiovascular and neuropsychiatric disorders. GCs contribute to accelerated aging; however, while the link between chronic GC exposure and disease onset is well established, the underpinning mechanisms are not clear. OBJECTIVE We explored the potential nexus between GCs or stress exposure and telomere length. METHODS In addition to rats exposed to 3 weeks of chronic stress, an iatrogenic mouse model of Cushing syndrome (CS), and a mouse neuronal cell line, we studied 32 patients with CS and age-matched controls and another cohort of 75 healthy humans. RESULTS (1) Exposure to stress in rats was associated with a 54.5% (P = 0.036) reduction in telomere length in T cells. Genomic DNA (gDNA) extracted from the dentate gyrus of stressed and unstressed rats showed 43.2% reduction in telomere length (P = 0.006). (2) Mice exposed to corticosterone had a 61.4% reduction in telomere length in blood gDNA (P = 5.75 × 10-5) and 58.8% reduction in telomere length in the dentate gyrus (P = 0.002). (3) We observed a 40.8% reduction in the telomere length in patients with active CS compared to healthy controls (P = 0.006). There was a 17.8% reduction in telomere length in cured CS patients, which was not different from that of healthy controls (P = 0.08). For both cured and active CS, telomere length correlated significantly with duration of hypercortisolism (R2 = 0.22, P = 0.007). (4) There was a 27.6% reduction in telomere length between low and high tertiles in bedtime cortisol levels of healthy participants (P = 0.019). CONCLUSION Our findings demonstrate that exposure to stress and/or GCs is associated with shortened telomeres, which may be partially reversible.
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Affiliation(s)
- Richard S Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Peter P Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA
| | - Alicia Santos
- Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unit747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Anna Aulinas
- Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unit747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jenny L Carey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Susan M Webb
- Endocrinology/Medicine Department, Hospital Sant Pau, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER, Unit747), IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Eugenia Resmini
- Correspondence: Eugenia Resmini, MD, PhD, Endocrinology/Medicine Department, Hospital Sant Pau, CIBER-ER, Unit747, IIB-Sant Pau, ISCIII, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Gary S Wand
- Gary S. Wand, MD, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
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15
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Lee RS, Zandi PP, Lin Y, Seifuddin F, Benke KS, McCaul ME, Reitz K, Wand GS. Methylomic and transcriptomic predictors of one-month exposure to cortisol in healthy individuals. Stress 2021; 24:840-848. [PMID: 34279166 DOI: 10.1080/10253890.2021.1946509] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Allostatic load (AL) refers to the cumulative "wear and tear" on an organism throughout its lifetime. One of the primary contributing factors to AL is prolonged exposure to stress or its primary catabolic agent cortisol. Chronic exposure to stress or cortisol is associated with numerous diseases, including cardiovascular disease, metabolic disorders, and psychiatric disorders. Therefore, a molecular marker capable of integrating a past history of cortisol exposure would be of great utility for assessing disease risk. To this end, we recruited 87 healthy males and females of European ancestry between 18 and 60 years old, extracted genomic DNA and RNA from leukocytes, and implemented a gene-centric DNA enrichment method coupled with bisulfite sequencing and RNA-Seq of total RNA for the determination of genome-wide methylation and gene transcription, respectively. Sequencing data were analyzed against awakening and bedtime cortisol data to identify differentially methylated regions (DMRs) and CpGs (DMCs) and differentially expressed genes (DEGs). Six candidate DMCs (punadjusted < 0.005) and nine DEGs (punadjusted < 0.0005) were used to construct a prediction model that could capture past 30+ days of both bedtime and awakening cortisol levels. Utilizing a cross-validation approach, we obtained a regression coefficient of R2 = 0.308 for predicting continuous awakening cortisol and an area under the curve (AUC) = 0.753 for dichotomous (high vs. low tertile) awakening cortisol, and R2 = 0.224 and AUC = 0.723 for continuous and dichotomous bedtime cortisol levels, respectively. To our knowledge, the current study represents the first attempt to identify genome-wide predictors of cortisol exposure that utilizes both methylation and transcription targets. The utility of our approach needs to be replicated in an independent cohort of samples for which similar cortisol metrics are available.
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Affiliation(s)
- Richard S Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Peter P Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yian Lin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fayaz Seifuddin
- Bioinformatics and Computational Biology Core, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kelly S Benke
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kendall Reitz
- Department of and Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gary S Wand
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of and Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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16
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Lesko CR, Nance RM, Lau B, Fojo AT, Hutton HE, Delaney JAC, Crane HM, Cropsey KL, Mayer KH, Napravnik S, Geng E, Mathews WC, McCaul ME, Chander G. Changing Patterns of Alcohol Use and Probability of Unsuppressed Viral Load Among Treated Patients with HIV Engaged in Routine Care in the United States. AIDS Behav 2021; 25:1072-1082. [PMID: 33064249 DOI: 10.1007/s10461-020-03065-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Accepted: 10/12/2020] [Indexed: 01/13/2023]
Abstract
We examined HIV viral load non-suppression ([Formula: see text] 200 copies/mL) subsequent to person-periods (3-18 months) bookended by two self-reports of alcohol use on a standardized patient reported outcome assessment among adults in routine HIV care. We examined the relative risk (RR) of non-suppression associated with increases and decreases in alcohol use (relative to stable use), stratified by use at the start of the person-period. Increases in drinking from abstinence were associated with higher risk of viral non-suppression (low-risk without binge: RR 1.16, 95% CI 1.03, 1.32; low-risk with binge: RR 1.35, 95% CI 1.11, 1.63; high-risk: RR 1.89, 95% CI 1.16, 3.08). Decreases in drinking from high-risk drinking were weakly, and not statistically significantly associated with lower risk of viral non-suppression. Other changes in alcohol use were not associated with viral load non-suppression. Most changes in alcohol consumption among people using alcohol at baseline were not strongly associated with viral non-suppression.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Robin M Nance
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Heidi M Crane
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Karen L Cropsey
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AB, USA
| | - Kenneth H Mayer
- Fenway Health, Beth Israel Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Elvin Geng
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | | | - Mary E McCaul
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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17
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Affiliation(s)
- Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ivana Grakalic
- Division of Neuroscience and Behavior, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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18
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Abstract
African-American (AA) women are overrepresented among women with HIV (WWH). In the United States, psychiatric disorders are prevalent among WWH and associated with adverse outcomes. However, little research has examined psychiatric disorders among AA WWH. 315 AA women who were hazardous/heavy drinkers (HD) or moderate/non-drinkers (ND) were recruited from an HIV clinic in a study on alcohol use disorders. We compared sample prevalence of Axis-1 psychiatric diagnoses using the Structured Clinical Interview for DSM-IV with those from general population AA women in the National Comorbidity Survey-Replication (NCS-R). While 29.9% of general population AA women had any lifetime disorder, 66.9% of HD and 62.4% of ND WWH met criteria for a lifetime Axis-1 disorder. Specifically, lifetime PTSD and lifetime MDD were over threefold higher; current PTSD and current MDD respectively were 11-fold and threefold higher. PTSD was the most frequent comorbid diagnosis. HD and ND WWH did not differ in prevalence of psychiatric diagnoses despite significantly higher rates of substance use among HD women. Diagnostic evaluation and intervention for psychiatric disorders should be a priority in HIV medical care settings to improve health outcomes. Interventions should be tailored to address the particular stressors, challenges, and resiliencies among AA WWH.
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Affiliation(s)
- Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
| | - Noa Cardin
- Department of Health Science, Towson University, Towson, MD, USA
| | - Keemi Ereme
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xiaoqiang Xu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
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19
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McCaul ME, Wand GS, Kuwabara H, Dannals RF, Wong D, Xu X. The Relationship of Varenicline Agonism of α4β2 Nicotinic Acetylcholine Receptors and Nicotine-Induced Dopamine Release in Nicotine-Dependent Humans. Nicotine Tob Res 2020; 22:892-899. [PMID: 31096265 PMCID: PMC7529151 DOI: 10.1093/ntr/ntz080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/15/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Cigarette smoking continues to be one of the most important behavioral causes of morbidity and mortality in the world. Varenicline, an α4β2 nicotinic acetylcholine receptor (nAChR) partial agonist, has been shown to increase smoking quit rates compared with nicotine-based products. This human laboratory, double-blind, placebo-controlled study examined varenicline and placebo effects on α4β2-nAChRs occupancy, nicotine-induced change in [11C]raclopride non-displaceable binding potential (BPND), and behavioral measures of cigarette smoking, nicotine craving, and withdrawal. METHODS Current nicotine dependent daily smokers (N = 17) were randomized to varenicline 1 mg twice daily or placebo for 13 days. Using positron emission tomography), we characterized α4β2-nAChRs occupancy using [18F]AZAN and dopamine receptor binding using [11C]raclopride as well as behavioral measures of cigarettes smoked, craving, and nicotine withdrawal. RESULTS Varenicline compared with placebo resulted in significant reductions in [18F]AZAN BPND in multiple brain regions including thalamus, midbrain, putamen, and ventral striatum. Following administration of a controlled-dose nicotine cigarette, dopamine release was significantly suppressed in the ventral striatum in the varenicline-treated compared with the placebo group. There was a significant relationship between α4β2-nAChRs BPND measured in thalamus during the [18F]AZAN scan and nicotine-induced change in raclopride BPND in the ventral striatum. CONCLUSION This is the first human study to demonstrate a direct relationship between the extent of varenicline occupancy of α4β2-nAChRs and the magnitude of dopamine release following nicotine use. IMPLICATIONS It has remained unclear how nicotinic receptor blockade through partial agonist medications such as varenicline promotes smoking cessation. One hypothesized mechanism is downstream dampening of the mesolimbic reward dopamine system. For the first time in human smokers, we observed a direct relationship between the extent of varenicline blockade of α4β2-nACh nicotinic receptors and the magnitude of dopamine release following smoking. This has mechanistic and therapeutic implications for improving smoking cessation interventions.
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Affiliation(s)
- Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gary S Wand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hiroto Kuwabara
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert F Dannals
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dean Wong
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Xiaoqiang Xu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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20
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Desmond JE, Rice LC, Cheng DT, Hua J, Qin Q, Rilee JJ, Faulkner ML, Sheu YS, Mathena JR, Wand GS, McCaul ME. Changes in Hemodynamic Response Function Resulting From Chronic Alcohol Consumption. Alcohol Clin Exp Res 2020; 44:1099-1111. [PMID: 32339317 DOI: 10.1111/acer.14327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Functional MRI (fMRI) task-related analyses rely on an estimate of the brain's hemodynamic response function (HRF) to model the brain's response to events. Although changes in the HRF have been found after acute alcohol administration, the effects of heavy chronic alcohol consumption on the HRF have not been explored, and the potential benefits or pitfalls of estimating each individual's HRF on fMRI analyses of chronic alcohol use disorder (AUD) are not known. METHODS Participants with AUD and controls (CTL) received structural, functional, and vascular scans. During fMRI, participants were cued to tap their fingers, and averaged responses were extracted from the motor cortex. Curve fitting on these HRFs modeled them as a difference between 2 gamma distributions, and the temporal occurrence of the main peak and undershoot of the HRF was computed from the mean of the first and second gamma distributions, respectively. RESULTS ANOVA and regression analyses found that the timing of the HRF undershoot increased significantly as a function of total lifetime drinking. Although gray matter volume in the motor cortex decreased with lifetime drinking, this was not sufficient to explain undershoot timing shifts, and vascular factors measured in the motor cortex did not differ among groups. Comparison of random-effects analyses using custom-fitted and canonical HRFs for CTL and AUD groups showed better results throughout the brain for custom-fitted versus canonical HRFs for CTL subjects. For AUD subjects, the same was true except for the basal ganglia. CONCLUSIONS These findings suggest that excessive alcohol consumption is associated with changes in the HRF undershoot. HRF changes could provide a possible biomarker for the effects of lifetime drinking on brain function. Changes in HRF topography affect fMRI activation measures, and subject-specific HRFs generally improve fMRI activation results.
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Affiliation(s)
- John E Desmond
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura C Rice
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dominic T Cheng
- Johns Hopkins University School of Medicine, Baltimore, Maryland.,Auburn University, Auburn, Alabama
| | - Jun Hua
- Johns Hopkins University School of Medicine, Baltimore, Maryland.,Kennedy Krieger Institute, Baltimore, Maryland
| | - Qin Qin
- Johns Hopkins University School of Medicine, Baltimore, Maryland.,Kennedy Krieger Institute, Baltimore, Maryland
| | - Jessica J Rilee
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Yi-Shin Sheu
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joanna R Mathena
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gary S Wand
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary E McCaul
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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21
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Cheng DT, Rice LC, McCaul ME, Rilee JJ, Faulkner ML, Sheu YS, Mathena JR, Desmond JE. Neural Substrates Underlying Eyeblink Classical Conditioning in Adults With Alcohol Use Disorders. Alcohol Clin Exp Res 2020; 44:620-631. [PMID: 31984510 DOI: 10.1111/acer.14288] [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] [Received: 09/04/2019] [Accepted: 01/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Excessive alcohol consumption produces changes in the brain that often lead to cognitive impairments. One fundamental form of learning, eyeblink classical conditioning (EBC), has been widely used to study the neurobiology of learning and memory. Participants with alcohol use disorders (AUD) have consistently shown a behavioral deficit in EBC. The present functional magnetic resonance imaging (fMRI) study is the first to examine brain function during conditioning in abstinent AUD participants and healthy participants. METHODS AUD participants met DSM-IV criteria for alcohol dependence, had at least a 10-year history of heavy drinking, and were abstinent from alcohol for at least 30 days. During fMRI, participants received auditory tones that predicted the occurrence of corneal airpuffs. Anticipatory eyeblink responses to these tones were monitored during the experiment to assess learning-related changes. RESULTS Behavioral results indicate that AUD participants showed significant conditioning deficits and that their history of lifetime drinks corresponded to these deficits. Despite this learning impairment, AUD participants showed hyperactivation in several key cerebellar structures (including lobule VI) during conditioning. For all participants, history of lifetime drinks corresponded with their lobule VI activity. CONCLUSIONS These findings suggest that excessive alcohol consumption is associated with abnormal cerebellar hyperactivation and conditioning impairments.
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Affiliation(s)
- Dominic T Cheng
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Psychology, Auburn University, Auburn, Alabama
| | - Laura C Rice
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary E McCaul
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica J Rilee
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Monica L Faulkner
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yi-Shin Sheu
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joanna R Mathena
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John E Desmond
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland
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22
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Ge S, McCaul ME, Nolan MT, Wei Z, Liu T, Chander G. The relationship between alcohol use and anxiety and retrospective attendance of primary care visits among women with human immunodeficiency virus. AIDS Care 2019; 31:1362-1368. [PMID: 31124373 DOI: 10.1080/09540121.2019.1619658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/23/2018] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
In this retrospective study, we sought to determine the associations between alcohol use and anxiety and RIC among WHIV. Alcohol use was assessed using the Timeline Follow-back to measure use over the 90 days preceding the interview. Anxiety symptoms scores, assessed with the Hospital Anxiety and Depression Scale- Anxiety Subscale (HADS-A). Primary care visits over twelve months prior to the interview were collected from clinic registration records. We used three logistic mixed models, adjusting for age, race, education, cocaine use, depression, viral load, and antiretroviral therapy (ART) status. Among 364 WHIV, mean attendance of primary care visits was 63.9%. Every one-day increase in drinking days (OR = 0.99, 95% CI 0.99, 1.00) or heavy drinking days (OR = 0.99, 95% CI 0.90, 1.00) was associated with decreased odds of attending primary care visits (P = 0.02). Moderate/severe anxiety scores, compared to minimal anxiety scores, were associated with decreased odds of attending primary care visits (OR = 0.69, 95% CI 0.50, 0.97). Cocaine use was associated with decreased odds of attending primary care visits (OR 0.56, 0.57). Our findings indicate that identifying and treating WHIV with alcohol use (especially heavy drinking), moderate/severe anxiety symptoms and/or cocaine use could potentially improve their RIC.
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Affiliation(s)
- Song Ge
- Department of Chronic Illness, Johns Hopkins University School of Nursing , Baltimore , MD , USA
- Department of Natural Sciences/Nursing, University of Houston-Downtown , Houston , TX , USA
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Marie T Nolan
- Department of Chronic Illness, Johns Hopkins University School of Nursing , Baltimore , MD , USA
| | - Zhe Wei
- Department of Statistics, The George Washington University , Washington , DC , USA
| | - Tingting Liu
- School of Nursing, University of Arkansas , Fayetteville , AR , USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine , Baltimore , MD , USA
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23
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Hutton HE, Lesko CR, Li X, Thompson CB, Lau B, Napravnik S, Mayer KH, Mathews WC, McCaul ME, Crane HM, Fredericksen RJ, Cropsey KL, Saag M, Christopoulos K, Chander G. Alcohol Use Patterns and Subsequent Sexual Behaviors Among Women, Men who have Sex with Men and Men who have Sex with Women Engaged in Routine HIV Care in the United States. AIDS Behav 2019; 23:1634-1646. [PMID: 30443807 PMCID: PMC6830881 DOI: 10.1007/s10461-018-2337-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 02/08/2023]
Abstract
Among people with HIV, alcohol use is associated with increased prevalence of sexual transmission behaviors. We examined associations between alcohol use in the prior year and sexual behaviors approximately six months later among 1857 women, 6752 men who have sex with men (MSM) and 2685 men who have sex with women (MSW). Any alcohol use was associated with increased risk of unsafe vaginal sex among women; anal sex and =>2 anal sex partners among MSM; and anal sex, =>2 anal or vaginal sex partners, and unsafe vaginal sex among MSW. In particular, among women >7 alcoholic drinks/week and among MSW =>5 alcoholic drinks/drinking day increased the likelihood of certain subsequent sexual behaviors. For all groups, especially women, the risk of sex under the influence of drugs/alcohol markedly increased with increases in quantity and frequency of alcohol consumption. These different patterns of drinking and sexual behaviors indicate the importance of tailored counseling messages to women, MSM and MSW.
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Affiliation(s)
- Heidi E Hutton
- Department of Psychiatry, Johns Hopkins University School of Medicine, Meyer 3-147, 600 N. Wolfe St, Baltimore, MD, 21287, USA.
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ximin Li
- Biostatics Center, Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Carol B Thompson
- Biostatics Center, Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Kenneth H Mayer
- Department of Global Health and Population, Harvard School of Public Health, Boston, USA
| | | | - Mary E McCaul
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - Rob J Fredericksen
- Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - Karen L Cropsey
- Department of Psychiatry, University of Alabama School of Medicine, Birmingham, USA
| | - Michael Saag
- Department of Medicine, University of Alabama School of Medicine, Birmingham, USA
| | - Katerina Christopoulos
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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24
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McCaul ME, Roach D, Hasin DS, Weisner C, Chang G, Sinha R. Alcohol and Women: A Brief Overview. Alcohol Clin Exp Res 2019; 43:774-779. [PMID: 30779446 DOI: 10.1111/acer.13985] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/11/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Mary E McCaul
- Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deidra Roach
- National Institute on Alcohol Abuse and Alcoholism , Rockville, Maryland
| | - Deborah S Hasin
- New York State Psychiatric Institute (NYSPI) , Columbia University, New York, New York
| | | | - Grace Chang
- Department of Psychiatry , Harvard Medical School, Boston, Massachusetts
| | - Rajita Sinha
- Department of Psychiatry, Neuroscience and Child Study , Yale University School of Medicine, New Haven, Connecticut
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25
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Fojo AT, Lesko CR, Calkins KL, Moore RD, McCaul ME, Hutton HE, Mathews WC, Crane H, Christopoulos K, Cropsey K, Mugavero MJ, Mayer K, Pence BW, Lau B, Chander G. Do Symptoms of Depression Interact with Substance Use to Affect HIV Continuum of Care Outcomes? AIDS Behav 2019; 23:580-591. [PMID: 30269230 PMCID: PMC6408233 DOI: 10.1007/s10461-018-2269-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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] [Indexed: 12/18/2022]
Abstract
Few studies examine how depression and substance use interact to affect HIV control. In 14,380 persons with HIV (PWH), we used logistic regression and generalized estimating equations to evaluate how symptoms of depression interact with alcohol, cocaine, opioid, and methamphetamine use to affect subsequent retention in care, maintaining an active prescription for ART, and consistent virologic suppression. Among PWH with no or mild depressive symptoms, heavy alcohol use had no association with virologic suppression (OR 1.00 [0.95-1.06]); among those with moderate or severe symptoms, it was associated with reduced viral suppression (OR 0.80 [0.74-0.87]). We found no interactions with heavy alcohol use on retention in care or maintaining ART prescription or with other substances for any outcome. These results highlight the importance of treating moderate or severe depression in PWH, especially with comorbid heavy alcohol use, and support multifaceted interventions targeting alcohol use and depression.
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Affiliation(s)
- Anthony T Fojo
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keri L Calkins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Richard D Moore
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mary E McCaul
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Heidi E Hutton
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - William C Mathews
- School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Heidi Crane
- School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Karen Cropsey
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael J Mugavero
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kenneth Mayer
- School of Medicine, Harvard University, Cambridge, MA, USA
| | - Brian W Pence
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lee RS, Mahon PB, Zandi PP, McCaul ME, Yang X, Bali U, Wand GS. DNA methylation and sex-specific expression of FKBP5 as correlates of one-month bedtime cortisol levels in healthy individuals. Psychoneuroendocrinology 2018; 97:164-173. [PMID: 30036794 PMCID: PMC6366448 DOI: 10.1016/j.psyneuen.2018.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/17/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Abstract
Chronic exposure to cortisol is associated with cardiovascular, metabolic, and psychiatric disorders. Although cortisol can be readily measured from peripheral sources such as blood, urine, or saliva, multiple samplings spanning several days to weeks are necessary to reliably assess chronic cortisol exposure levels (referred to as cortisol load). Although cortisol levels in hair have been proposed as a measure of cortisol load, measurement is cumbersome and many people are not candidates due to short hair length and use of hair dyes. To date, there are no blood biomarkers that capture cortisol load. To identify a blood biomarker capable of integrating one-month cortisol exposure levels, 75 healthy participants provided 30+ days of awakening and bedtime saliva cortisol and completed psychosocial measures of anxiety, depression, and stress. Mean daily awakening and bedtime cortisol levels were then compared to CpG methylation levels, gene expression, and genotypes of the stress response gene FKBP5 obtained from blood drawn on the last day of the study. We found a correlation between FKBP5 methylation levels and mean 30+day awakening and bedtime cortisol levels (|r|≥0.32, p ≤ 0.006). We also observed a sex-specific correlation between bedtime cortisol levels and FKBP5 mRNA expression in female participants (r = 0.42, p = 0.005). Dividing the 30-day sampling period into four weekly bins showed that the correlations for both methylation and expression were not being driven by cortisol levels in the week preceding the blood draw. We also identified a female-specific association between FKBP5 mRNA expression and scores on the Beck Anxiety Inventory (r = 0.37, p = 0.013) and Beck Depression Inventory-II (r = 0.32, p = 0.033). Finally, DNA was genotyped at four SNPs, and variation in rs4713902 was shown to have an effect on FKBP5 expression under a codominant model (f = 3.41, p = 0.048) for females only. Our results suggest that blood FKBP5 DNA methylation and mRNA expression levels may be a useful marker for determining general or sex-specific 30-day cortisol load and justifies genome-wide approaches that can potentially identify additional cortisol markers with broader clinical utility.
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Affiliation(s)
- Richard S Lee
- Department of Psychiatry and Behavioral Sciences and Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States
| | - Pamela B Mahon
- Department of Psychiatry and Behavioral Sciences and Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States; Department of Psychiatry, Brigham & Women's Hospital and Harvard Medical School, Boston, MA 02115, United States
| | - Peter P Zandi
- Department of Psychiatry and Behavioral Sciences and Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States; Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, 21205, United States
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences and Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States
| | - Xiaoju Yang
- Department of Psychiatry and Behavioral Sciences and Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States
| | - Utsav Bali
- Sygnature Discovery, Nottingham, NG1 1GF, UK
| | - Gary S Wand
- Department of Psychiatry and Behavioral Sciences and Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, 21205, United States.
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Yang C, DeBartolo P, McCaul ME, Hutton HE, Gebrekristos H, Chander G. The role of personal and household members' substance use in health-related quality of life in women living with HIV/AIDS. AIDS Care 2018; 30:473-479. [PMID: 29271242 PMCID: PMC5818997 DOI: 10.1080/09540121.2017.1417972] [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] [Indexed: 10/18/2022]
Abstract
Advances in HIV treatments have led to a greater focus on health-related quality of life (HRQOL) among people living with HIV/AIDS. The current study examined factors associated with HRQOL among 378 women in HIV care. HRQOL was measured using a modified version of the 12-Item Short Form Health Survey; scores were derived for the mental and physical composite summaries (MCS and PCS). We measured personal alcohol use and drug use. Household members' substance use were assessed by asking participants about the alcohol/drug status of persons with whom they live. Multivariate generalized linear models were used to estimate the linear association between MCS and PCS scores and personal and household members' alcohol and drug use. We found lower MCS scores were significantly associated with personal alcohol use and living with someone with alcohol or/and drug problems. Lower PCS scores were not significantly associated with personal alcohol use or living with someone with alcohol or/and drug problems. Findings suggest that universal screening and targeted interventions for alcohol use by the patient or household members may offer potential strategies for improving mental health quality of life among women living with HIV/AIDS.
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Affiliation(s)
- Cui Yang
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205
| | | | - Mary E. McCaul
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Heidi E. Hutton
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Hirut Gebrekristos
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205
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Weeks SR, Sun Z, McCaul ME, Zhu H, Anders RA, Philosophe B, Ottmann SE, Garonzik Wang JM, Gurakar AO, Cameron AM. Liver Transplantation for Severe Alcoholic Hepatitis, Updated Lessons from the World’s Largest Series. J Am Coll Surg 2018; 226:549-557. [DOI: 10.1016/j.jamcollsurg.2017.12.044] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 12/19/2022]
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McCaul ME, Wand GS, Weerts EM, Xu X. A paradigm for examining stress effects on alcohol-motivated behaviors in participants with alcohol use disorder. Addict Biol 2018; 23:836-845. [PMID: 28419649 PMCID: PMC5645206 DOI: 10.1111/adb.12511] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 10/13/2016] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 11/30/2022]
Abstract
Although epidemiological research has shown an increase in drinking following stressors and trauma, limited paradigms have been validated to study the relationship between stress and drinking in the human laboratory. The current study developed a progressive ratio (PR) operant procedure to examine the effects of psychosocial stress on alcohol craving and several alcohol-motivated behaviors in persons with alcohol use disorder. Current heavy, nontreatment-seeking drinkers (N = 30) were media-recruited and completed a comprehensive assessment of recent drinking, mood and health. Participants were admitted to the clinical research unit and underwent 4-day, physician-monitored alcohol abstinence. On days 4 and 5, participants underwent the Trier Social Stress Test or a neutral session in random order followed by the alcohol-motivated response (AMR) procedure in which subjects worked for money or alcohol under a PR operant procedure. Subjects received earned money vouchers or alcohol at the conclusion of the session. The Trier Social Stress Test increased alcohol craving and rate of responding and decreased the number of changeovers between alcohol versus money reinforcers on the PR schedule. There was a positive relationship between alcohol craving and drinks earned during the stress session. This novel paradigm provides an experimental platform to examine motivation to drink without confounding by actual alcohol ingestion during the work session, thereby setting the stage for future studies of alcohol interventions.
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Affiliation(s)
- Mary E. McCaul
- Department of Psychiatry and Behavioral SciencesThe Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Gary S. Wand
- Department of MedicineThe Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Elise M. Weerts
- Department of Psychiatry and Behavioral SciencesThe Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Xiaoqiang Xu
- Department of Psychiatry and Behavioral SciencesThe Johns Hopkins University School of MedicineBaltimoreMDUSA
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Bilal U, McCaul ME, Crane HM, Mathews WC, Mayer KH, Geng E, Napravnik S, Cropsey KL, Mugavero MJ, Saag MS, Hutton H, Lau B, Chander G. Predictors of Longitudinal Trajectories of Alcohol Consumption in People with HIV. Alcohol Clin Exp Res 2018; 42:561-570. [PMID: 29265385 DOI: 10.1111/acer.13583] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 12/12/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our aim was to describe alcohol consumption trajectories in a cohort of people living with HIV and determine clinical and sociodemographic predictors of each trajectory. METHODS This is a prospective cohort study of 7,906 patients in the 7 Centers for AIDS Research Network of Integrated Clinical Systems sites. Alcohol consumption was categorized as none, moderate, and alcohol misuse. Predictors included age, race/ethnicity, depressive or anxiety symptoms, illicit drug use (opioids, methamphetamines, cocaine/crack), marijuana use, hepatitis C virus (HCV) infection, HIV transmission risk factor, and HIV disease progression. We estimated sex-stratified alcohol consumption trajectories and their predictors. RESULTS We found 7 trajectories of alcohol consumption in men: stable nondrinking and increased drinking (71% and 29% of initial nondrinking); stable moderate, reduced drinking, and increased alcohol misuse (59%, 21%, and 21% of initial moderate alcohol use); and stable alcohol misuse and reduced alcohol misuse (75% and 25% of initial alcohol misuse). Categories were similar in women, except lack of an increase to alcohol misuse trajectory among women that begin with moderate use. Older men and women were more likely to have stable nondrinking, while younger men were more likely to increase to or remain in alcohol misuse. Minorities, people with depressive or anxiety symptoms, HCV-infected individuals, and people who injected drugs were more likely to reduce use. Illicit drug use was associated with a reduction in overall drinking, while marijuana use was associated with stable moderate drinking or misuse. CONCLUSIONS Longitudinal trajectories of increasing alcohol use and stable misuse highlight the need to integrate routine screening and alcohol misuse interventions into HIV primary care.
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Affiliation(s)
- Usama Bilal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Heidi M Crane
- Department of Medicine, UW School of Medicine, University of Washington, Seattle, Washington
| | | | - Kenneth H Mayer
- School of Medicine, Harvard University, Boston, Massachusetts.,School of Public Health, Harvard University, Boston, Massachusetts.,Fenway Health, Boston, Massachusetts
| | - Elvin Geng
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Karen L Cropsey
- Department of Medicine, University of Alabama, Birmingham, Alabama
| | | | - Michael S Saag
- Department of Medicine, University of Alabama, Birmingham, Alabama
| | - Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Geetanjali Chander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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McCaul ME, Wand GS. Detecting Deception in Our Research Participants: Are Your Participants Who You Think They Are? Alcohol Clin Exp Res 2017; 42:230-237. [PMID: 29286543 DOI: 10.1111/acer.13556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/09/2017] [Indexed: 12/20/2022]
Abstract
There is increasing awareness of the potential negative impacts of participant deception on research, including possibly undermining reliability and reproducibility of study findings. These deceptive individuals set their personal interests above the rules of study participation, thereby jeopardizing data quality as well as placing themselves and others at risk. The costs of participant deception are numerous. Overall, it reduces statistical power and may even result in false conclusions about efficacy and safety. To date, most studies have not utilized sufficient methods to detect rule-breaking subjects. The purpose of this article is to bring to the attention of alcohol and other drug researchers issues involving deceptive participants. The review will suggest alcohol-specific as well as more general strategies to identify and thereby minimize enrollment of these deceptive participants. Specifically, we will identify strategies that are employed in different phases of human alcohol research and advance approaches that may be helpful to the field in reducing these contaminants. As a field, we need to be more proactive in identifying the deceptive participant even at the cost of more burdensome study enrollment. In light of the systemic nature and multipronged damage that this emerging pattern of deception inflicts on clinical research, it is imperative that we each assume greater responsibility for our role in mitigating this source of research contamination.
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Affiliation(s)
- Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Medicine , The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gary S Wand
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Medicine , The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Sinha S, McCaul ME, Hutton HE, Monroe AK, Alvanzo A, Lesko C, Lau B, Keruly J, Moore RD, Chander G. Marijuana use and HIV treatment outcomes among PWH receiving care at an urban HIV clinic. J Subst Abuse Treat 2017; 82:102-106. [PMID: 29021107 DOI: 10.1016/j.jsat.2017.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND While marijuana use is prevalent among persons with HIV (PWH), few studies have examined the relationship between marijuana use and HIV treatment outcomes independent of alcohol and other drug use. METHODS We conducted a prospective cohort study to examine the relationships between frequency of marijuana use and antiretroviral therapy (ART) adherence and viral suppression in patients enrolled in the Johns Hopkins HIV Clinical Cohort between September 2013 through November 2015 (N=1377). We categorized marijuana use as no use, none in the last 3months, monthly use or less, weekly/daily. Our outcomes of interest were use of ART, ≥90 ART adherence, and viral suppression (HIV1-RNA<200 copies). We conducted multivariable analyses to examine associations between the frequency of marijuana use and our treatment outcomes, using generalized estimating equations to account for repeated measures. Other independent variables of interest included alcohol use, other drug use, and depressive symptoms. Analyses were adjusted for age, race, sex and HIV acquisition risk factor. RESULTS In multivariable analyses we found no statistically significant association between frequency of marijuana use and our treatment outcomes. Alcohol use, other drug use and depressive symptoms were associated with lower odds of ART adherence and viral suppression. CONCLUSIONS In this sample of PWH in care, frequency of marijuana use independent of other substance use does not appear to be associated with negative HIV treatment outcomes. Our results indicate that unlike alcohol, other substances and depression, marijuana use may not be a barrier to the effective treatment of HIV.
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Affiliation(s)
- Sagarika Sinha
- University of Maryland School of Medicine, United States
| | - Mary E McCaul
- Johns Hopkins University School of Medicine, United States
| | - Heidi E Hutton
- Johns Hopkins University School of Medicine, United States
| | - Anne K Monroe
- Johns Hopkins University School of Medicine, United States
| | - Anika Alvanzo
- Johns Hopkins University School of Medicine, United States
| | - Catherine Lesko
- Johns Hopkins University, Bloomberg School of Public Health, United States
| | - Bryan Lau
- Johns Hopkins University, Bloomberg School of Public Health, United States
| | - Jeanne Keruly
- Johns Hopkins University School of Medicine, United States
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Hutton H, Lesko CR, Chander G, Lau B, Wand GS, McCaul ME. Differential effects of perceived stress on alcohol consumption in moderate versus heavy drinking HIV-infected women. Drug Alcohol Depend 2017; 178:380-385. [PMID: 28704766 PMCID: PMC5604751 DOI: 10.1016/j.drugalcdep.2017.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine the association between perceived stress and subsequent alcohol use in women living with HIV. METHODS Women (n=338) receiving HIV care between April 2006 and July 2010 who enrolled in either a brief intervention for hazardous drinking or a cohort of non-hazardous drinkers completed a 90-day drinking and drug use history, and completed stress, depression and anxiety measures at 0, 6, and 12 months. We examined the association between perceived stress at months 0 or 6 and measures of quantity and frequency of alcohol use in months 3-6 and 9-12, respectively. RESULTS The association between perceived stress and subsequent alcohol use depended on whether women were heavy or moderate drinkers at index visit. Among women reporting ≥7 drinks/week at index visit, high levels of perceived stress were associated with subsequent increased alcohol intake. However, among women reporting >0 but <7 drinks/week at index visit, high levels of perceived stress were associated with a subsequent reduction in drinking. CONCLUSIONS Baseline drinking status moderates the relationship between perceived stress and subsequent alcohol use. Perceived stress is an important therapeutic target in women who are heavy drinkers.
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Affiliation(s)
- Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, John Hopkins School of Medicine, United States.
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
| | - Geetanjali Chander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States; Department of Medicine, Johns Hopkins School of Medicine, United States
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
| | - Gary S Wand
- Department of Medicine, Johns Hopkins School of Medicine, United States
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, John Hopkins School of Medicine, United States
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Kim HN, Crane HM, Rodriguez CV, Van Rompaey S, Mayer KH, Christopoulos K, Napravnik S, Chander G, Hutton H, McCaul ME, Cachay ER, Mugavero MJ, Moore R, Geng E, Eron JJ, Saag MS, Merrill JO, Kitahata MM. The Role of Current and Historical Alcohol Use in Hepatic Fibrosis Among HIV-Infected Individuals. AIDS Behav 2017; 21:1878-1884. [PMID: 28035496 DOI: 10.1007/s10461-016-1665-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We examined risk factors for advanced hepatic fibrosis [fibrosis-4 (FIB)-4 >3.25] including both current alcohol use and a diagnosis of alcohol use disorder among HIV-infected patients. Of the 12,849 patients in our study, 2133 (17%) reported current hazardous drinking by AUDIT-C, 2321 (18%) had a diagnosis of alcohol use disorder, 2376 (18%) were co-infected with chronic hepatitis C virus (HCV); 596 (5%) had high FIB-4 scores >3.25 as did 364 (15%) of HIV/HCV coinfected patients. In multivariable analysis, HCV (adjusted odds ratio (aOR) 6.3, 95% confidence interval (CI) 5.2-7.5), chronic hepatitis B (aOR 2.0, 95% CI 1.5-2.8), diabetes (aOR 2.3, 95% CI 1.8-2.9), current CD4 <200 cells/mm3 (aOR 5.4, 95% CI 4.2-6.9) and HIV RNA >500 copies/mL (aOR 1.3, 95% CI 1.0-1.6) were significantly associated with advanced fibrosis. A diagnosis of an alcohol use disorder (aOR 1.9, 95% CI 1.6-2.3) rather than report of current hazardous alcohol use was associated with high FIB-4. However, among HIV/HCV coinfected patients, both current hazardous drinkers (aOR 1.6, 95% CI 1.1-2.4) and current non-drinkers (aOR 1.6, 95% CI 1.2-2.0) were more likely than non-hazardous drinkers to have high FIB-4, with the latter potentially reflecting the impact of sick abstainers. These findings highlight the importance of using a longitudinal measure of alcohol exposure when evaluating the impact of alcohol on liver disease and associated outcomes.
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Noorhasan M, Drozd DR, Grunfeld C, Merrill JO, Burkholder GA, Mugavero MJ, Willig JH, Willig AL, Cropsey KL, Mayer KH, Blashill A, Mimiaga M, McCaul ME, Hutton H, Chander G, Mathews WC, Napravnik S, Eron JJ, Christopoulos K, Fredericksen RJ, Nance RM, Delaney JC, Crane PK, Saag MS, Kitahata MM, Crane HM, on behalf of the Centers For AIDS R. Associations Between At-Risk Alcohol Use, Substance Use, and Smoking with Lipohypertrophy and Lipoatrophy Among Patients Living with HIV. AIDS Res Hum Retroviruses 2017; 33:534-545. [PMID: 28092168 DOI: 10.1089/aid.2015.0357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/13/2022] Open
Abstract
OBJECTIVE To examine associations between lipohypertrophy and lipoatrophy and illicit drug use, smoking, and at-risk alcohol use among a large diverse cohort of persons living with HIV (PLWH) in clinical care. METHODS 7,931 PLWH at six sites across the United States completed 21,279 clinical assessments, including lipohypertrophy and lipoatrophy, drug/alcohol use, physical activity level, and smoking. Lipohypertrophy and lipoatrophy were measured using the FRAM body morphology instrument and associations were assessed with generalized estimating equations. RESULTS Lipohypertrophy (33% mild, 4% moderate-to-severe) and lipoatrophy (20% mild, 3% moderate-to-severe) were common. Older age, male sex, and higher current CD4 count were associated with more severe lipohypertrophy (p values <.001-.03). Prior methamphetamine or marijuana use, and prior and current cocaine use, were associated with more severe lipohypertrophy (p values <.001-.009). Older age, detectable viral load, and low current CD4 cell counts were associated with more severe lipoatrophy (p values <.001-.003). In addition, current smoking and marijuana and opiate use were associated with more severe lipoatrophy (p values <.001-.03). Patients with very low physical activity levels had more severe lipohypertrophy and also more severe lipoatrophy than those with all other activity levels (p values <.001). For example, the lipohypertrophy score of those reporting high levels of physical activity was on average 1.6 points lower than those reporting very low levels of physical activity (-1.6, 95% CI: -1.8 to -1.4, p < .001). CONCLUSIONS We found a high prevalence of lipohypertrophy and lipoatrophy among a nationally distributed cohort of PLWH. While low levels of physical activity were associated with both lipohypertrophy and lipoatrophy, associations with substance use and other clinical characteristics differed between lipohypertrophy and lipoatrophy. These results support the conclusion that lipohypertrophy and lipoatrophy are distinct, and highlight differential associations with specific illicit drug use.
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Affiliation(s)
| | - Daniel R. Drozd
- Department of Medicine, University of Washington, Seattle, Washington
| | - Carl Grunfeld
- Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Joseph O. Merrill
- Department of Medicine, University of Washington, Seattle, Washington
| | - Greer A. Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael J. Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - James H. Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Amanda L. Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karen L. Cropsey
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth H. Mayer
- Department of Medicine, Fenway Institute, Harvard Medical School, Boston, Massachusetts
| | - Aaron Blashill
- Department of Medicine, Fenway Institute, Harvard Medical School, Boston, Massachusetts
| | - Matthew Mimiaga
- Division of Psychiatry, Fenway Institute, Harvard Medical School, Boston, Massachusetts
| | - Mary E. McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | | | - William C. Mathews
- Department of Medicine, University of California San Diego, San Diego, California
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Joseph J. Eron
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Katerina Christopoulos
- Department of Medicine, University of California at San Francisco, San Francisco, California
| | | | - Robin M. Nance
- Department of Medicine, University of Washington, Seattle, Washington
| | | | - Paul K. Crane
- Department of Medicine, University of Washington, Seattle, Washington
| | - Michael S. Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mari M. Kitahata
- Department of Medicine, University of Washington, Seattle, Washington
| | - Heidi M. Crane
- Department of Medicine, University of Washington, Seattle, Washington
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Weerts EM, Wand GS, Maher B, Xu X, Stephens MA, Yang X, McCaul ME. Independent and Interactive Effects of OPRM1 and DAT1 Polymorphisms on Alcohol Consumption and Subjective Responses in Social Drinkers. Alcohol Clin Exp Res 2017; 41:1093-1104. [PMID: 28376280 DOI: 10.1111/acer.13384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 03/27/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The current study examined independent and interactive effects of polymorphisms of the mu opioid receptor gene (OPRM1, A118G) and variable number tandem repeats of the dopamine transporter gene (DAT1, SLC6A3) on alcohol consumption and subjective responses to alcohol in 127 young, healthy, social drinkers. METHODS Participants completed an in-person assessment, which included self-reported alcohol drinking patterns and blood sampling for DNA, and in a second visit, a cumulative alcohol dosing procedure with subjective ratings across multiple time points and breath alcohol contents (0.03 to 0.1%). DNA was analyzed for OPRM1 AA versus AG/GG (*G) genotypes, DAT1 10-repeat allele (A10) versus 9 or lesser alleles (A9), and ancestral informative markers. RESULTS There were significant epistatic interactions between OPRM1 and DAT1 genotypes. Subjective High Assessment Scale scores after alcohol consumption were highest in *G and A9 carriers, and lowest in *G and A10 carriers. Negative subjective effects were also highest in *G and A9 carriers. Effects were similar in a sensitivity analysis limited to Caucasian subjects. There were independent and epistatic interactions on drinking. The OPRM1 *G allele was independently associated with fewer heavy drinking days. The A9 allele was associated with a greater number of drinking days, which was attenuated in carriers of the *G allele. CONCLUSIONS These findings highlight the biological importance of interactions between these 2 genes and interactions between brain opioid and dopamine systems.
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Affiliation(s)
- Elise M Weerts
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gary S Wand
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brion Maher
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Mental Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Xiaoqiang Xu
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Ann Stephens
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xiaoju Yang
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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McCaul ME, Hutton HE, Stephens MAC, Xu X, Wand GS. Anxiety, Anxiety Sensitivity, and Perceived Stress as Predictors of Recent Drinking, Alcohol Craving, and Social Stress Response in Heavy Drinkers. Alcohol Clin Exp Res 2017; 41:836-845. [PMID: 28281290 PMCID: PMC5388456 DOI: 10.1111/acer.13350] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [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: 08/31/2016] [Accepted: 02/06/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Stress and anxiety are widely considered to be causally related to alcohol craving and consumption, as well as development and maintenance of alcohol use disorder (AUD). However, numerous preclinical and human studies examining effects of stress or anxiety on alcohol use and alcohol-related problems have been equivocal. This study examined relationships between scores on self-report anxiety, anxiety sensitivity, and stress measures and frequency and intensity of recent drinking, alcohol craving during early withdrawal, as well as laboratory measures of alcohol craving and stress reactivity among heavy drinkers with AUD. METHODS Media-recruited, heavy drinkers with AUD (N = 87) were assessed for recent alcohol consumption. Anxiety and stress levels were characterized using paper-and-pencil measures, including the Beck Anxiety Inventory (BAI), the Anxiety Sensitivity Index-3 (ASI-3), and the Perceived Stress Scale (PSS). Eligible subjects (N = 30) underwent alcohol abstinence on the Clinical Research Unit; twice daily measures of alcohol craving were collected. On day 4, subjects participated in the Trier Social Stress Test; measures of cortisol and alcohol craving were collected. RESULTS In multivariate analyses, higher BAI scores were associated with lower drinking frequency and reduced drinks/drinking day; in contrast, higher ASI-3 scores were associated with higher drinking frequency. BAI anxiety symptom and ASI-3 scores also were positively related to Alcohol Use Disorders Identification Test total scores and AUD symptom and problem subscale measures. Higher BAI and ASI-3 scores but not PSS scores were related to greater self-reported alcohol craving during early alcohol abstinence. Finally, BAI scores were positively related to laboratory stress-induced cortisol and alcohol craving. In contrast, the PSS showed no relationship with most measures of alcohol craving or stress reactivity. CONCLUSIONS Overall, clinically oriented measures of anxiety compared with perceived stress were more strongly associated with a variety of alcohol-related measures in current heavy drinkers with AUD.
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Affiliation(s)
- Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Ann C Stephens
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xiaoqiang Xu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gary S Wand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Alvanzo AAH, Wand GS, Kuwabara H, Wong DF, Xu X, McCaul ME. Family history of alcoholism is related to increased D 2 /D 3 receptor binding potential: a marker of resilience or risk? Addict Biol 2017; 22:218-228. [PMID: 26416591 DOI: 10.1111/adb.12300] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/21/2015] [Accepted: 08/08/2015] [Indexed: 12/01/2022]
Abstract
The aim of this study was to examine the relationship between family history of alcohol use disorder and striatal dopamine using positron emission tomography imaging. Participants were 84 healthy, 18- to 30-year-old, social drinkers recruited via fliers and newspaper advertisements. At assessment, participants completed measures of lifetime personal and family substance use and psychiatric symptoms. Participants underwent two consecutive positron emission tomography scans using the D2 /D3 dopamine receptor radioligand [11 C]raclopride. Scans were preceded by intravenous saline and amphetamine 0.3 mg/kg, providing measures of baseline [11 C]raclopride binding potential (BPND ) and change in [11 C]raclopride (ΔBPND ). Subjective ratings of stimulant drug effects were collected during scans. Subjects were classified as family history positive (FHP) if they reported any first-degree relative with alcohol use disorder (AUD) and family history negative (FHN) if no first-degree relatives had history of AUD. Participants were predominantly White (69.0 percent) and male (62.1 percent). Baseline [11 C]raclopride BPND was generally higher in FHP compared with FHN subjects across striatal subdivisions. There were no differences in ΔBPND across regions. Negative subjective drug effects were more pronounced in FHP than in FHN subjects. While FHN subjects evidenced the expected positive relationship between ΔBPND and positive subjective drug effects, this relationship was disrupted in FHP subjects. There are key differences in dopamine status and subjective stimulant drug experiences as a function of family AUD history. These findings have important implications for understanding risk for AUD development in FHP offspring.
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Affiliation(s)
- Anika A. H. Alvanzo
- Division of General Internal Medicine; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Gary S. Wand
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Hiroto Kuwabara
- Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Dean F. Wong
- Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore MD USA
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins School of Medicine; Baltimore MD USA
- Solomon H. Snyder Department of Neuroscience; Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Xiaoqiang Xu
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins School of Medicine; Baltimore MD USA
| | - Mary E. McCaul
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins School of Medicine; Baltimore MD USA
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40
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Canan CE, Lau B, McCaul ME, Keruly J, Moore RD, Chander G. Effect of alcohol consumption on all-cause and liver-related mortality among HIV-infected individuals. HIV Med 2016; 18:332-341. [PMID: 27679418 DOI: 10.1111/hiv.12433] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The aim of the study was to examine the association between levels of past and current alcohol consumption and all-cause and liver-related mortality among people living with HIV (PLWH). METHODS A prospective cohort study of 1855 PLWH in Baltimore, MD was carried out from 2000 to 2013. We ascertained alcohol use by (1) self-report (SR) through a computer-assisted self interview, and (2) medical record abstraction of provider-documented (PD) alcohol use. SR alcohol consumption was categorized as heavy (men: > 4 drinks/day or > 14 drinks/week; women: > 3 drinks/day or > 7 drinks/week), moderate (any alcohol consumption less than heavy), and none. We calculated the cumulative incidence of liver-related mortality and fitted adjusted cause-specific regression models to account for competing risks. RESULTS All-cause and liver-related mortality rates (MRs) were 43.0 and 7.2 per 1000 person-years (PY), respectively. All-cause mortality was highest among SR nondrinkers with PD recent (< 6 months) heavy drinking (MR = 85.4 deaths/1000 PY) and lowest among SR moderate drinkers with no PD history of heavy drinking (MR = 23.0 deaths/1000 PY). Compared with SR moderate drinkers with no PD history of heavy drinking, SR nondrinkers and moderate drinkers with PD recent heavy drinking had higher liver-related mortality [hazard ratio (HR) = 7.28 and 3.52, respectively]. However, SR nondrinkers and moderate drinkers with a PD drinking history of > 6 months ago showed similar rates of liver-related mortality (HR = 1.06 and 2.00, respectively). CONCLUSIONS Any heavy alcohol consumption was associated with all-cause mortality among HIV-infected individuals, while only recent heavy consumption was associated with liver-related mortality. Because mortality risk among nondrinkers varies substantially by drinking history, current consumption alone is insufficient to assess risk.
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Affiliation(s)
- C E Canan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - B Lau
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - M E McCaul
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - J Keruly
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - R D Moore
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - G Chander
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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41
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Crane HM, Nance RM, Merrill JO, Hutton H, Chander G, McCaul ME, Mathews WC, Fredericksen R, Simoni JM, Mayer K, Mugavero MJ, Willig JH, Burkholder G, Drozd DR, Mimiaga M, Lau B, Kim HN, Cropsey K, Moore RD, Christopoulos K, Geng E, Eron JJ, Napravnik S, Kitahata MM, Saag MS, Delaney JA. Not all non-drinkers with HIV are equal: demographic and clinical comparisons among current non-drinkers with and without a history of prior alcohol use disorders. AIDS Care 2016; 29:177-184. [PMID: 27482893 DOI: 10.1080/09540121.2016.1204418] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 10/21/2022]
Abstract
Studies of persons living with HIV (PLWH) have compared current non-drinkers to at-risk drinkers without differentiating whether current non-drinkers had a prior alcohol use disorder (AUD). The purpose of this study was to compare current non-drinkers with and without a prior AUD on demographic and clinical characteristics to understand the impact of combining them. We included data from six sites across the US from 1/2013 to 3/2015. Patients completed tablet-based clinical assessments at routine clinic appointments using the most recent assessment. Current non-drinkers were identified by AUDIT-C scores of 0. We identified a prior probable AUD by a prior AUD diagnosis in the electronic medical record (EMR) or a report of attendance at alcohol treatment in the clinical assessment. We used multivariate logistic regression to examine factors associated with prior AUD. Among 2235 PLWH who were current non-drinkers, 36% had a prior AUD with more patients with an AUD identified by the clinical assessment than the EMR. Higher proportions with a prior AUD were male, depressed, and reported current drug use compared to non-drinkers without a prior AUD. Former cocaine/crack (70% vs. 25%), methamphetamine/crystal (49% vs. 16%), and opioid/heroin use (35% vs. 7%) were more commonly reported by those with a prior AUD. In adjusted analyses, male sex, past methamphetamine/crystal use, past marijuana use, past opioid/heroin use, past and current cocaine/crack use, and cigarette use were associated with a prior AUD. In conclusion, this study found that among non-drinking PLWH in routine clinical care, 36% had a prior AUD. We found key differences between those with and without prior AUD in demographic and clinical characteristics, including drug use and depression. These results suggest that non-drinkers are heterogeneous and need further differentiation in studies and that prior alcohol misuse (including alcohol treatment) should be included in behavioural health assessments as part of clinical care.
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Affiliation(s)
- Heidi M Crane
- a Department of Medicine , University of Washington , Seattle , WA , USA
| | - Robin M Nance
- a Department of Medicine , University of Washington , Seattle , WA , USA
| | - Joseph O Merrill
- a Department of Medicine , University of Washington , Seattle , WA , USA
| | - Heidi Hutton
- b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University , Baltimore , MD , USA
| | - Geetanjali Chander
- c Department of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Mary E McCaul
- b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University , Baltimore , MD , USA
| | - W Chris Mathews
- d Department of Medicine , University of California , San Diego , CA , USA
| | - Rob Fredericksen
- a Department of Medicine , University of Washington , Seattle , WA , USA
| | - Jane M Simoni
- e Department of Psychology , University of Washington , Seattle , WA , USA
| | - Kenneth Mayer
- f Fenway Institute and Department of Medicine , Harvard Medical School , Boston , MA , USA
| | - Michael J Mugavero
- g Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| | - James H Willig
- g Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Greer Burkholder
- g Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Daniel R Drozd
- a Department of Medicine , University of Washington , Seattle , WA , USA
| | - Matthew Mimiaga
- h Departments of Behavioral and Social Sciences , Brown University , Providence , RI , USA
| | - Bryan Lau
- i Department of Epidemiology , Johns Hopkins University , Baltimore , MD , USA
| | - H Nina Kim
- a Department of Medicine , University of Washington , Seattle , WA , USA
| | - Karen Cropsey
- j Department of Psychiatry , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Richard D Moore
- c Department of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Katerina Christopoulos
- k Department of Medicine , University of California at San Francisco , San Francisco , CA , USA
| | - Elvin Geng
- k Department of Medicine , University of California at San Francisco , San Francisco , CA , USA
| | - Joseph J Eron
- l Department of Medicine , University of North Carolina , Chapel Hill , NC , USA
| | - Sonia Napravnik
- l Department of Medicine , University of North Carolina , Chapel Hill , NC , USA
| | - Mari M Kitahata
- a Department of Medicine , University of Washington , Seattle , WA , USA
| | - Michael S Saag
- g Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Joseph Ac Delaney
- m Department of Epidemiology , University of Washington , Seattle , WA , USA
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42
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Gibbons LE, Fredericksen R, Merrill JO, McCaul ME, Chander G, Hutton H, Lober WB, Mathews WC, Mayer K, Burkholder G, Willig JH, Mugavero MJ, Saag MS, Kitahata MM, Edwards TC, Patrick DL, Crane HM, Crane PK. Suitability of the PROMIS alcohol use short form for screening in a HIV clinical care setting. Drug Alcohol Depend 2016; 164:113-119. [PMID: 27209223 PMCID: PMC4896136 DOI: 10.1016/j.drugalcdep.2016.04.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 04/05/2016] [Accepted: 04/30/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND At-risk alcohol use is important to identify in clinical settings to facilitate interventions. The Patient-Reported Outcomes Measurement Information System (PROMIS) Alcohol Use Short Form was developed through an item response theory process, but its utility as a screening instrument in clinical care has not been reported. OBJECTIVE To determine the ability of the PROMIS Alcohol Use Short Form to identify people with current or future at-risk alcohol use defined by the Alcohol Use Disorders Identification Test consumption (AUDIT-C) instrument. METHODS Observational study of people living with HIV (PLWH) in clinical care at four sites across the US. Patients completed a tablet-based clinical assessment prior to seeing their providers at clinic appointments. We used 3 definitions of clinically-relevant at-risk alcohol use and determined the proportion of PLWH with current or future at-risk drinking identified by the PROMIS instrument. RESULTS Of 2497 PLWH who endorsed ≥1 drink in the prior 12 months, 1500 PLWH (60%) endorsed "never" for all PROMIS items. In that group, 26% had clinically-relevant at-risk alcohol use defined by one or more AUDIT-C definitions. At follow-up (N=1608), high baseline PROMIS scores had 55% sensitivity for at-risk drinking among those with at-risk drinking at baseline, and 22% sensitivity among those without baseline risk. CONCLUSIONS The PROMIS Alcohol Use Short Form cannot be used alone to identify PLWH with clinically-relevant at-risk alcohol use. Optimal assessment of problem drinking behavior is not clear, but there does not seem to be an important role for the PROMIS instrument in this clinical setting.
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Affiliation(s)
- Laura E. Gibbons
- Division of General Internal Medicine, Department of Medicine, University of Washington, 325 9 Ave., Box 359780, Seattle, WA 98104 USA,Corresponding author: Laura E. Gibbons, Box 359781, 325 9 Ave., Seattle, WA 98104; ; (206) 744-1842 (phone), (206) 897-4688 (fax)
| | - Rob Fredericksen
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 325 9 Ave., Box 359931, Seattle, WA 98104 USA
| | - Joseph O. Merrill
- Division of General Internal Medicine, Alcohol and Drug Abuse Institute, Department of Medicine, University of Washington, 325 9 Ave., Box 359780, Seattle, WA 98104 USA
| | - Mary E. McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 911 N. Broadway, Baltimore, MD 21205 USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Carnegie, Baltimore, MD 21287 USA
| | - Heidi Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 911 N. Broadway, Baltimore, MD 21205 USA
| | - William B. Lober
- School of Nursing, University of Washington, T615 Health Sciences 1959 NE Pacific St., Box 357266, Seattle, WA 98195 USA
| | - W. Chris Mathews
- Division of General Internal Medicine, Department of Medicine, University of California at San Diego, UCSD Medical Center, 8681, 200 W. Arbor Dr., San Diego, CA 92103 USA
| | - Kenneth Mayer
- Fenway Institute and Division of Infectious Diseases, Department of Medicine, Harvard Medical School, 1340 Boylston Street 8th Floor, Boston, MA 02215 USA
| | - Greer Burkholder
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, 845 19th St S, Birmingham, AL 35205 USA
| | - James H. Willig
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, 1900 University Blvd Ste 215, Birmingham, AL 35233 USA
| | - Michael J. Mugavero
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, 150 Hill University Center, 1400 University Boulevard, Birmingham, AL 35294 USA
| | - Michael S. Saag
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, 150 Hill University Center 1400 University Boulevard, Birmingham, Alabama 35294 USA
| | - Mari M. Kitahata
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 325 9 Ave., Box 359931, Seattle, WA 98104-2499 USA
| | - Todd C. Edwards
- Department of Health Services, School of Public Health, University of Washington, Box 359455, Seattle, WA 98195 USA
| | - Donald L Patrick
- Department of Health Services, School of Public Health, University of Washington, Box 359455, Seattle, WA 98195 USA
| | - Heidi M. Crane
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, 325 9 Ave., Box 359931, Seattle, WA 98104-2499 USA,Corresponding author: Laura E. Gibbons, Box 359781, 325 9 Ave., Seattle, WA 98104; ; (206) 744-1842 (phone), (206) 897-4688 (fax)
| | - Paul K. Crane
- Division of General Internal Medicine, Department of Medicine, University of Washington, 325 9 Ave., Box 359780, Seattle, WA 98104-2499 USA
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Bilal U, Lau B, Lazo M, McCaul ME, Hutton HE, Sulkowski MS, Moore RD, Chander G. Interaction Between Alcohol Consumption Patterns, Antiretroviral Therapy Type, and Liver Fibrosis in Persons Living with HIV. AIDS Patient Care STDS 2016; 30:200-7. [PMID: 27158847 DOI: 10.1089/apc.2016.0010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We examined the longitudinal association between alcohol use and liver fibrosis, measured by FIB-4 Score, among HIV-infected individuals by (1) antiretroviral therapy (ART) class, and (2) the presence of hepatitis C (HCV) co-infection. This was a prospective cohort study of 550 individuals in the Johns Hopkins HIV Clinical Cohort initiating ART between 2000 and 2012. The relationship between alcohol consumption (defined using NIAAA categories of non-, moderate, and hazardous drinkers) and liver fibrosis (FIB-4 score) by ART class was assessed using linear mixed effects models. Additionally, we examined whether the presence of HCV modified and whether viral load mediated the relationship between alcohol use and liver fibrosis. Overall, FIB-4 levels were 15.6% higher in hazardous drinkers compared to moderate drinkers (p = 0.025) after adjusting by age, sex, and race. Hazardous drinkers on PI-based regimens had FIB-4 scores 26.9% higher than moderate drinkers (p = 0.015). However, there was no difference in FIB-4 levels between hazardous drinkers on non-PI-based regimens compared to moderate drinkers (1.83% versus moderate drinkers, p = 0.848). There was no significant difference in FIB-4 between nondrinkers and moderate drinkers, irrespective of ART regimen. These associations were not modified by HCV status or mediated by viral load changes. Individuals with hazardous alcohol consumption and on PI-based regimens had significantly increased liver fibrosis, as measured by the FIB-4. These data suggest that providers should consider level of alcohol consumption when choosing an ART regimen to minimize detrimental effects on the liver.
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Affiliation(s)
- Usama Bilal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mariana Lazo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary E. McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Heidi E. Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark S. Sulkowski
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard D. Moore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Geetanjali Chander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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44
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Chander G, Monroe AK, Crane HM, Hutton HE, Saag MS, Cropsey K, Eron JJ, Quinlivan EB, Geng E, Mathews WC, Boswell S, Rodriquez B, Ellison M, Kitahata MM, Moore RD, McCaul ME. HIV primary care providers--Screening, knowledge, attitudes and behaviors related to alcohol interventions. Drug Alcohol Depend 2016; 161:59-66. [PMID: 26857898 PMCID: PMC4841449 DOI: 10.1016/j.drugalcdep.2016.01.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Alcohol has particularly harmful health effects in HIV-infected patients; therefore, HIV clinics are an important setting for integration of brief alcohol intervention and alcohol pharmacotherapy to improve patient outcomes. Current practices of alcohol screening, counseling, and prescription of pharmacotherapy by HIV providers are unknown. METHODS We conducted a cross-sectional survey of HIV providers from 8 HIV clinical sites across the United States. Surveys queried knowledge and use of alcohol screening, brief advice, counseling and pharmacotherapy, confidence and willingness to prescribe pharmacotherapy and barriers to their use of alcohol pharmacotherapy. We used multivariable logistic regression to examine provider factors associated with confidence and willingness to prescribe pharmacotherapy. RESULTS Providers (N=158) were predominantly female (58%) and Caucasian (73%); almost half were infectious disease physicians and 31% had been in practice 10-20 years. Most providers (95%) reported always or usually screening for alcohol use, although only 10% reported using a formal screening tool. Over two-thirds never or rarely treated alcohol-dependent patients with pharmacotherapy themselves. Most (71%) referred alcohol-dependent patients for treatment. Knowledge regarding alcohol pharmacotherapy was low. The major barrier to prescribing pharmacotherapy was insufficient training on use of pharmacotherapy. Provider confidence ratings were positively correlated with their practice patterns. CONCLUSIONS HIV providers reported high rates of screening for alcohol use, though few used a formal screening tool. Most providers referred alcohol dependent patients to outside resources for treatment. Few reported prescribing alcohol pharmacotherapy. Increased training on alcohol pharmacotherapy may increase confidence in prescribing and use of these medications in HIV care settings.
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Affiliation(s)
- Geetanjali Chander
- Department of Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States.
| | - Anne K Monroe
- Department of Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States.
| | - Heidi M Crane
- Department of Medicine, Division of Infectious Disease, University of Washington, 325 9th Ave, NJB 1366 Box 359931, Seattle, WA 98104, United States.
| | - Heidi E Hutton
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, United States.
| | - Michael S Saag
- Department of Internal Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL. 1720 7th Ave S., Birmingham, AL 35294-0017, United States.
| | - Karen Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1720 7th Ave S., Birmingham, AL 35294-0017, United States.
| | - Joseph J Eron
- Department of Medicine, Division of Infectious Disease, University of North Carolina, Chapel Hill CB# 7030, Bioinformatics Building, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599-7030, United States.
| | - E Byrd Quinlivan
- Department of Medicine, Division of Infectious Disease, University of North Carolina, Chapel Hill CB# 7030, Bioinformatics Building, 130 Mason Farm Road, 2nd Floor, Chapel Hill, NC 27599-7030, United States.
| | - Elvin Geng
- Department of Medicine, University of California at San Francisco, 1001 Potrero Ave, SFGH 80, San Francisco, CA 94110, United States.
| | - William Christopher Mathews
- Department of Medicine, University of California San Diego, 200 W Arbor Dr # 140, San Diego, CA 92103, United States.
| | - Stephen Boswell
- Department of Medicine, Harvard University School of Medicine, Mass Fenway Community Health Ctr, 1340 Boylston St, Boston, MA 02215, United States.
| | - Benigno Rodriquez
- Department of Medicine-Infectious Diseases, Case Western Reserve University, 111000 Euclid Ave, Cleveland, OH 44106, United States
| | - Megan Ellison
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, United States.
| | - Mari M Kitahata
- Department of Medicine, Division of Infectious Disease, University of Washington, 325 9th Ave, NJB 1366 Box 359931, Seattle, WA 98104, United States.
| | - Richard D Moore
- Department of Medicine, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, Baltimore, MD 21287, United States.
| | - Mary E McCaul
- Department of Psychiatry & Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, United States.
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Lewis D, Hutton HE, Agee TA, McCaul ME, Chander G. Alcohol Use and Unintended Sexual Consequences among Women Attending an Urban Sexually Transmitted Infections Clinic. Womens Health Issues 2015; 25:450-7. [PMID: 26115942 DOI: 10.1016/j.whi.2015.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 03/03/2015] [Accepted: 04/23/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although alcohol use has been linked with a variety of sexual behaviors, we lack an understanding of what precise events occur when women drink that may lead to emotional or physical harms. METHODS To fill this gap, we qualitatively explored the unintended sexual events occurring while drinking among a particularly at-risk clinic population: urban women attending a public sexually transmitted infections (STI) clinic. This was a secondary data analysis of 20 semistructured, in-depth interviews conducted between December 2009 and August 2010 with 20 sexually active adult women attending the Baltimore City Health Department STI Clinic. We purposively sampled women presenting for care in the STI clinic who reported either binge drinking in the past 6 months or engaging in vaginal or anal intercourse while under the influence of alcohol. Interviews were analyzed using a grounded theory approach. RESULTS Five major unintended sexual events emerged: sex with new partners; alternative sexual activities, including anal sex and "rough" sex; unprotected sex; blacked out sex or sex occurring during alcohol-related amnesia; and rape. Themes often overlapped, and sexual victimization was a common thread throughout multiple themes. An additional theme, alcohol and prey, largely occurring in bars and nightclubs, emerged as an important precursor to many of the unintended events described. CONCLUSIONS Alcohol use was associated with a variety of--often dangerous--unintended sexual events. Our results highlight the link between alcohol use and sexual victimization and the need for intervention development to reduce the emotional and physical harms resulting from the unintended consequences of alcohol use.
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Affiliation(s)
- Dinah Lewis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tracy A Agee
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Yang C, Crane HM, Cropsey K, Hutton H, Chander G, Saag M, McCaul ME. Implementation of Computer-delivered Brief Alcohol Intervention in HIV Clinical Settings: Who Agrees to Participate? ACTA ACUST UNITED AC 2015; 7. [PMID: 27274904 PMCID: PMC4890715 DOI: 10.4172/2155-6105.1000276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Addressing alcohol use in primary HIV settings can improve medical outcomes and overall quality of life of persons living with HIV (PLWH). In order to assess the feasibility of computer-delivered brief alcohol intervention (CBI) and to inform future efforts to improve access to CBI, we examined patient-level socio-demographic, clinical and behavioral characteristics associated with agreement to participate in CBI among non-treatment seeking PLWH with alcohol misuse. Methods Participants were recruited from two Centres for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) HIV clinics. PLWH completed a clinical assessment of patient-reported measures and outcomes using tablet-based assessments, including socio-demographic and behavioural characteristics. HIV biological indicators, i.e., CD4 count and viral load, were also available from the electronic medical record. Participants were approached for CBI participation based on scores on the Alcohol Use Disorders Identification Test (AUDIT); no incentives were offered for CBI participation. We performed chi-square tests, analysis of variance and multivariate logistic regression to compare socio-demographic, behavioural and clinical factors among participants who agreed to participate compared with those who refused/postponed participation. Results We observed that 42% of non-treatment seeking, non-incentivized PLWH with alcohol misuse provided written agreement to participate in on-site CBI delivered in their HIV primary care clinic. A larger proportion of PLWH who agreed to enrol in CBI had detectable viral loads, heavier weekly alcohol use, and higher DSM-5 alcohol use disorder symptom counts and mental health symptoms. Neither socio-demographic background nor drug use status was associated with CBI enrolment. Conclusion CBI implementation reached those patients most in need of care. The findings of this study may assist HIV-care providers to better identify appropriate patients and initiate discussions to facilitate the participation of PLWH in alcohol intervention services.
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Affiliation(s)
- Cui Yang
- Department of Health, Behaviour and Society, Johns Hopkins Bloomberg School of Public Health Baltimore, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington Seattle, USA
| | - Karen Cropsey
- Department of Psychiatry and Behavioural Neurobiology, University of Alabama at Birmingham, USA
| | - Heidi Hutton
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine Baltimore, USA
| | - Geetanjali Chander
- Department of General Internal Medicine, Johns Hopkins University School of Medicine Baltimore, USA
| | - Michael Saag
- Department of Medicine, University of Alabama at Birmingham, USA
| | - Mary E McCaul
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine Baltimore, USA
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Hutton HE, McCaul ME, Norris J, Valliant JD, Abrefa-Gyan T, Chander G. Sex-Related Alcohol Expectancies Among African American Women Attending an Urban STI Clinic. J Sex Res 2014; 52:580-589. [PMID: 25110958 PMCID: PMC4324376 DOI: 10.1080/00224499.2014.931336] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
African American women are disproportionately affected by human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and sexually transmitted infections (STIs). Alcohol use is a significant risk factor for HIV/STI acquisition. Sex-related alcohol expectancies (SRAEs) may partially account for alcohol-related risky sexual behaviors. Using qualitative interviews we explored the link between alcohol use and risky sex among 20 African American women attending an STI clinic who had consumed four or more alcoholic drinks per drinking day (binge drinking) and/or reported vaginal or anal sex while under the influence of alcohol. Four SRAEs emerged, which we named drink for sexual desire, drink for sexual power, drink for sexual excuse, and drink for anal sex. While the desire SRAE has been documented, this study identified three additional SRAEs not currently assessed by expectancy questionnaires. These SRAEs may contribute to high-risk sex when under the influence of alcohol and suggests the importance of developing integrated alcohol-sexual risk reduction interventions for high-risk women.
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Affiliation(s)
- Heidi E. Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287 USA
| | - Mary E. McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287 USA
| | - Jeanette Norris
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105 USA
| | - Julia D. Valliant
- Illinois Children's Environmental Health Research Center, and Family Resiliency Center, University of Illinois, Urbana-Champagne, Urbana, IL 61801 USA
| | - Tina Abrefa-Gyan
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD 21201 USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287 USA
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Weerts EM, Wand GS, Kuwabara H, Xu X, Frost JJ, Wong DF, McCaul ME. Association of smoking with μ-opioid receptor availability before and during naltrexone blockade in alcohol-dependent subjects. Addict Biol 2014; 19:733-42. [PMID: 23252742 DOI: 10.1111/adb.12022] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 11/30/2022]
Abstract
Persons with a history of alcohol dependence are more likely to use tobacco and to meet criteria for nicotine dependence compared with social drinkers or non-drinkers. The high levels of comorbidity of nicotine and alcohol use and dependence are thought to be related to interactions between nicotinic, opioid and dopamine receptors in mesolimbic regions. The current study examined whether individual differences in regional μ-opioid receptor (MOR) availability were associated with tobacco use, nicotine dependence and level of nicotine craving in 25 alcohol-dependent (AD) subjects. AD subjects completed an inpatient protocol, which included medically supervised alcohol withdrawal, monitored alcohol abstinence, transdermal nicotine maintenance (21 mg/day) and Positron Emission Tomography (PET) imaging using the MOR agonist [(11) C]-carfentanil (CFN) before (basal scan) and during treatment with 50 mg/day naltrexone (naltrexone scan). Subjects who had higher scores on the Fagerström Nicotine Dependence Test had significantly lower basal scan binding potential (BPND ) across mesolimbic regions, including the amygdala, cingulate, globus pallidus, thalamus and insula. Likewise, the number of cigarettes per day was negatively associated with basal scan BPND in mesolimbic regions. Higher nicotine craving was significantly associated with lower BPND in amygdala, globus pallidus, putamen, thalamus and ventral striatum. Although blunted during naltrexone treatment, the negative association was maintained for nicotine dependence and cigarettes per day, but not for nicotine craving. These findings suggest that intensity of cigarette smoking and severity of nicotine dependence symptoms are systematically related to reduced BPND across multiple brain regions in AD subjects.
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Affiliation(s)
- Elise M. Weerts
- Department of Psychiatry and Behavioral Sciences; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Gary S. Wand
- Department of Psychiatry and Behavioral Sciences; The Johns Hopkins University School of Medicine; Baltimore MD USA
- Department of Medicine; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Hiroto Kuwabara
- Department of Radiology; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Xiaoqiang Xu
- Department of Psychiatry and Behavioral Sciences; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - J. James Frost
- Department of Radiology; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Dean F. Wong
- Department of Psychiatry and Behavioral Sciences; The Johns Hopkins University School of Medicine; Baltimore MD USA
- Department of Radiology; The Johns Hopkins University School of Medicine; Baltimore MD USA
- Department of Neuroscience; The Johns Hopkins University School of Medicine; Baltimore MD USA
- Department of Environmental Health Sciences; The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Mary E. McCaul
- Department of Psychiatry and Behavioral Sciences; The Johns Hopkins University School of Medicine; Baltimore MD USA
- Department of Medicine; The Johns Hopkins University School of Medicine; Baltimore MD USA
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Lucas GM, Mullen BA, Galai N, Moore RD, Cook K, McCaul ME, Glass S, Oursler KK, Rand C. Directly administered antiretroviral therapy for HIV-infected individuals in opioid treatment programs: results from a randomized clinical trial. PLoS One 2013; 8:e68286. [PMID: 23874575 PMCID: PMC3712961 DOI: 10.1371/journal.pone.0068286] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 05/24/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Data regarding the efficacy of directly administered antiretroviral therapy (DAART) are mixed. Opioid treatment programs (OTPs) provide a convenient framework for DAART. In a randomized controlled trial, we compared DAART and self-administered therapy (SAT) among HIV-infected subjects attending five OTPs in Baltimore, MD. METHODS HIV-infected individuals attending OTPs were eligible if they were not taking antiretroviral therapy (ART) or were virologically failing ART at last clinical assessment. In subjects assigned to DAART, we observed one ART dose per weekday at the OTP for up to 12 months. SAT subjects administered ART at home. The primary efficacy comparison was the between-arm difference in the average proportions with HIV RNA <50 copies/mL during the intervention phase (3-, 6-, and 12-month study visits), using a logistic regression model accounting for intra-person correlation due to repeated observations. Adherence was measured with electronic monitors in both arms. RESULTS We randomized 55 and 52 subjects from five Baltimore OTPs to DAART and SAT, respectively. The average proportions with HIV RNA <50 copies/mL during the intervention phase were 0.51 in DAART and 0.40 in SAT (difference 0.11, 95% CI: -0.020 to 0.24). There were no significant differences between arms in electronically-measured adherence, average CD4 cell increase from baseline, average change in log10 HIV RNA from baseline, opportunistic conditions, hospitalizations, mortality, or the development of new drug resistance mutations. CONCLUSIONS In this randomized trial, we found little evidence that DAART provided clinical benefits compared to SAT among HIV-infected subjects attending OTPs. TRIAL REGISTRATION ClinicalTrials.gov NCT00279110 NCT00279110?term = NCT00279110&rank = 1.
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Affiliation(s)
- Gregory M Lucas
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
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Wong DF, Kuwabara H, Kim J, Brasic JR, Chamroonrat W, Gao Y, Valentine H, Willis W, Mathur A, McCaul ME, Wand G, Gean EG, Dannals RF, Horti AG. PET imaging of high-affinity α4β2 nicotinic acetylcholine receptors in humans with 18F-AZAN, a radioligand with optimal brain kinetics. J Nucl Med 2013; 54:1308-14. [PMID: 23801676 DOI: 10.2967/jnumed.112.108001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [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: 11/16/2022] Open
Abstract
UNLABELLED We evaluated (-)-2-(6-[(18)F]fluoro-2,3'-bipyridin-5'-yl)-7-methyl-7-aza-bicyclo[2.2.1]heptane ((18)F-AZAN), a novel radiotracer that binds to α4β2 nicotinic acetylcholine receptors (α4β2-nAChRs) and shows high specific binding and rapid and reversible kinetics in the baboon and human brain. METHODS We tested safety tolerability and test-retest reliability (n = 5) and proposed initial quantification of (18)F-AZAN receptors in 3 healthy human subjects who had nicotine exposure and 9 who did not. We also present a receptor blocking study in a nicotine subject dosed with the α4β2-nAChR-selective partial agonist varenicline. RESULTS Radiation dosimetry PET/CT experiments indicated that most human organs received doses between 0.008 and 0.015 mSv/MBq, with an effective dose of approximately 0.014 mSv/MBq. The tracer rapidly entered the brain, and the peak was reached before 20 min, even for thalamus. Ninety-minute scans were sufficient for (18)F-AZAN to obtain the ratio at equilibrium of specifically bound radioligand to nondisplaceable radioligand in tissue (BPND) using plasma reference graphical analysis, which showed excellent reproducibility of BPND (test-retest variability < 10%) in the nAChR-rich brain regions. Regional plasma reference graphical analysis BP(ND) values exceeded 2 in the midbrain tegmental nuclei, lateral geniculate body, and thalamus for nonsmokers (n = 9) but were less than 1 in the nAChR-poor brain regions. There was a dramatic reduction of (18)F-AZAN brain uptake in smokers and varenicline-treated subjects. CONCLUSION (18)F-AZAN is a highly specific, safe, and effective PET radioligand for human subjects that requires only 90 min of PET scanning to estimate high-affinity α4β2-nAChR in the living human brain.
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Affiliation(s)
- Dean F Wong
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
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