1
|
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.
Collapse
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
| |
Collapse
|
2
|
Rudolph AE, Nance RM, Bobashev G, Brook D, Akhtar W, Cook R, Cooper HL, Friedmann PD, Frost SDW, Go VF, Jenkins WD, Korthuis PT, Miller WC, Pho MT, Ruderman SA, Seal DW, Stopka TJ, Westergaard RP, Young AM, Zule WA, Tsui JI, Crane HM, Whitney BM, Delaney JAC. Evaluation of respondent-driven sampling in seven studies of people who use drugs from rural populations: findings from the Rural Opioid Initiative. BMC Med Res Methodol 2024; 24:94. [PMID: 38654219 PMCID: PMC11036624 DOI: 10.1186/s12874-024-02206-5] [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: 02/06/2023] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Accurate prevalence estimates of drug use and its harms are important to characterize burden and develop interventions to reduce negative health outcomes and disparities. Lack of a sampling frame for marginalized/stigmatized populations, including persons who use drugs (PWUD) in rural settings, makes this challenging. Respondent-driven sampling (RDS) is frequently used to recruit PWUD. However, the validity of RDS-generated population-level prevalence estimates relies on assumptions that should be evaluated. METHODS RDS was used to recruit PWUD across seven Rural Opioid Initiative studies between 2018-2020. To evaluate RDS assumptions, we computed recruitment homophily and design effects, generated convergence and bottleneck plots, and tested for recruitment and degree differences. We compared sample proportions with three RDS-adjusted estimators (two variations of RDS-I and RDS-II) for five variables of interest (past 30-day use of heroin, fentanyl, and methamphetamine; past 6-month homelessness; and being positive for hepatitis C virus (HCV) antibody) using linear regression with robust confidence intervals. We compared regression estimates for the associations between HCV positive antibody status and (a) heroin use, (b) fentanyl use, and (c) age using RDS-1 and RDS-II probability weights and no weights using logistic and modified Poisson regression and random-effects meta-analyses. RESULTS Among 2,842 PWUD, median age was 34 years and 43% were female. Most participants (54%) reported opioids as their drug of choice, however regional differences were present (e.g., methamphetamine range: 4-52%). Many recruitment chains were not long enough to achieve sample equilibrium. Recruitment homophily was present for some variables. Differences with respect to recruitment and degree varied across studies. Prevalence estimates varied only slightly with different RDS weighting approaches, most confidence intervals overlapped. Variations in measures of association varied little based on weighting approach. CONCLUSIONS RDS was a useful recruitment tool for PWUD in rural settings. However, several violations of key RDS assumptions were observed which slightly impacts estimation of proportion although not associations.
Collapse
Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA, USA
| | - Robin M Nance
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| | - Georgiy Bobashev
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Daniel Brook
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, 43210, USA
| | - Wajiha Akhtar
- University of Wisconsin-Madison, Population Health Institute, 610 Walnut Street, 575 WARF, Madison, WI, 53726, USA
| | - Ryan Cook
- General Internal Medicine and Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA
| | - Hannah L Cooper
- Rollins School of Public Health, Emory University, Grace Crum Rollins Building, 1518 Clifton Road, Atlanta, Georgia, 30322, USA
| | - Peter D Friedmann
- Baystate Medical Center-University of Massachusetts, Office of Research, UMass Chan Medical School - Baystate, 3601 Main Street, 3rd Floor, Springfield, MA, 01199, USA
| | - Simon D W Frost
- Microsoft Premonition, Microsoft Building 99, 14820 NE 36th St. Redmond, Seattle, WA, 98052, USA
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Vivian F Go
- University of North Carolina-Chapel Hill, 363 Rosenau Hall, CB# 7440, Chapel Hill, NC, 27599, USA
| | - Wiley D Jenkins
- Southern Illinois University, 201 E Madison Street, Springfield, IL, 62702, USA
| | - Philip T Korthuis
- Oregon Health & Science University, 3270 Southwest Pavilion Loop OHSU Physicians Pavilion, Suite 350, Portland, OR, 97239, USA
| | - William C Miller
- The Ohio State University, 302 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
| | - Mai T Pho
- University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Stephanie A Ruderman
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| | - David W Seal
- Tulane University, 1440 Canal Street, Suite 2210, New Orleans, LA, 70112, USA
| | - Thomas J Stopka
- Tufts University School of Medicine, Public Health and Community Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA
| | - Ryan P Westergaard
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI, 53705-2281, USA
| | - April M Young
- University of Kentucky, 760 Press Avenue, Suite 280, Lexington, KY, 40536, USA
| | - William A Zule
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Judith I Tsui
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| | - Heidi M Crane
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA.
| | - Bridget M Whitney
- Harborview Medical Center, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| | - Joseph A C Delaney
- Harborview Medical Center, University of Washington and University of Manitoba, University of Washington, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA
| |
Collapse
|
3
|
Sibley AL, Klein E, Cooper HLF, Livingston MD, Baker R, Walters SM, Gicquelais RE, Ruderman SA, Friedmann PD, Jenkins WD, Go VF, Miller WC, Westergaard RP, Crane HM. The relationship between felt stigma and non-fatal overdose among rural people who use drugs. Harm Reduct J 2024; 21:77. [PMID: 38582851 PMCID: PMC10998326 DOI: 10.1186/s12954-024-00988-x] [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: 06/13/2023] [Accepted: 03/19/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Drug overdose deaths in the United States exceeded 100,000 in 2021 and 2022. Substance use stigma is a major barrier to treatment and harm reduction utilization and is a priority target in ending the overdose epidemic. However, little is known about the relationship between stigma and overdose, especially in rural areas. We aimed to characterize the association between felt stigma and non-fatal overdose in a multi-state sample of rural-dwelling people who use drugs. METHODS Between January 2018 and March 2020, 2,608 people reporting past 30-day opioid use were recruited via modified chain-referral sampling in rural areas across 10 states. Participants completed a computer-assisted survey of substance use and substance-related attitudes, behaviors, and experiences. We used multivariable logistic regression with generalized estimating equations to test the association between felt stigma and recent non-fatal overdose. RESULTS 6.6% of participants (n = 173) reported an overdose in the past 30 days. Recent non-fatal overdose was significantly associated with felt stigma after adjusting for demographic and substance use-related covariates (aOR: 1.47, 95% CI: 1.20-1.81). The association remained significant in sensitivity analyses on component fear of enacted stigma items (aOR: 1.48, 95% CI: 1.20-1.83) and an internalized stigma item (aOR: 1.51, 95% CI: 1.07-2.14). CONCLUSIONS Felt stigma related to substance use is associated with higher risk of non-fatal overdose in rural-dwelling people who use drugs. Stigma reduction interventions and tailored services for those experiencing high stigma are underutilized approaches that may mitigate overdose risk.
Collapse
Affiliation(s)
- Adams L Sibley
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
| | - Emma Klein
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Melvin D Livingston
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Robin Baker
- OHSU-PSU School of Public Health, Oregon Health & Science University, 1810 SW 5th Ave, Suite 510, Portland, OR, 97201, USA
| | - Suzan M Walters
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, 180 Madison, New York, NY, 10016, USA
| | - Rachel E Gicquelais
- School of Nursing, University of Wisconsin-Madison, 4257 Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI, 53705, USA
| | - Stephanie A Ruderman
- Department of Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, USA
| | - Peter D Friedmann
- University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main St, Springfield, MA, 01199, USA
| | - Wiley D Jenkins
- Southern Illinois University School of Medicine, 201 E Madison Street, Springfield, IL, 62702, USA
| | - Vivian F Go
- Department of Health Behavior, UNC Gillings School of Global Public Health, 170 Rosenau Hall CB #7400, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - William C Miller
- Department of Epidemiology, UNC Gillings School of Global Public Health, CB#8050, 3rd Floor Carolina Square, Chapel Hill, NC, 27516, USA
| | - Ryan P Westergaard
- University of Wisconsin-Madison, 1685 Highland Avenue, 5th Floor, Madison, WI, 53705-2281, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Mail Stop 359931, Seattle, WA, 98104, USA
| |
Collapse
|
4
|
Haidar L, Crane HM, Nance RM, Webel A, Ruderman SA, Whitney BM, Willig AL, Napravnik S, Mixson LS, Leong C, Lavu A, Aboulatta L, Dai M, Hahn A, Saag MS, Bamford L, Cachay E, Kitahata MM, Mayer KH, Jacobson J, Moore RD, Delaney JAC, Drumright LN, Eltonsy S. Weight loss associated with semaglutide treatment among people with HIV. AIDS 2024; 38:531-535. [PMID: 37976053 PMCID: PMC10922142 DOI: 10.1097/qad.0000000000003791] [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: 11/19/2023]
Abstract
OBJECTIVE There is limited real-world evidence about the effectiveness of semaglutide for weight loss among people with HIV (PWH). We aimed to investigate weight change in a US cohort of PWH who initiated semaglutide treatment. DESIGN Observational study using the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. METHODS We identified adult PWH who initiated semaglutide between 2018 and 2022 and with at least two weight measurements. The primary outcome was within-person bodyweight change in kilograms at 1 year. The secondary outcome was within-person Hemoglobin A1c percentage (HbA1c) change. Both outcomes were estimated using multivariable linear mixed model. RESULTS In total, 222 new users of semaglutide met inclusion criteria. Mean follow-up was 1.1 years. Approximately 75% of new semaglutide users were men, and at baseline, mean age was 53 years [standard deviation (SD): 10], average weight was 108 kg (SD: 23), mean BMI was 35.5 kg/m 2 , mean HbA1c was 7.7% and 77% had clinically recognized diabetes. At baseline, 97% were on ART and 89% were virally suppressed (viral load < 50 copies/ml). In the adjusted mixed model analysis, treatment with semaglutide was associated with an average weight loss of 6.47 kg at 1 year (95% CI -7.67 to -5.18) and with a reduction in HbA1c of 1.07% at 1 year (95% CI -1.64 to -0.50) among the 157 PWH with a postindex HbA1c value. CONCLUSION Semaglutide was associated with significant weight loss and HbA1c reduction among PWH, comparable to results of previous studies from the general population.
Collapse
Affiliation(s)
- Lara Haidar
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA
| | - Robin M Nance
- Department of Medicine, University of Washington, Seattle, WA
| | - Allison Webel
- Department of Medicine, University of Washington, Seattle, WA
| | | | | | - Amanda L Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Sonia Napravnik
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - L Sarah Mixson
- Department of Medicine, University of Washington, Seattle, WA
| | - Christine Leong
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alekhya Lavu
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laila Aboulatta
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mindy Dai
- Department of Medicine, University of Washington, Seattle, WA
| | - Andrew Hahn
- Department of Medicine, University of Washington, Seattle, WA
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Laura Bamford
- Department of Medicine, University of California San Diego, San Diego, CA
| | - Edward Cachay
- Department of Medicine, University of California San Diego, San Diego, CA
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA
| | - Kenneth H Mayer
- Department of Medicine, Harvard Medical School, Fenway Institute, Boston, MA
| | - Jeffrey Jacobson
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph A C Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Sherif Eltonsy
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
5
|
Crane HM, Nance RM, Ruderman SA, Haidar L, Tenforde MW, Heckbert SR, Budoff MJ, Hahn AW, Drumright LN, Ma J, Mixson LS, Lober WB, Barnes GS, McReynolds J, Attia EF, Peter I, Moges T, Bamford L, Cachay E, Mathews WC, Christopolous K, Hunt PW, Napravnik S, Keruly J, Moore RD, Burkholder G, Willig AL, Lindstrom S, Whitney BM, Saag MS, Kitahata MM, Crothers KA, Delaney JAC. Venous Thromboembolism Among People With HIV: Design, Implementation, and Findings of a Centralized Adjudication System in Clinical Care Sites Across the United States. J Acquir Immune Defic Syndr 2024; 95:207-214. [PMID: 37988634 DOI: 10.1097/qai.0000000000003339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/30/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND People with HIV (PWH) are at increased risk for venous thromboembolism (VTE). We conducted this study to characterize VTE including provoking factors among PWH in the current treatment era. METHODS We included PWH with VTE between 2010 and 2020 at 6 sites in the CFAR Network of Integrated Clinical Systems cohort. We ascertained for possible VTE using diagnosis, VTE-related imaging, and VTE-related procedure codes, followed by centralized adjudication of primary data by expert physician reviewers. We evaluated sensitivity and positive predictive value of VTE ascertainment approaches. VTEs were classified by type and anatomic location. Reviewers identified provoking factors such as hospitalizations, infections, and other potential predisposing factors such as smoking. RESULTS We identified 557 PWH with adjudicated VTE: 239 (43%) had pulmonary embolism with or without deep venous thrombosis, and 318 (57%) had deep venous thrombosis alone. Ascertainment with clinical diagnoses alone missed 6% of VTEs identified with multiple ascertainment approaches. DVTs not associated with intravenous lines were most often in the proximal lower extremities. Among PWH with VTE, common provoking factors included recent hospitalization (n = 134, 42%), infection (n = 133, 42%), and immobilization/bed rest (n = 78, 25%). Only 57 (10%) PWH had no provoking factor identified. Smoking (46%), HIV viremia (27%), and injection drug use (22%) were also common. CONCLUSIONS We conducted a robust adjudication process that demonstrated the benefits of multiple ascertainment approaches followed by adjudication. Provoked VTEs were more common than unprovoked events. Nontraditional and modifiable potential predisposing factors such as viremia and smoking were common.
Collapse
Affiliation(s)
- Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA
| | - Robin M Nance
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Lara Haidar
- Department of Pharmacy, University of Manitoba, Manitoba, CA
| | - Mark W Tenforde
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, CA
| | - Andrew W Hahn
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Jimmy Ma
- Department of Medicine, University of Washington, Seattle, WA
| | - L S Mixson
- Department of Medicine, University of Washington, Seattle, WA
| | - William B Lober
- Department of Medicine and Clinical Informatics Research Group, University of Washington, Seattle, WA
| | - Gregory S Barnes
- Clinical Informatics Research Group, University of Washington, Seattle, WA
| | - Justin McReynolds
- Clinical Informatics Research Group, University of Washington, Seattle, WA
| | - Engi F Attia
- Department of Medicine, University of Washington, Seattle, WA
| | - Inga Peter
- Department of Genetics, Mount Sinai University, New York NY
| | - Tesfaye Moges
- Department of Medicine, University of California, San Diego, CA
| | - Laura Bamford
- Department of Medicine, University of California, San Diego, CA
| | - Edward Cachay
- Department of Medicine, University of California, San Diego, CA
| | | | | | - Peter W Hunt
- Department of Medicine, University of California, San Francisco, CA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Jeanne Keruly
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Greer Burkholder
- Department of Medicine, University of Alabama Birmingham, Birmingham, AL
| | - Amanda L Willig
- Department of Medicine, University of Alabama Birmingham, Birmingham, AL
| | - Sara Lindstrom
- Department of Genetics, University of Washington, Seattle, WA; and
| | | | - Michael S Saag
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Joseph A C Delaney
- Department of Medicine, University of Washington, Seattle, WA
- Department of Medicine, University of Manitoba, Manitoba, CA
| |
Collapse
|
6
|
Ruderman SA, Drumright LN, Delaney JAC, Webel AR, Fitzpatrick AL, Whitney BM, Nance RM, Hahn AW, Ma J, Mixson LS, Eltonsy S, Willig AL, Mayer KH, Napravnik S, Greene M, McCaul M, Cachay E, Kritchevsky SB, Austad SN, Landay A, Saag MS, Kitahata MM, Lau B, Lesko C, Chander G, Crane HM, Odden MC. Evaluating the Sick Quitting Hypothesis for Frailty Status and Reducing Alcohol Use Among People With HIV in a Longitudinal Clinical Cohort Study. J Assoc Nurses AIDS Care 2024; 35:5-16. [PMID: 38150572 DOI: 10.1097/jnc.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
ABSTRACT "Sick quitting," a phenomenon describing reductions in alcohol consumption following poor health, may explain observations that alcohol appears protective for frailty risk. We examined associations between frailty and reductions in drinking frequency among people with HIV (PWH). At six Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites between January 2012 and August 2021, we assessed whether frailty, measured through validated modified frailty phenotype, precedes reductions in drinking frequency. We associated time-updated frailty with quitting and reducing frequency of any drinking and heavy episodic drinking (HED), adjusted for demographic and clinical characteristics in Cox models. Among 5,654 PWH reporting drinking, 60% reported >monthly drinking and 18% reported ≥monthly HED. Over an average of 5.4 years, frail PWH had greater probabilities of quitting (HR: 1.56, 95% confidence interval [95% CI] [1.13-2.15]) and reducing (HR: 1.35, 95% CI [1.13-1.62]) drinking frequency, as well as reducing HED frequency (HR: 1.58, 95% CI [1.20-2.09]) versus robust PWH. Sick quitting likely confounds the association between alcohol use and frailty risk, requiring investigation for control.
Collapse
Affiliation(s)
- Stephanie A Ruderman
- Stephanie A. Ruderman, PhD, MPH, is a Research Scientist, School of Medicine, University of Washington, Seattle, Washington, USA. Lydia N. Drumright, PhD, MPH, is a Clinical Assistant Professor, School of Nursing, University of Washington, Seattle, Washington, USA. Joseph A. C. Delaney, PhD, is a Research Associate Professor, College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada, and School of Medicine, University of Washington, Seattle, Washington, USA. Allison R. Webel, RN, PhD, is an Associate Dean for Research, School of Nursing, University of Washington, Seattle, Washington, USA. Annette L. Fitzpatrick, PhD, is a Research Professor, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Bridget M. Whitney, PhD, MPH, is a Senior Research Scientist, School of Medicine, University of Washington, Seattle, Washington, USA. Robin M. Nance, PhD, is a Research Scientist, School of Medicine, University of Washington, Seattle, Washington, USA. Andrew W. Hahn, MD, is a Clinical Assistant Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Jimmy Ma, MD, is an Infectious Disease Specialist, School of Medicine, University of Washington, Seattle, Washington, USA. L. Sarah Mixson, MPH, is a Research Scientist, School of Medicine, University of Washington, Seattle, Washington, USA. Sherif Eltonsy, PhD, is an Assistant Professor, College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada. Amanda L Willig, PhD, RD, is an Associate Professor, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Kenneth H. Mayer, MD, is a Professor, Harvard Medical School, Fenway Institute, Boston, Massachusetts, USA. Sonia Napravnik, PhD, MPH, is an Associate Professor, Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA. Meredith Greene, MD, is an Associate Professor, Department of Medicine, University of California San Francisco, San Francisco, California, USA. Mary McCaul, PhD, is a Professor, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. Edward Cachay, MD, is a Professor, Department of Medicine, University of California San Diego, San Diego, California, USA. Stephen B. Kritchevsky, PhD, is a Professor, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. Steven N. Austad, PhD, is a Distinguished Professor, Department of Biology, University of Alabama at Birmingham, Birmingham, Alabama, USA. Alan Landay, PhD, is a Professor, Department of Internal Medicine, Rush University, Chicago, Illinois, USA. Michael S. Saag, MD, is a Professor and Associate Dean, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Mari M. Kitahata, MD, MPH, is a Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Bryan Lau, PhD, is a Professor, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA. Catherine Lesko, PhD, MPH, is an Assistant Professor, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA. Geetanjali Chander, MD, MPH, is a Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Heidi M. Crane, MD, MPH, is a Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Michelle C. Odden, PhD, is an Associate Professor, Department of Epidemiology, Stanford University, Stanford, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Ruderman SA, Odden MC, Webel AR, Fitzpatrick AL, Crane PK, Nance RM, Drumright LN, Whitney BM, Mixson LS, Ma J, Willig AL, Haidar L, Eltonsy S, Mayer KH, O'Cleirigh C, Cropsey KL, Eron JJ, Napravnik S, Greene M, McCaul M, Chander G, Cachay E, Lober WB, Kritchevsky SB, Austad S, Landay A, Pandya C, Cartujano-Barrera F, Saag MS, Kamen C, Hahn AW, Kitahata MM, Delaney JAC, Crane HM. Tobacco Smoking and Pack-Years Are Associated With Frailty Among People With HIV. J Acquir Immune Defic Syndr 2023; 94:135-142. [PMID: 37368939 PMCID: PMC10527292 DOI: 10.1097/qai.0000000000003242] [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: 08/05/2022] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Tobacco smoking increases frailty risk among the general population and is common among people with HIV (PWH) who experience higher rates of frailty at younger ages than the general population. METHODS We identified 8608 PWH across 6 Centers for AIDS Research Network of Integrated Clinical Systems sites who completed ≥2 patient-reported outcome assessments, including a frailty phenotype measuring unintentional weight loss, poor mobility, fatigue, and inactivity, and scored 0-4. Smoking was measured as baseline pack-years and time-updated never, former, or current use with cigarettes/day. We used Cox models to associate smoking with risk of incident frailty (score ≥3) and deterioration (frailty score increase by ≥2 points), adjusted for demographics, antiretroviral medication, and time-updated CD4 count. RESULTS The mean follow-up of PWH was 5.3 years (median: 5.0), the mean age at baseline was 45 years, 15% were female, and 52% were non-White. At baseline, 60% reported current or former smoking. Current (HR: 1.79; 95% confidence interval: 1.54 to 2.08) and former (HR: 1.31; 95% confidence interval: 1.12 to 1.53) smoking were associated with higher incident frailty risk, as were higher pack-years. Current smoking (among younger PWH) and pack-years, but not former smoking, were associated with higher risk of deterioration. CONCLUSIONS Among PWH, smoking status and duration are associated with incident and worsening frailty.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jimmy Ma
- University of Washington, Seattle, WA, USA
| | | | - Lara Haidar
- University of Manitoba, Winnipeg, Manitoba, CA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Ruderman SA, Nance RM, Drumright LN, Whitney BM, Hahn AW, Ma J, Haidar L, Eltonsy S, Mayer KH, Eron JJ, Greene M, Mathews WC, Webel A, Saag MS, Willig AL, Kamen C, McCaul M, Chander G, Cachay E, Lober WB, Pandya C, Cartujano-Barrera F, Kritchevsky SB, Austad SN, Landay A, Kitahata MM, Crane HM, Delaney JAC. Development of Frail RISC-HIV: a Risk Score for Predicting Frailty Risk in the Short-term for Care of People with HIV. AIDS 2023; 37:967-975. [PMID: 36723488 PMCID: PMC10079563 DOI: 10.1097/qad.0000000000003501] [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: 02/02/2023]
Abstract
OBJECTIVE Frailty is common among people with HIV (PWH), so we developed frail risk in the short-term for care (RISC)-HIV, a frailty prediction risk score for HIV clinical decision-making. DESIGN We followed PWH for up to 2 years to identify short-term predictors of becoming frail. METHODS We predicted frailty risk among PWH at seven HIV clinics across the United States. A modified self-reported Fried Phenotype captured frailty, including fatigue, weight loss, inactivity, and poor mobility. PWH without frailty were separated into training and validation sets and followed until becoming frail or 2 years. Bayesian Model Averaging (BMA) and five-fold-cross-validation Lasso regression selected predictors of frailty. Predictors were selected by BMA if they had a greater than 45% probability of being in the best model and by Lasso if they minimized mean squared error. We included age, sex, and variables selected by both BMA and Lasso in Frail RISC-HIV by associating incident frailty with each selected variable in Cox models. Frail RISC-HIV performance was assessed in the validation set by Harrell's C and lift plots. RESULTS Among 3170 PWH (training set), 7% developed frailty, whereas among 1510 PWH (validation set), 12% developed frailty. BMA and Lasso selected baseline frailty score, prescribed antidepressants, prescribed antiretroviral therapy, depressive symptomology, and current marijuana and illicit opioid use. Discrimination was acceptable in the validation set, with Harrell's C of 0.76 (95% confidence interval: 0.73-0.79) and sensitivity of 80% and specificity of 61% at a 5% frailty risk cutoff. CONCLUSIONS Frail RISC-HIV is a simple, easily implemented tool to assist in classifying PWH at risk for frailty in clinics.
Collapse
Affiliation(s)
| | | | | | | | | | - Jimmy Ma
- University of Washington, Seattle, Washington, USA
| | - Lara Haidar
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Kenneth H Mayer
- Harvard Medical School, Fenway Institute, Boston, Massachusetts
| | - Joseph J Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Michael S Saag
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Mary McCaul
- Johns Hopkins University, Baltimore, Maryland
| | - Geetanjali Chander
- University of Washington, Seattle, Washington, USA
- Johns Hopkins University, Baltimore, Maryland
| | - Edward Cachay
- University of California San Diego, San Diego, California
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Ruderman SA, Webel AR, Willig AL, Drumright LN, Fitzpatrick AL, Odden MC, Cleveland JD, Burkholder G, Davey CH, Fleming J, Buford TW, Jones R, Nance RM, Whitney BM, Mixson LS, Hahn AW, Mayer KH, Greene M, Saag MS, Kamen C, Pandya C, Lober WB, Kitahata MM, Crane PK, Crane HM, Delaney JAC. Validity Properties of a Self-reported Modified Frailty Phenotype Among People With HIV in Clinical Care in the United States. J Assoc Nurses AIDS Care 2023; 34:158-170. [PMID: 36652200 PMCID: PMC10088432 DOI: 10.1097/jnc.0000000000000389] [Citation(s) in RCA: 4] [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: 01/19/2023]
Abstract
ABSTRACT Modifications to Fried's frailty phenotype (FFP) are common. We evaluated a self-reported modified frailty phenotype (Mod-FP) used among people with HIV (PWH). Among 522 PWH engaged in two longitudinal studies, we assessed validity of the four-item Mod-FP compared with the five-item FFP. We compared the phenotypes via receiver operator characteristic curves, agreement in classifying frailty, and criterion validity via association with having experienced falls. Mod-FP classified 8% of PWH as frail, whereas FFP classified 9%. The area under the receiver operator characteristic curve for Mod-FP classifying frailty was 0.93 (95% CI = 0.91-0.96). We observed kappa ranging from 0.64 (unweighted) to 0.75 (weighted) for categorizing frailty status. Both definitions found frailty associated with a greater odds of experiencing a fall; FFP estimated a slightly greater magnitude (i.e., OR) for the association than Mod-FP. The Mod-FP has good performance in measuring frailty among PWH and is reasonable to use when the gold standards of observed assessments (i.e., weakness and slowness) are not feasible.
Collapse
Affiliation(s)
- Stephanie A Ruderman
- Stephanie A. Ruderman, MPH, is a PhD candidate, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Allison R. Webel, RN, PhD, is an Associate Dean for Research, School of Nursing, University of Washington, Seattle, Washington, USA. Amanda L. Willig, PhD, RD, is an Associate Professor, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Lydia N. Drumright, PhD, MPH, is a Clinical Assistant Professor, School of Nursing, University of Washington, Seattle, Washington, USA. Annette L. Fitzpatrick, PhD, is a Research Professor, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Michelle C. Odden, PhD, is an Associate Professor, Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, USA. John D. Cleveland, MS, is a Statistician, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. Greer Burkholder, MD, is an Assistant Professor, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Christine H. Davey, RN, PhD, is a Postdoctoral Fellow, School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA. Julia Fleming, MD, is an Infectious Disease Specialist, Harvard Medical School, Fenway Institute, Boston, Massachusetts, USA. Thomas W. Buford, PhD, is a Professor, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA. Raymond Jones, PhD, is an Assistant Professor, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Robin M. Nance, PhD, is a Research Scientist, School of Medicine, University of Washington, Seattle, Washington, USA. Bridget M. Whitney, PhD, MPH, is a Senior Research Scientist, School of Medicine, University of Washington, Seattle, Washington, USA. L. Sarah Mixson, MPH, is a Research Scientist, School of Medicine, University of Washington, Seattle, Washington, USA. Andrew W. Hahn, MD, is a Clinical Assistant Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Kenneth H. Mayer, MD, is a Professor, Harvard Medical School, Fenway Institute, Boston, Massachusetts, USA. Meredith Greene, MD, is an Associate Professor, Department of Medicine, University of California San Francisco, San Francisco, California, USA. Michael S. Saag, MD, is a Professor and Associate Dean, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Charles Kamen, PhD, MPH, is an Associate Professor, Department of Surgery, University of Rochester, Rochester, New York, USA. Chintan Pandya, PhD, is an Assistant Scientist, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. William B. Lober, MD, MS, is a Professor, School of Nursing, University of Washington, Seattle, Washington, USA. Mari M. Kitahata, MD, MPH, is a Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Paul K. Crane, MD, MPH, is a Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Heidi M. Crane, MD, MPH, is a Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Joseph A. C. Delaney, PhD, is an Associate Professor, College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Hahn AW, Ruderman SA, Nance RM, Whitney BW, Eltonsy S, Haidar L, Delaney JAC, Drumright LN, Ma J, Mayer KH, 'Cleirigh CO, Napravnik S, Eron JJ, Christopoulos K, Bamford L, Cachay E, Jacobson JM, Willig A, Cropsey K, Chander G, Crane HM, Fredericksen RJ. Vaporized Nicotine (E-Cigarette) and Tobacco Smoking Among People With HIV: Use Patterns and Associations With Depression and Panic Symptoms. J Acquir Immune Defic Syndr 2023; 92:197-203. [PMID: 36399783 PMCID: PMC9928884 DOI: 10.1097/qai.0000000000003132] [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: 05/31/2022] [Accepted: 10/18/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vaporized nicotine (VN) use is increasing among people with HIV (PWH). We examined demographics, patterns of use, depression, and panic symptoms associated with VN and combustible cigarette (CC) use among PWH. METHODS We analyzed VN use among PWH in care at 7 US sites. PWH completed a set of patient-reported outcomes, including substance use and mental health. We categorized VN use as never vs. ever with the frequency of use (days/month) and CC use as never, former, or current. We used relative risk regression to associate VN and CC use, depression, and panic symptoms. Linear regression estimated each relationship with VN frequency. Models were adjusted for demographics. RESULTS Among 7431 PWH, 812 (11%) reported ever-using VN, and 264 (4%) reported daily use. Half (51%) of VN users concurrently used CC. VN users were more likely than those without use to be younger, to be White, and to report ever-using CC. PWH reporting former CC use reported ≥8.5 more days per month of VN use compared with never CC use [95% confidence interval (95% CI): 5.5 to 11.5 days/month] or current CC use (95% CI: 6.6 to 10.5 days/month). Depression (relative risk: 1.20 [95% CI: 1.02 to 1.42]) and panic disorder (1.71 [95% CI: 1.43 to 2.05]) were more common among PWH ever-using VN. Depression was common among PWH using VN (27%) and CC (22%), as was panic disorder (21% for VN and 16% for CC). CONCLUSION Our study elucidated demographic associations with VN use among PWH, revealed the overlap of VN and CC use, and associations with depression/panic symptoms, suggesting roles of VN in self-medication and CC substitution, warranting further longitudinal/qualitative research.
Collapse
Affiliation(s)
- Andrew W Hahn
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Robin M Nance
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Sherif Eltonsy
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lara Haidar
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Jimmy Ma
- Department of Medicine, University of Washington, Seattle, WA
| | - Kenneth H Mayer
- Department of Medicine, Harvard Medical School, Fenway Institute, Boston, MA
| | - Conall O 'Cleirigh
- Department of Psychiatry, Harvard Medical School, Fenway Institute, Boston, MA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | | | - Laura Bamford
- Department of Medicine, University of California San Diego, San Diego, CA
| | - Edward Cachay
- Department of Medicine, University of California San Diego, San Diego, CA
| | | | - Amanda Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; and
| | - Karen Cropsey
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; and
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL
| | | | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA
| | | |
Collapse
|
12
|
Drumright LN, Nance RM, Ruderman SA, Ma J, Whitney BM, Hahn A, Fredericksen RJ, Luu B, Lober WB, Moore RD, Budoff MJ, Keruly JC, Christopoulos K, Puryear S, Willig A, Cropsey K, Mathews WC, Cachay E, Bamford L, Eron JJ, Napravnik S, Mayer KH, O'Cleirigh C, Mccaul ME, Chander G, Feinstein MJ, Saag MS, Kitahata MM, Heckbert SR, Crane HM, Delaney JAC. Associations between alcohol and cigarette use and type 1 and 2 myocardial infarction among people with HIV. HIV Med 2023. [PMID: 36855253 DOI: 10.1111/hiv.13466] [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] [Received: 06/08/2022] [Accepted: 01/19/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES People with HIV have a higher risk of myocardial infarction (MI) than the general population, with a greater proportion of type 2 MI (T2MI) due to oxygen demand-supply mismatch compared with type 1 (T1MI) resulting from atherothrombotic plaque disruption. People living with HIV report a greater prevalence of cigarette and alcohol use than do the general population. Alcohol use and smoking as risk factors for MI by type are not well studied among people living with HIV. We examined longitudinal associations between smoking and alcohol use patterns and MI by type among people living with HIV. DESIGN AND METHODS Using longitudinal data from the Centers for AIDS Research Network of Integrated Clinical Systems cohort, we conducted time-updated Cox proportional hazards models to determine the impact of smoking and alcohol consumption on adjudicated T1MI and T2MI. RESULTS Among 13 506 people living with HIV, with a median 4 years of follow-up, we observed 177 T1MI and 141 T2MI. Current smoking was associated with a 60% increase in risk of both T1MI and T2MI. In addition, every cigarette smoked per day was associated with a 4% increase in risk of T1MI, with a suggestive, but not significant, 2% increase for T2MI. Cigarette use had a greater impact on T1MI for men than for women and on T2MI for women than for men. Increasing alcohol use was associated with a lower risk of T1MI but not T2MI. Frequency of heavy episodic alcohol use was not associated with MI. CONCLUSIONS Our findings reinforce the prioritization of smoking reduction, even without cessation, and cessation among people living with HIV for MI prevention and highlight the different impacts on MI type by gender.
Collapse
Affiliation(s)
- Lydia N Drumright
- University of Washington, Seattle, Washington, USA.,University of Cambridge, Cambridge, UK
| | | | | | - Jimmy Ma
- University of Washington, Seattle, Washington, USA
| | | | - Andrew Hahn
- University of Washington, Seattle, Washington, USA
| | | | - Brandon Luu
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | | | | | | | | | | | - Sarah Puryear
- University of California, San Francisco, California, USA
| | | | | | | | - Edward Cachay
- University of California, San Diego, California, USA
| | - Laura Bamford
- University of California, San Diego, California, USA
| | - Joseph J Eron
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sonia Napravnik
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | | | - Geetanjali Chander
- University of Washington, Seattle, Washington, USA.,Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | | | | | | | | |
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
Luu BR, Nance RM, Delaney JAC, Ruderman SA, Heckbert SR, Budoff MJ, Mathews WC, Moore RD, Feinstein MJ, Burkholder GA, Mugavero MJ, Eron JJ, Saag MS, Kitahata MM, Crane HM, Whitney BM. Brief Report: Insomnia and Risk of Myocardial Infarction Among People With HIV. J Acquir Immune Defic Syndr 2022; 90:50-55. [PMID: 35001042 PMCID: PMC8986570 DOI: 10.1097/qai.0000000000002910] [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] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Insomnia is common among people with HIV (PWH) and may be associated with increased risk of myocardial infarction (MI). This study examines the association between insomnia and MI by MI type among PWH. SETTING Longitudinal cohort study of PWH at 5 Centers for AIDS Research Network of Integrated Clinical Systems sites. METHODS Clinical data and patient-reported measures and outcomes from PWH in care between 2005 and 2018 were used in this study. Insomnia, measured at baseline, was defined as having difficulty falling or staying asleep with bothersome symptoms. The Centers for AIDS Research Network of Integrated Clinical Systems centrally adjudicates MIs using expert reviewers, with distinction between type 1 MI (T1MI) and type 2 MI (T2MI). Associations between insomnia and first incident MI by MI type were measured using separate Cox proportional hazard models adjusted for age, sex, race/ethnicity, traditional cardiovascular disease risk factors (hypertension, dyslipidemia, poor kidney function, diabetes, and smoking), HIV markers (antiretroviral therapy, viral suppression, and CD4 cell count), and stimulant use (cocaine/crack and methamphetamine). RESULTS Among 12,448 PWH, 48% reported insomnia. Over a median of 4.4 years of follow-up, 158 T1MIs and 109 T2MIs were identified; approximately half of T2MIs were attributed to sepsis or stimulant use. After adjustment for potential confounders, we found no association between insomnia and T1MI (hazard ratio = 1.05, 95% confidence interval: 0.76 to 1.45) and a 65% increased risk of T2MI among PWH reporting insomnia compared with PWH without insomnia (hazard ratio = 1.65, 95% confidence interval: 1.11 to 2.45). CONCLUSIONS PWH reporting insomnia are at an increased risk of T2MI, but not T1MI, compared with PWH without insomnia, highlighting the importance of distinguishing MI types among PWH.
Collapse
Affiliation(s)
- Brandon R Luu
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Robin M Nance
- Department of Medicine, University of Washington, Seattle, WA
| | | | | | | | - Matthew J Budoff
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - William C Mathews
- Department of Medicine, University of California San Diego, San Diego, CA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Greer A Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; and
| | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; and
| | - Joseph J Eron
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; and
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA
| | | |
Collapse
|
15
|
Neff Warner LR, Ruderman SA, Zinsli KA, Jones-Smith JC, Littman AJ. Menu Labeling Utilization and Socioeconomic Status in West Virginia and Mississippi. J Nutr Educ Behav 2022; 54:172-180. [PMID: 35148871 DOI: 10.1016/j.jneb.2021.11.005] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Determine the association between socioeconomic status and self-reported noticing and using calorie menu labels in 2 states with high poverty and obesity. DESIGN Cross-sectional study of responses to the 2016 Behavioral Risk Factor Surveillance System Menu Labeling Module. PARTICIPANTS Representative sample of noninstitutionalized adults aged ≥ 18 years in West Virginia and Mississippi (n = 9,469). MAIN OUTCOME MEASURES The outcomes were reported noticing and using menu labels to make decisions at fast-food restaurants. Independent variables were highest attained education and federal poverty level (% FPL). ANALYSIS Generalized linear models estimated prevalence ratios for noticing and using menu labels. Models mutually adjusted for education, % FPL, age, sex, race/ethnicity, and body mass index. RESULTS Eighty-six percent of respondents reported noticing, and 56% reported using menu labels. Compared with individuals with less than high school education, college graduates were 11% more likely to report noticing (95% confidence interval, 1.06-1.18; P < 0.001) and 18% more likely to report using (95% confidence interval, 1.06-1.30; P < 0.01) menu labels. Patterns were similar for % FPL. CONCLUSIONS AND IMPLICATIONS These data support further investigation of menu labels among subgroups and a larger geographic scope. Limitations of the menu labeling module question and the cross-sectional nature of the existing literature warrant additional research.
Collapse
Affiliation(s)
| | | | - Kaitlin A Zinsli
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Jessica C Jones-Smith
- Department of Epidemiology, University of Washington, Seattle, WA; Department of Health Services, University of Washington, Seattle, WA
| | - Alyson J Littman
- Department of Epidemiology, University of Washington, Seattle, WA; Department of Veterans Affairs, Seattle Epidemiologic Research and Information Center, Puget Sound Health Care System, Seattle, WA; Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System, Health Services, Seattle, WA
| |
Collapse
|
16
|
Harding BN, Avoundjian T, Heckbert SR, Whitney BM, Nance RM, Ruderman SA, Kalani R, Tirschwell DL, Ho EL, Becker KJ, Zunt J, Chow F, Huffer A, Mathews WC, Eron J, Moore RD, Marra CM, Burkholder G, Saag MS, Kitahata MM, Crane HM, Delaney JC. HIV Viremia and Risk of Stroke Among People Living with HIV Who Are Using Antiretroviral Therapy. Epidemiology 2021; 32:457-464. [PMID: 33591056 PMCID: PMC8012252 DOI: 10.1097/ede.0000000000001331] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rates of stroke are higher in people living with HIV compared with age-matched uninfected individuals. Causes of elevated stroke risk, including the role of viremia, are poorly defined. METHODS Between 1 January 2006 and 31 December 2014, we identified incident strokes among people living with HIV on antiretroviral therapy at five sites across the United States. We considered three parameterizations of viral load (VL) including (1) baseline (most recent VL before study entry), (2) time-updated, and (3) cumulative VL (copy-days/mL of virus). We used Cox proportional hazards models to estimate hazard ratios (HRs) for stroke risk comparing the 75th percentile ("high VL") to the 25th percentile ("low VL") of baseline and time-updated VL. We used marginal structural Cox models, with most models adjusted for traditional stroke risk factors, to estimate HRs for stroke associated with cumulative VL. RESULTS Among 15,974 people living with HIV, 139 experienced a stroke (113 ischemic; 18 hemorrhagic; eight were unknown type) over a median follow-up of 4.2 years. Median baseline VL was 38 copies/mL (interquartile interval: 24, 3,420). High baseline VL was associated with increased risk of both ischemic (HR: 1.3; 95% CI = 0.96-1.7) and hemorrhagic stroke (HR: 3.1; 95% CI = 1.6-5.9). In time-updated models, high VL was also associated with an increased risk of any stroke (HR: 1.8; 95% CI = 1.4-2.3). We observed no association between cumulative VL and stroke risk. CONCLUSIONS Our findings are consistent with the hypothesis that elevated HIV VL may increase stroke risk, regardless of previous VL levels.
Collapse
Affiliation(s)
| | | | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA
| | | | - Robin M Nance
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Rizwan Kalani
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Emily L Ho
- Department of Medicine, University of Washington, Seattle, WA
| | - Kyra J Becker
- Department of Medicine, University of Washington, Seattle, WA
| | - Joseph Zunt
- Department of Medicine, University of Washington, Seattle, WA
| | - Felicia Chow
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Andrew Huffer
- Department of Medicine, University of Washington, Seattle, WA
| | | | - Joseph Eron
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | | | | | - Greer Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA
| | - Joseph C Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
17
|
Ruderman SA, Crane HM, Nance RM, Whitney BM, Harding BN, Mayer KH, Moore RD, Eron JJ, Geng E, Mathews WC, Rodriguez B, Willig AL, Burkholder GA, Lindström S, Wood BR, Collier AC, Vannappagari V, Henegar C, Van Wyk J, Curtis L, Saag MS, Kitahata MM, Delaney JAC. Brief Report: Weight Gain Following ART Initiation in ART-Naïve People Living With HIV in the Current Treatment Era. J Acquir Immune Defic Syndr 2021; 86:339-343. [PMID: 33148997 PMCID: PMC7878311 DOI: 10.1097/qai.0000000000002556] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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: 06/29/2020] [Accepted: 10/09/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Evaluate differences in weight change by regimen among people living with HIV (PLWH) initiating antiretroviral therapy (ART) in the current era. METHODS Between 2012 and 2019, 3232 ART-naïve PLWH initiated ≥3-drug ART regimens in 8 Centers for AIDS Research Network of Integrated Clinical Systems sites. We estimated weight change by regimen for 11 regimens in the immediate (first 6 months) and extended (all follow-up on initial regimen) periods using linear mixed models adjusted for time on regimen, interaction between time and regimen, age, sex, race/ethnicity, hepatitis B/C coinfection, nadir CD4, smoking, diabetes, antipsychotic medication, and site. We included more recently approved regimens [eg, with tenofovir alafenamide fumarate (TAF)] only in the immediate period analyses to ensure comparable follow-up time. RESULTS Mean follow-up was 1.9 years on initial ART regimen. In comparison to efavirenz/tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC), initiating bictegravir/TAF/FTC {3.9 kg [95% confidence interval (CI): 2.2 to 5.5]} and dolutegravir/TAF/FTC [4.4 kg (95% CI: 2.1 to 6.6)] were associated with the greatest weight gain in the immediate period, followed by darunavir/TDF/FTC [3.7 kg (95% CI: 2.1 to 5.2)] and dolutegravir/TDF/FTC [2.6 kg (95% CI: 1.3 to 3.9)]. In the extended period, compared with efavirenz/TDF/FTC, initiating darunavir/TDF/FTC was associated with a 1.0 kg (95% CI: 0.5 to 1.5) per 6-months greater weight gain, whereas dolutegravir/abacavir/FTC was associated with a 0.6-kg (95% CI: 0.3 to 0.9) and dolutegravir/TDF/FTC was associated with a 0.6-kg (95% CI: 0.1 to 1.1) per 6-months greater gain. Weight gain on dolutegravir/abacavir/FTC and darunavir/TDF/FTC was significantly greater than that for several integrase inhibitor-based regimens. CONCLUSIONS There is heterogeneity between regimens in weight gain following ART initiation among previously ART-naïve PLWH; we observed greater gain among PLWH taking newer integrase strand transfer inhibitors (DTG, BIC) and DRV-based regimens.
Collapse
Affiliation(s)
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA
| | - Robin M Nance
- Department of Medicine, University of Washington, Seattle, WA
| | | | | | | | | | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Elvin Geng
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - William C Mathews
- Department of Medicine, University of California San Diego, San Diego, CA
| | - B Rodriguez
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Brian R Wood
- Department of Medicine, University of Washington, Seattle, WA
| | - Ann C Collier
- Department of Medicine, University of Washington, Seattle, WA
| | | | | | | | | | | | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA
| | - Joseph A C Delaney
- University of Washington, Seattle, WA
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
18
|
Fredericksen RJ, Harding BN, Ruderman SA, McReynolds J, Barnes G, Lober WB, Fitzsimmons E, Nance RM, Whitney BM, Delaney JAC, Mathews WC, Willig J, Crane PK, Crane HM. Patient acceptability and usability of a self-administered electronic patient-reported outcome assessment in HIV care: relationship with health behaviors and outcomes. AIDS Care 2020; 33:1167-1177. [PMID: 33190523 DOI: 10.1080/09540121.2020.1845288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We assessed acceptability/usability of tablet-based patient-reported outcome (PRO) assessments among patients in HIV care, and relationships with health outcomes using a modified Acceptability E-Scale (AES) within a self-administered PRO assessment. Using multivariable linear regression, we measured associations between patient characteristics and continuous combined AES score. Among 786 patients (median age=48; 91% male; 49% white; 17% Spanish-speaking) overall mean score was 26/30 points (SD: 4.4). Mean scores per dimension (max 5, 1=lowest acceptability, 5=highest): ease of use 4.7, understandability 4.7, time burden 4.3, overall satisfaction 4.3, helpfulness describing symptoms/behaviors 4.2, and enjoyability 3.8. Higher overall score was associated with race/ethnicity (+1.3 points/African-American patients (95%CI:0.3-2.3); +1.6 points/Latino patients (95%CI:0.9-2.3) compared to white patients). Patients completing PROs in Spanish scored +2.4 points on average (95%CI:1.6-3.3). Higher acceptability was associated with better quality of life (0.3 points (95%CI:0.2-0.5)) and adherence (0.4 points (95%CI:0.2-0.6)). Lower acceptability was associated with: higher depression symptoms (-0.9 points (95%CI:-1.4 to -0.4)); recent illicit opioid use (-2.0 points (95%CI:-3.9 to -0.2)); multiple recent sex partners (-0.8 points (95%CI:-1.5 to -0.1)). While patients endorsing depression symptoms, recent opioid use, condomless sex, or multiple sex partners found PROs less acceptable, overall, patients found the assessments highly acceptable and easy to use.
Collapse
Affiliation(s)
| | | | | | | | - G Barnes
- University of Washington, Seattle, WA, USA
| | - W B Lober
- University of Washington, Seattle, WA, USA
| | | | - R M Nance
- University of Washington, Seattle, WA, USA
| | | | | | - W C Mathews
- University of California at San Diego, San Diego, CA, USA
| | - J Willig
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - P K Crane
- University of Washington, Seattle, WA, USA
| | - H M Crane
- University of Washington, Seattle, WA, USA
| |
Collapse
|
19
|
Harding BN, Whitney BM, Nance RM, Ruderman SA, Crane HM, Burkholder G, Moore RD, Mathews WC, Eron JJ, Hunt PW, Volberding P, Rodriguez B, Mayer KH, Saag MS, Kitahata MM, Heckbert SR, Delaney JAC. Anemia risk factors among people living with HIV across the United States in the current treatment era: a clinical cohort study. BMC Infect Dis 2020; 20:238. [PMID: 32197585 PMCID: PMC7085166 DOI: 10.1186/s12879-020-04958-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Anemia is common among people living with HIV infection (PLWH) and is associated with adverse health outcomes. Information on risk factors for anemia incidence in the current antiretroviral therapy (ART) era is lacking. Methods Within a prospective clinical cohort of adult PLWH receiving care at eight sites across the United States between 1/2010–3/2018, Cox proportional hazards regression analyses were conducted among a) PLWH free of anemia at baseline and b) PLWH free of severe anemia at baseline to determine associations between time-updated patient characteristics and development of anemia (hemoglobin < 10 g/dL), or severe anemia (hemoglobin < 7.5 g/dL). Linear mixed effects models were used to examine relationships between patient characteristics and hemoglobin levels during follow-up. Hemoglobin levels were ascertained using laboratory data from routine clinical care. Potential risk factors included: age, sex, race/ethnicity, body mass index, smoking status, hazardous alcohol use, illicit drug use, hepatitis C virus (HCV) coinfection, estimated glomerular filtration rate (eGFR), CD4 cell count, viral load, ART use and time in care at CNICS site. Results This retrospective cohort study included 15,126 PLWH. During a median follow-up of 6.6 (interquartile range [IQR] 4.3–7.6) years, 1086 participants developed anemia and 465 participants developed severe anemia. Factors that were associated with incident anemia included: older age, female sex, black race, HCV coinfection, lower CD4 cell counts, VL ≥400 copies/ml and lower eGFR. Conclusion Because anemia is a treatable condition associated with increased morbidity and mortality among PLWH, hemoglobin levels should be monitored routinely, especially among PLWH who have one or more risk factors for anemia.
Collapse
Affiliation(s)
- B N Harding
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA.
| | - B M Whitney
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - R M Nance
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - S A Ruderman
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - H M Crane
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - G Burkholder
- University of Alabama Birmingham, Birmingham, USA
| | - R D Moore
- Johns Hopkins University, Baltimore, USA
| | - W C Mathews
- University of California San Diego, San Diego, USA
| | - J J Eron
- University of North Carolina, Chapel Hill, USA
| | - P W Hunt
- University of California San Francisco, San Francisco, USA
| | - P Volberding
- University of California San Francisco, San Francisco, USA
| | - B Rodriguez
- Case Western Reserve University, Cleveland, USA
| | - K H Mayer
- Fenway Health Institute, Boston, USA
| | - M S Saag
- University of Alabama Birmingham, Birmingham, USA
| | - M M Kitahata
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - S R Heckbert
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| | - J A C Delaney
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-26, Box 357236, Seattle, WA, 98195, USA
| |
Collapse
|