HIV Seropositivity: Vlahov D

Klein RS, Flanigan T, Schuman P, Smith D, Vlahov D. · Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10467, USA. Disease, Department of Medicine, · J Allergy Clin Immunol. · Pubmed #9893191 No free full text.

Abstract: BACKGROUND: Controversy exists about both the clinical utility of anergy testing and the optimal criteria for defining anergy. OBJECTIVE: We sought to assess various definitions of cutaneous anergy for ability to distinguish HIV status, level of immunodeficiency, and ability to mount a tuberculin reaction among women with or at risk for HIV infection. METHODS: HIV-seropositive (n = 721) and HIV-seronegative (n = 358) at-risk women at academic medical centers in Baltimore, Detroit, New York, and Providence had cutaneous testing with mumps, Candida, tetanus toxoid, and tuberculin antigens. Associations with HIV status and CD4+ lymphocyte levels were analyzed. RESULTS: Candida, mumps, and tetanus antigens alone or in combination elicited reactions significantly less often in HIV-seropositive than in HIV-seronegative women and less often in seropositive women with lower CD4+ counts, regardless of induration cutpoint chosen to define a positive reaction. The best antigen combinations for distinguishing groups included tetanus and mumps. Some women nonreactive to the 3 antigens ("anergic") had positive tuberculin reactions among both seropositive subjects (range, 1.1% to 2.9% depending on induration cutpoint for defining anergy) and seronegative subjects (range, 8.9% to 14%). CONCLUSION: Absence of reactions to Candida, mumps, and tetanus antigens alone or in combination and at any induration cutpoint is associated with HIV status and with CD4+ level. Combinations, including tetanus and mumps antigens with an induration cutpoint of less than 2 mm, may be the best for defining anergy.

Macalino GE, Celentano DD, Latkin C, Strathdee SA, Vlahov D. · Department of Community Health, Brown University, School of Medicine, Providence, RI 02912, USA. · AIDS Educ Prev. · Pubmed #12413183 No free full text.

Abstract: Audio computer assisted self-interview (ACASI) has been shown to elicit significantly higher reports of sensitive HIV risk behaviors compared with interviewer-administered questionnaires (IAQ). Injection drug users were randomized to either ACASI (n = 556) or IAQ (n = 586) in order to evaluate reporting differences. A significant interaction was found between mode of administration (ACASI/IAQ) and HIV status. HIV-seropositive respondents on ACASI compared with IAQ were less likely to report condom use (odds ratio [OR] = .42, p < .01) and condom use frequency (OR = .28, p < .002), compared with HIV-seronegative respondents. Based on ACASI results, HIV-seropositive individuals engaged in fewer preventive behaviors than suggested by IAQ. These findings support the validity of ACASI as an important mode of data collection in reducing socially desirable responding, especially among HIV-seropositive subjects.

Shardell M, Scharfstein DO, Vlahov D, Galai N. · Department of Epidemiology and Preventive Medicine, University of Maryland, 660 West Redwood Street, Baltimore, MD 21201-1596, USA. · Stat Med. · Pubmed #18759370 No free full text.

Abstract: We consider the problem of comparing cumulative incidence functions of non-mortality events in the presence of informative coarsening and the competing risk of death. We extend frequentist-based hypothesis tests previously developed for non-informative coarsening and propose a novel Bayesian method based on comparing a posterior parameter transformation with its expected distribution under the null hypothesis of equal cumulative incidence functions. Both methods use estimates derived by extending previously published estimation procedures to accommodate censoring by death. The data structure and analysis goal are exemplified by the AIDS Link to the Intravenous Experience (ALIVE) study, where researchers are interested in comparing incidence of human immunodeficiency virus seroconversion by risk behavior categories. Coarsening in the forms of interval and right censoring and censoring by death in ALIVE is thought to be informative; thus, we perform a sensitivity analysis by incorporating elicited expert information about the relationship between seroconversion and censoring into the model.

Cook JA, Grey DD, Burke-Miller JK, Cohen MH, Vlahov D, Kapadia F, Wilson TE, Cook R, Schwartz RM, Golub ET, Anastos K, Ponath C, Goparaju L, Levine AM. · Center on Mental Health Services Research and Policy, Department of Psychiatry M/C 912, University of Illinois at Chicago, 1601 W. Taylor Street M/C 912, Chicago, IL 60612, USA. · Drug Alcohol Depend. · Pubmed #17291696 No free full text.

Abstract: BACKGROUND: We examined the interaction of illicit drug use and depressive symptoms, and how they affect the subsequent likelihood of highly active antiretroviral therapy (HAART) use among women with HIV/AIDS. METHODS: Subjects included 1710 HIV-positive women recruited from six sites in the U.S. including Brooklyn, Bronx, Chicago, Los Angeles, San Francisco/Bay Area, and Washington, DC. Cases of probable depression were identified using depressive symptom scores on the Center for Epidemiologic Studies Depression Scale. Crack, cocaine, heroin, and amphetamine use were self-reported at 6-month time intervals. We conducted multivariate random logistic regression analysis of data collected during 16 waves of semiannual interviews conducted from April 1996 through March 2004. RESULTS: We found an interaction effect between illicit drug use and depression that acted to suppress subsequent HAART use, controlling for virologic and immunologic indicators, socio-demographic variables, time, and study site. CONCLUSIONS: This is the first study to document the interactive effects of drug use and depressive symptoms on reduced likelihood of HAART use in a national cohort of women. Since evidence-based behavioral health and antiretroviral therapies for each of these three conditions are now available, comprehensive HIV treatment is an achievable public health goal.

Smit E, Crespo CJ, Semba RD, Jaworowicz D, Vlahov D, Ricketts EP, Ramirez-Marrero FA, Tang AM. · School of Community Health, Portland State University, Portland, OR 97207-0751, USA. · AIDS Care. · Pubmed #17012097 No free full text.

Abstract: Physical activity is beneficial for persons with HIV infection but little is known about the relationships between physical activity, HIV treatment and injection drug use (IDU). This study compared physical activity levels between HIV-negative and HIV-positive injection drug users (IDUs) and between HIV-positive participants not on any treatment and participants on highly active antiretroviral therapy (HAART). Anthropometric measurements were obtained and an interviewer-administered modified Paffenbarger physical activity questionnaire was administered to 324 participants in a sub-study of the AIDS Linked to Intravenous Experiences (ALIVE) cohort, an ongoing study of HIV-negative and HIV-positive IDUs. Generalized linear models were used to obtain univariate means and to adjust for confounding (age, gender, employment and recent IDU). Vigorous activity was lower among HAART participants than HIV-positive participants not on treatment (p=0.0025) and somewhat lower than HIV-negative participants (p=0.11). Injection drug use and viral load were not associated with vigorous activity. Energy expenditure in vigorous activity was also lower among HAART participants than both HIV-negative and HIV-positive participants not on treatment. Thus, HIV-positive participants on HAART spend less time on vigorous activity independent of recent IDU. More research is needed into the reasons and mechanism for the lack of vigorous activities, including behavioral, psychological and physiological reasons.

Mehta SH, Galai N, Astemborski J, Celentano DD, Strathdee SA, Vlahov D, Nelson KE. · Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21202, USA. · J Acquir Immune Defic Syndr. · Pubmed #16980912 No free full text.

Abstract: BACKGROUND: We examined recent trends (1999-2004) in HIV incidence among a cohort of injection drug users (IDUs) followed since 1988 in Baltimore, Maryland. METHODS: One thousand eighty-three HIV-seronegative individuals with a history of injection drug use were recruited between 1988 and 1998 and returned for >or=1 semiannual follow-up visit, where they underwent HIV antibody testing and interviews eliciting risk behaviors. Person-time methods were used to calculate HIV incidence rates per 100 person-years (PYs). RESULTS: Over 14,770 PYs, 304 individuals seroconverted to HIV (2.06 per 100 PYs). Annual incidence declined from 4.57 in 1988 to 0.53 per 100 PYs in 2004. Similarly, among individuals actively injecting drugs, incidence steadily declined from 5.43 in 1988 to 0 in 2004, with the exception of 2003, when an incidence of 2.59 per 100 PYs was observed. Reported sexual risk behaviors and drug injection declined from 1988 through 2004, but among those actively injecting, reported needle sharing declined from 1988 through 1998 and then increased from 30% in 1998 to nearly 40% in 2003 through 2004. CONCLUSIONS: Long-term declines in HIV incidence among IDUs are consistent with other reports; however, in 2003, we observed an unexpected increase in seroconversion that seems to be related to needle sharing. Although additional follow-up is needed to identify trends, these data indicate the need to reinforce HIV prevention efforts and to continue surveillance of drug users' behaviors.

Lee J, Vlahov D, Freudenberg N. · Division of General Internal Medicine, Weill Cornell Medical College, USA. · J Health Care Poor Underserved. · Pubmed #16520527 No free full text.

Abstract: Factors associated with primary care utilization and health insurance coverage were examined among 511 women leaving jail in New York City from 1997-2001. One year after release, roughly half of the sample reported primary care utilization (47%) and health insurance coverage (56%). Neither outcome was more likely among those reporting diabetes, asthma, or depression. Primary care utilization was more likely among those reporting receipt of public benefits, health insurance coverage, moderate social support, avoidance of illegal activity, and HIV seropositivity. Health insurance coverage was associated with receipt of public benefits, hospitalization, primary care, and avoiding re-arrest. This study demonstrated that a majority of women leaving jail, including those with chronic diseases, lack primary care. These data highlight the need to plan for continuity of care from corrections to the community and suggest further that this can be facilitated with provision of health benefits and social support.

Washington TA, Galai N, Cohn S, Celentano DD, Vlahov D, Strathdee SA. · Drug Abuse Research Program, Morgan State University, Baltimore, Maryland 21251, USA. · Arch Sex Behav. · Pubmed #16502154 No free full text.

Abstract: Data are sparse on injection drug using (IDU) men who have sex with men (MSM). Previous literature suggests perceived taboos can result in an underreporting of atypical sexual orientation (i.e., bisexuality, homosexuality). As a result, HIV prevention programs have been difficult to mount, particularly programs for IDU-MSM. The association between self-reported sexual orientation and sexual behavior at semi-annual study visits was longitudinally assessed in a population of 1300 male IDUs in Baltimore during the period 1993 to 1998. Overall, a small minority (5%) of the male IDUs inconsistently reported their sexual orientation over time. Logistic regression analyses were performed, which yielded five significant predictors. These men tended to be older, to have been incarcerated, to have attended shooting galleries during follow-up, and were more than twice as likely to be HIV-seropositive (OR, 2.66; 95% CI, 1.62-4.36) compared with those who consistently reported their sexual orientation. Furthermore, men reporting inconsistent sexual orientation tended to engage in higher risk behaviors, suggesting that these men should be especially targeted for interventions.

Mehta SH, Astemborski J, Sterling TR, Thomas DL, Vlahov D. · Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland 21205, USA. · AIDS Res Hum Retroviruses. · Pubmed #16438640 No free full text.

Abstract: Low albumin levels have been associated with HIV progression. The objective of this analysis was to confirm this association and to further examine the effect of albumin before and after HIV seroconversion on disease progression. The association was first examined among individuals already infected with HIV at entry into a community-based cohort (n = 453) and further assessed among HIV seroconverters with albumin concentrations measured after (n = 219) and before seroconversion (n = 138). The prognostic effect of albumin on AIDS, AIDS mortality, and all-cause mortality was examined using Cox regression. Among 453 HIV-infected individuals, albumin <35 g/liter was associated with faster progression to AIDS [adjusted relative hazard (ARH), 1.8; 95% confidence interval (CI), 1.2-2.8], AIDS mortality (ARH, 2.2; 95% CI, 1.3-3.8), and all-cause mortality (ARH, 2.4; 95% CI, 1.6-3.5). Analyses restricted to HIV seroconverters were similar. Preseroconversion levels of albumin did not predict outcomes, but HIV seroconversion appeared to lower albumin levels. These data show that albumin <35 g/liter after HIV seroconversion is associated with faster HIV disease progression and suggest that low albumin levels are probably a consequence of HIV infection rather than merely reflective of some individuals inherently having low albumin levels.

Shah NG, Galai N, Celentano DD, Vlahov D, Strathdee SA. · Epidemiology and Response Division, New Mexico Department of Health, 1190 St. Francis Drive, P.O. Box 26110, Santa Fe, NM 87502-6110, USA. · Drug Alcohol Depend. · Pubmed #16364568 No free full text.

Abstract: OBJECTIVE: To determine predictors of injection drug use cessation and subsequent relapse among a cohort of injection drug users (IDUs). METHODS: IDUs in Baltimore, MD were recruited through community outreach in 1988-1989. Among IDUs with at least three follow-up visits, parametric survival models for time to injection cessation (>or=6 months) and subsequent relapse were constructed. RESULTS: Of 1327 IDUs, 94.8% were African American, 77.2% were male, median age was 34 years, and 37.7% were HIV-infected. Among 936 (70.5%) subjects who ceased injection, median time from baseline to cessation was 4.0 years. Three-quarters subsequently resumed injection drug use, among whom median time to relapse was 1.0 year. Factors independently associated with a shorter time to cessation were: age <30 years, stable housing, HIV seropositivity, methadone maintenance treatment, detoxification, abstinence from cigarettes and alcohol, injecting less than daily, not injecting heroin and cocaine together, and not having an IDU sex partner. Factors independently associated with shorter time to injection relapse were male gender, homelessness, HIV seropositivity, use of alcohol, cigarettes, non-injection cocaine, sexual abstinence and having a longer time to the first cessation. CONCLUSIONS: This study provides strong support for targeting cessation efforts among young IDUs and severely dependent, unstably housed, and HIV-infected individuals.

Deloria-Knoll M, Steinhoff M, Semba RD, Nelson K, Vlahov D, Meinert CL. · National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA. · Vaccine. · Pubmed #16256250 No free full text.

Abstract: HIV-infected individuals have impaired immune responses to vaccines and high rates of pneumococcal disease. The effect of vitamin A and zinc supplementation on the immunogenicity of a 7-valent pneumococcal CRM-197 conjugate vaccine (PC-7) was evaluated in 118 HIV+ injection drug users. Subjects were randomized to oral 400,000 IU vitamin A, 300 mg zinc, vitamin A + zinc, or placebo, then immunized. Geometric mean titer increased 1.3-3.3-fold for all pneumococcal serotypes. PC-7 elicited an immune response in HIV-infected adults but neither vitamin A nor zinc altered the immunogenicity of the evaluated vaccines.

Dancheck B, Tang AM, Thomas AM, Smit E, Vlahov D, Semba RD. · Johns Hopkins School of Medicine, Baltimore, MD, USA. · J Acquir Immune Defic Syndr. · Pubmed #16186738 No free full text.

Abstract: The risk factors for iron deficiency and iron deficiency anemia among female injection drug users are not well characterized. We measured hemoglobin and plasma ferritin and obtained demographic information and injection drug use history in the last 6 months in a cross-sectional study of 200 female injection drug users (134 HIV-positive and 66 HIV-negative). The women were participants in a natural history study, the AIDS Linked to Intravenous Experiences study in Baltimore, Maryland. In multivariate analyses adjusting for age, hepatitis C virus status, and HIV status, injection drug use within the last 6 months was associated with iron deficiency (odds ratio [OR] = 2.61, 95% confidence interval [CI]: 1.33 to 5.09) and iron deficiency anemia (OR = 6.65, 95% CI: 2.33 to 18.9). Among 134 HIV-positive women, injection drug use in the last 6 months was associated with iron deficiency (OR = 2.43, 95% CI: 1.08 to 5.48) and iron deficiency anemia (OR = 6.05, 95% CI: 1.82 to 20.1) in multivariate analyses adjusting for hepatitis C virus status and CD4 lymphocyte count. Injection drug use seems to be associated with iron deficiency and iron deficiency anemia. Further longitudinal studies are needed to gain insight into the nature of this association.

Kapadia F, Cook JA, Cohen MH, Sohler N, Kovacs A, Greenblatt RM, Choudhary I, Vlahov D. · Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10029, USA. · Addiction. · Pubmed #15955015 No free full text.

Abstract: AIMS: To evaluate the effects of longitudinal patterns and types of non-injection drug use (NIDU) on HIV progression in the highly active antiretroviral therapy (HAART) era. DESIGN: Women's Interagency HIV Study (WIHS), a prospective cohort study conducted at six US sites. METHODS: Data were collected semi-annually from 1994 to 2002 on 1046 HIV(+) women. Multivariate Cox proportional hazards modeling was used to estimate relative hazards for developing AIDS and for death by pattern and type of NIDU. FINDINGS: During follow-up, 285 AIDS events and 287 deaths, of which 177 were AIDS-related, were reported. At baseline, consistent and former NIDU was associated with CD4(+) counts of < 200 cells/microl (43% and 46%, respectively) and viral load > 40,000 copies/ml (53% and 55%, respectively). Consistent NIDU reported less HAART use (53%) compared with other NIDU patterns. Stimulant use was associated with CD4(+) cell counts of < 200 cells/microl (53%) and lower HAART initiation (63%) compared with other NIDU types. In multivariate analyses, progression to AIDS was significantly higher among consistent (RH = 2.52), inconsistent (RH = 1.63) and former (RH = 1.56) users compared with never users; and for stimulant (RH = 2.04) and polydrug (RH = 1.65) users compared with non-users. Progression to all-cause death was higher only among former users (RH = 1.48) compared with never users in multivariate analysis. NIDU behaviors were not associated with progression to AIDS-related death. CONCLUSIONS: In this study, pattern and type of NIDU were associated with HIV progression to AIDS and all-cause mortality. These differences were associated with lower HAART utilization among consistent NIDU and use of stimulants, and poor baseline immunological and virological status among former users.

Wang C, Vlahov D, Galai N, Cole SR, Bareta J, Pollini R, Mehta SH, Nelson KE, Galea S. · Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. · AIDS. · Pubmed #15905674 No free full text.

Abstract: OBJECTIVES: To quantify the association of HIV infection with overdose mortality and explore the potential mechanisms. DESIGN: A prospective cohort study. METHODS: A total of 1927 actively injecting drug users who were HIV seronegative at baseline, of whom 308 later HIV seroconverted, were followed semi-annually for death from 1988 to 2001. Survival analyses using marginal structural and standard Cox models were used to evaluate the effect of HIV infection on the risk of overdose mortality. RESULTS: Overdose death rates were higher in HIV-seropositive than HIV-seronegative drug users: 13.9 and 5.6 per 1000 person-years, respectively (P < 0.01). The hazard ratio (HR) was 2.54 [95% confidence interval (CI) 1.47, 4.38] for the marginal structural model and 2.06 (95% CI 1.25, 3.38) for the standard Cox model, both adjusted for demographics, drug injection characteristics, alcohol abuse, substance abuse treatment, and sexual orientation. Adjusting for possible time-varying mediators (i.e. drug use, medical conditions and healthcare access) in extended marginal structural models reduced the effect of HIV on overdose mortality by 30% (HR 1.82, 95% CI 1.01, 3.30). Abnormal liver function was associated with a higher risk of overdose mortality (HR 2.00, 95% CI 1.05, 3.84); adjustment for this further reduced the effect of HIV on overdose mortality. CONCLUSION: HIV infection was associated with a higher risk of overdose mortality. Drug use behavior, systematic disease and liver damage associated with HIV infection appeared to account for a substantial portion of this association. The data suggest a group to target with interventions to reduce overdose mortality rates.

Duggal P, Winkler CA, An P, Yu XF, Farzadegan H, O'Brien SJ, Beaty TH, Vlahov D. · Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. · J Acquir Immune Defic Syndr. · Pubmed #15793370 No free full text.

Abstract: HIV-1 plasma RNA is a prognostic indicator of HIV-1, and increased levels of HIV-1 plasma RNA are associated with rapid progression to AIDS. Because chemokines and chemokine receptors are involved in the binding and entry of HIV-1, possible effects of host genetics on viral RNA levels should be visible in early infection. HIV-1 plasma RNA was measured within 2 years of seroconversion in 198 seroincident injection drug users followed in the AIDS Link to Intravenous Experience cohort. Genetic variants were identified in the chemokine receptors (CCR2, CCR5, and CCR5 promoter) and the chemokine RANTES using TaqMan and restriction fragment length polymorphism assays. Linear regression of RANTES haplotypes on early HIV-1 plasma RNA identified individuals homozygous for the RANTES R1 haplotype as having a lower viral load by almost one-half log10 unit compared with those bearing non-RANTES R1 haplotypes (-0.43, 95% confidence interval: -0.74, -0.12). Genetic variants in RANTES may downregulate RANTES gene expression and increase early HIV-1 plasma RNA. Because RANTES is a critical chemokine and competitively inhibits HIV-1 by binding to its receptor CCR5, treatment to enhance RANTES expression may assist in delaying the progression of AIDS by decreasing the initial viral load.

Fuller CM, Absalon J, Ompad DC, Nash D, Koblin B, Blaney S, Galea S, Vlahov D. · Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 5th Avenue, New York, NY 10029, USA. · J Urban Health. · Pubmed #15738320 No free full text.

Abstract: The purpose of this analysis was to determine the prevalence and correlates of HIV infection among a street-recruited sample of heroin- and cocaine-using men who have sex with men (MSM). Injection (injecting <or=3 years) and non-injection drug users (heroin, crack, and/or cocaine use <10 years) between 18 and 40 years of age were simultaneously street-recruited into two cohort studies in New York City, 2000-2003, by using identical recruitment techniques. Baseline data collected among young adult men who either identified as gay/bisexual or reported ever having sex with a man were used for this analysis. Nonparametric statistics guided interpretation. Of 95 heroin/ cocaine-using MSM, 25.3% tested HIV seropositive with 75% reporting a previous HIV diagnosis. The majority was black (46%) or Hispanic (44%), and the median age was 28 years (range 18-40). HIV-seropositive MSM were more likely than seronegatives to be older and to have an HIV-seropositive partner but less likely to report current homelessness, illegal income, heterosexual identity, multiple sex partners, female partners, and sex for money/drug partners than seronegatives. These data indicate high HIV prevalence among street-recruited, drug-using MSM compared with other injection drug use (IDU) subgroups and drug-using MSM; however, lower risk behaviors were found among HIV seropositives compared with seronegatives. Large-scale studies among illicit drug-using MSM from more marginalized neighborhoods are warranted.

Sterling TR, Pisell-Noland T, Perez JL, Astemborski J, McGriff JR, Nutting L, Hoover DR, Vlahov D, Bollinger RC. · Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · J Infect Dis. · Pubmed #15717262 No free full text.

Abstract: Sex-based differences in the levels of human immunodeficiency virus 1 (HIV-1) RNA in plasma could be associated with differences in the strength of HIV-1-specific CD8(+) T cell responses. CD8(+) effector responses in 18 men and 15 women were measured 0-2 years (time A) and 5-7 years (time B) after seroconversion. CD8(+) effector responses were seen in 7 (39%) of 18 men and 2 (13%) of 15 women at time A (P=.13) and in 12 (67%) of 18 men and 10 (67%) of 15 women at time B (P=.99). At time B, the strength of CD8(+) effector responses correlated with the number of CD4(+) lymphocytes in women ( rho =-0.68; P=.005) but not in men ( rho =-0.14; P=.58). The level of HIV-1 RNA was not associated with the strength of CD8(+) effector responses according to sex, but there was a sex-based difference in the correlation between the strength of CD8(+) effector response and the number of CD4(+) lymphocytes.

Smit E, Semba RD, Pilibosian E, Vlahov D, Tun W, Purvis L, Tang AM. · Department of Social and Preventive Medicine, University at Buffalo, Buffalo, New York 14214, USA. · AIDS Patient Care STDS. · Pubmed #15665632 No free full text.

Abstract: We determined anthropometric measurements (including height, weight, circumferences, and skinfolds) and self-reported symptoms related to body habitus changes in 324 HIV-seropositive and HIV-seronegative inner city injection drug users (IDUs) who participated in a substudy from the ALIVE (AIDS Linked to Intravenous Experiences) cohort. Participants who reported lipoatrophy in body parts had consistently lower anthropometric measurements and those reporting adiposity had correspondingly higher anthropometric measurements than participants who did not report these changes. Peripheral lipoatrophy was more common among all HIV-seropositive than HIV-seronegative participants, however, it was not associated with highly active antiretroviral therapy (HAART) (39% HIV-seronegatives; 58% HIV-seropositive not receiving HIV treatment [No Tx]; 49% HAART, p = 0.04). Central adiposity was more common among HAART (52%) than No Tx (26.6%) and HIV-seronegative (42%) participants (p = 0.001). However, waist circumference, while somewhat higher among HAART than No Tx participants, did not differ significantly from HIV-seronegative participants (85.2 cm HIV-seronegatives; 83.3 cm No Tx; 85.8 cm HAART). A large proportion of those who reported peripheral lipoatrophy also reported central lipoatrophy (76.9% HIV-seronegatives; 69.6% No Tx; 66.2% HAART). A large proportion of those who reported central adiposity also reported adiposity of the peripheral sites (88.1% HIV seronegatives; 66.7% No Tx; 74.3% HAART). The combination of lipoatrophy and adiposity was associated with HAART treatment (6% HIV-seronegatives; 3% No Tx; 16% HAART, p = 0.002), but may be driven by the association with adiposity. These data suggest validity of self-reports for body habitus changes among injection drug users.

Hamburger ME, Moore J, Koenig LJ, Vlahov D, Schoenbaum EE, Schuman P, Mayer K, Anonymous00333. · Division of HIV/AIDS Prevention, Surveillance and Epidemiology, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. · AIDS Behav. · Pubmed #15475680 No free full text.

Abstract: This study longitudinally examines the relation between a history of experiencing childhood and adult physical or sexual abuse, and male condom use by women with or at risk for HIV. Abuse history and prospective condom use data were collected from 214 HIV infected and 189 uninfected women participating in the HIV Epidemiology Research Study (HERS) who were inconsistent condom users at baseline and received two safer sex counseling sessions. Analyses were conducted to assess the association between abuse history and condom use while controlling for sociodemographic variables and other risk factors. HIV-uninfected women with a history of adult physical abuse were five times less likely to report consistent condom use at 1-year follow-up than uninfected women without a history of abuse while holding control variables constant. Expectations of a negative reaction by the partner to suggested condom use did not explain this association. Though in the same direction as in uninfected women, abuse history was not significantly related to consistent condom use among HIV-infected women. These data indicate the need to develop risk prevention strategies tailored to uninfected women with a history of adult abuse. In lieu of specialized interventions, health care providers should assess women's abuse history and supplement HIV prevention counseling with mental health counseling when indicated.

Dezzutti CS, Astemborski J, Thomas DL, Marshall JH, Cabrera T, Purdy M, Vlahov D, Garfein RS. · Centers for Disease Control and Prevention, Mailstop G19, 1600 Clifton Road, NE, Atlanta, GA 30333, USA. · J Clin Virol. · Pubmed #15465414 No free full text.

Abstract: BACKGROUND: Coinfection with human immunodeficiency virus (HIV) has been shown to influence the natural history of hepatitis C infection. OBJECTIVE: Our interest was to determine if HIV coinfection influences the prevalence of cryoglobulinemia in hepatitis C virus (HCV) infected persons. STUDY DESIGN: A total of 384 HCV RNA positive (234 HIV-infected and 150 HIV-uninfected) participants were tested at two visits, 18 months apart, for HCV and HIV RNA, CD4, and liver enzyme levels. Serum cryoglobulin levels were measured at a subsequent visit for a subset of the sample. RESULTS: HIV-infected participants had significantly higher HCV RNA levels (P < 0.0001) and aspartate transaminase (AST) levels (P < 0.0001), but not alanine transaminase (ALT) levels (P > 0.05) as compared with HIV-uninfected participants. These findings were consistent at both visits and no significant changes were observed between visits. Fifty (19%) of the 264 participants tested had detectable cryoglobulins. No difference was observed in HIV seropositivity among participants with or without cryoglobulinemia (68% versus 61%; odds ratio = 1.34, P = 0.37). However, among HIV coinfected participants, elevated AST levels (P = 0.04) and lower CD4 levels (P = 0.02) were associated with cryoglobulinemia. CONCLUSIONS: While previously reported associations were found between HIV and coinfection with HCV in this study, we did not find an association between HIV infection and cryoglobulinemia.

Wang C, Vlahov D, Galai N, Bareta J, Strathdee SA, Nelson KE, Sterling TR. · Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA. · J Infect Dis. · Pubmed #15319852 No free full text.

Abstract: BACKGROUND: The optimal time to initiate highly active antiretroviral therapy (HAART) remains unclear. METHODS: Five hundred eighty-three human immunodeficiency virus (HIV)-seropositive and 920 HIV-seronegative injection drug users (IDUs) were followed from 1997 to 2000. HIV-seropositive participants were categorized according to receipt of HAART (either initiated or switched to HAART) and initial CD4 cell count. Survival analysis that included delayed-entry and Cox proportional-hazards models was used to evaluate the effect of HAART, with adjustments for factors associated with access to HAART. RESULTS: Compared with HIV-seronegative participants, overall survival was similar in HIV-seropositive participants who received HAART at >350 CD4 cells/microL, but mortality was higher both in participants with >350 CD4 cells/microL who did not receive HAART and in participants who received HAART at 200-350 CD4 cells/microL (mortality rates, 19.9, 24.0, 43.0, and 50.5/1000 person-years, respectively). In proportional-hazards models in which HIV-seronegative participants were the reference group and in which age, sex, race, frequency of drug use, substance-abuse treatment, and health-care utilization were adjusted for, hazard ratios were 1.01 (95% confidence interval [CI], 0.41-2.45), 2.28 (95% CI, 1.38-3.78), and 2.09 (95% CI, 1.07-4.10) for the latter 3 groups. In HIV-seropositive participants, HAART significantly improved survival when initiated at CD4 cell counts < 200 cells/microL. CONCLUSIONS: Survival of HIV-seropositive participants receiving HAART approximated that of HIV-seronegative participants only when therapy was given at CD4 cell counts > 350 cells/microL. These data, restricted to IDUs, suggest initiating or switching to HAART at higher CD4 cell levels than are currently recommended.

Sethi AK, Celentano DD, Gange SJ, Gallant JE, Vlahov D, Farzadegan H. · Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. · J Acquir Immune Defic Syndr. · Pubmed #15021315 No free full text.

Abstract: Evidence of increasing prevalence of drug resistance among recent HIV seroconverters indicates a growing public health concern and warrants an examination of the problem from a prevention perspective. Among 638 HIV-infected injection drug users (IDUs) completing 2731 visits between December 1996 and February 2000 in an ongoing cohort study in Baltimore, Maryland, factors associated with unprotected sex and needle sharing were determined. Participants were classified as being at higher or lower risk of HIV and of drug-resistant HIV transmission based on viral load, antiretroviral therapy use, and reported high-risk behavior. Stored plasma of those at higher risk of drug-resistant HIV transmission was tested for resistance by VirtualPhenotype (Vircolab, Rockville, MD). Women were nearly twice as likely as men to engage in unprotected sex, and IDUs were more likely to have unprotected sex if their sexual partners were also HIV infected. IDUs were at higher risk of HIV and drug-resistant HIV transmission at 19% and 6% of all visits, respectively. Participants were infected with drug-resistant HIV at 14% of visits when they were at higher risk of HIV transmission. Intensive risk reduction counseling is needed and must be integrated into routine HIV clinical care.

Pilowsky DJ, Zybert PA, Hsieh PW, Vlahov D, Susser E. · Mailman School of Public Health at Columbia University, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #12874497 No free full text.

Abstract: OBJECTIVE: Associations between human immunodeficiency virus (HIV) status of injection drug users (IDUs) and their children's psychopathology and social functioning were examined. METHOD: Parents (N = 61) were drawn from an ongoing longitudinal study of inner city, primarily African-American IDUs. Children (N = 79) were 6 to 11 years of age, currently living with the IDU parent. Parental variables included HIV status, apparent and inapparent HIV infection (with HIV-related medical symptoms and/or disclosure of parental HIV status to children; with neither medical symptoms nor disclosure, respectively), presence of HIV-related medical symptoms, HIV disclosure status to each child, and depression as ascertained by the Center for Epidemiologic Studies-Depression. Children's outcomes (competencies, psychiatric symptoms, and disorders) were assessed with the Child Behavior Checklist and the Schedule for Affective Disorders and Schizophrenia for School-Age Children. RESULTS: Children of IDU parents exhibited high rates of psychopathology. Parental HIV infection per se had no discernible impact on children's outcomes. The apparent HIV infection of a parent was associated with an eightfold increase (odds ratio 7.80; 95% confidence interval 1.56-39.09) in the prevalence of disruptive behavior disorders (compared with children of HIV-negative parents). Parental depression was associated with a threefold increase in the prevalence of children's disruptive behavior disorders (odds ratio 3.49, 95% confidence interval 1.11-11.04). CONCLUSIONS: Parental HIV status per se does not seem to have a differential impact on the affected children. The apparent HIV infection of a parent may be associated with children's externalizing symptoms and disorders.

Sheu M, Hogan J, Allsworth J, Stein M, Vlahov D, Schoenbaum EE, Schuman P, Gardner L, Flanigan T. · Brown University Department of Medicine and Center for Statistical Sciences, Providence, Rhode Island. · J Womens Health (Larchmt). · Pubmed #12570040 No free full text.

Abstract: OBJECTIVES: Incarceration rates in the United States have tripled over the past two decades and have increased even more rapidly among women than men. To identify risk factors that predict incarceration in HIV-positive (HIV+) and high-risk HIV-negative (HIV-) women and to evaluate the association between continuity of medical care and risk of incarceration, this analysis was conducted. METHODS: This was a prospective cohort study of HIV+ and high-risk HIV- women enrolled between April 1993 and January 1995 at four urban centers: Providence, Rhode Island; New York, New York; Baltimore, Maryland; and Detroit, Michigan. The HIV Epidemiology Research (HER) Study enrolled 871 HIV+ and 439 high-risk HIV- innercity women between the ages of 16 and 55 years. All participants had a history of injection drug use or high-risk sexual behavior. Interviews, including questions on continuity of medical care and incarceration, were administered at baseline and 6 and 12 months after enrollment. Any incarceration in the 1-year period following enrollment was the main outcome measure. Continuity of care was measured as having seen one healthcare provider for at least 2 years, having received medical care from one usual physician or clinic, and having obtained medical care in a primary care setting as opposed to an emergency room or drug treatment center. RESULTS: Twelve percent of women were incarcerated within 1 year postenrollment. Factors associated with incarceration included recent drug use, prior incarceration, lack of college education, engaging in sex for drugs or money, and having multiple unmet basic needs at the time of enrollment in the study. Continuity of care with a single healthcare provider for more than 2 years prior to enrollment in the study was associated with decreased rates of incarceration even after adjusting for possible confounding factors (OR = 0.67, 95% CI = 0.48 - 0.92). HIV serostatus did not correlate with incarceration. CONCLUSIONS: History of prior incarceration and recent drug use were associated with increased risk of incarceration. Continuity of medical care by a single healthcare provider was associated with decreased likelihood of incarceration, suggesting that the provider may play an important role in designing interventions to prevent incarceration in this high-risk population.

Mulherin SA, O'Brien TR, Ioannidis JP, Goedert JJ, Buchbinder SP, Coutinho RA, Jamieson BD, Meyer L, Michael NL, Pantaleo G, Rizzardi GP, Schuitemaker H, Sheppard HW, Theodorou ID, Vlahov D, Rosenberg PS, Anonymous00224. · Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH/DHHS, 6120 Executive Boulevard, Rockville, MD 20852, USA. · AIDS. · Pubmed #12556692 No free full text.

Abstract: OBJECTIVE: To examine temporal variation in the effects of CCR5-Delta32 and CCR2-64I chemokine receptor gene polymorphisms on HIV-1 disease progression. DESIGN: Pooled analysis of individual patient data from 10 cohorts of HIV-1 seroconverters from the United States, Europe, and Australia. METHODS: We studied HIV-1 seroconverters of European (n = 1635) or African (n = 215) ancestry who had been genotyped for CCR5-Delta32 and CCR2-64I. We used Cox proportional hazards models with time-varying coefficients to determine whether the genetic protection against AIDS (1987 case definition) and death varied with time since seroconversion. RESULTS: Protection against AIDS conferred by CCR5-Delta32 held constant at a 31% (RH 0.69, 95% CI 0.54, 0.88) reduction in risk over the course of HIV-1 infection, whereas protection against death held constant at a 39% reduction in risk (RH 0.61, 95% CI 0.45, 0.88). When the period from AIDS to death was isolated, the survival benefit of CCR5-Delta32 diminished 2 years after AIDS. Protection against AIDS conferred by CCR2-64I was greatest early in the disease course. Compared with individuals without CCR5-Delta32 or CCR2-64I, individuals with one or two copies of CCR2-64I had a 58% lower risk of AIDS during the first 4 years after seroconversion (RH 0.42, 95% CI 0.23, 0.76), a 19% lower risk during the subsequent 4 years (RH 0.81, 95% CI 0.59, 1.12), and no significant protection thereafter. CONCLUSION: The protection against AIDS provided by CCR5-Delta32 is continuous during the course of infection. In contrast, the protection provided by CCR2-64I is greatest early in the course of infection.