Search

Introduction: Among people living with HIV (PLWH), alcohol use can have negative impacts beyond HIV-related outcomes. The objectives of this study are to identify the most common alcohol-related consequences among PLWH in Florida and describe factors associated with experiencing more alcohol-related consequences. Methods: Data were collected from PLWH in the Florida Cohort study who drank at least monthly in the past year (n=397). Self-reported consequences were assessed by the 15-item Short Inventory of Problems Revised (SIP-2R). Nonparametric tests and a generalized estimating equation model with inverse probability of exposure weighting were used to evaluate associations between the total SIP-2R score and socio-demographics, mental health, and substance use while controlling for alcohol use. Results: Over half (56%) endorsed at least one consequence and 29% endorsed 5 or more consequences. The most common consequences were doing something they regretted and taking foolish risks (both endorsed by 37% of participants), both in the impulse control domain. After controlling for alcohol use and other covariates, homelessness and injection drug use remained significantly associated with greater SIP-2R scores. Conclusion: PLWH who are experiencing homelessness or injecting drugs could benefit from receiving additional screening for alcohol-related consequences if they report any alcohol use. [ABSTRACT FROM AUTHOR]

Objectives: Antiretroviral therapy is affording longer lifespans for people living with HIV (PLWH), yet factors such as substance use play an increasing role in morbidity and mortality in this population. Though previous studies have examined substance use differences between age cohorts of PLWH, no study has examined the influence of birth cohort on current substance use patterns. Thus, this study investigated the prevalence of past 12-month self-reported substance use between four birth cohorts, <1970 (M age = 54.1), 1970s (M age = 41.5), 1980s (M age = 31.3 years old), and 1990s (M age = 23.2 years old) of PLWH in Florida. Methods: PLWH (N = 934) recruited from community health clinics in Florida completed a questionnaire assessing sociodemographics, health status, and substance use. Multivariate logistic regressions utilizing the <1970 cohort as the referent group examined the relationship between birth cohort and substance use. Results: The 1980s cohort had significantly greater odds of marijuana use compared to the oldest cohort (<1970s), while the three younger cohorts (1970s, 1980s, and 1990s) evidenced a significantly greater odds of ecstasy use compared to the oldest group. Contrastingly, the three younger birth cohorts reported significantly less crack use than the oldest cohort, while the youngest group (1990s) also demonstrated an 80% reduction in injection drug use compared to the oldest group. Conclusion: The older cohort evidenced significantly greater crack and injection drug use, while the younger cohorts evidenced greater marijuana and ecstasy use. Therefore, it is important to develop age-specific substance use interventions among PLWH. [ABSTRACT FROM AUTHOR]

Background: The long-term effects of marijuana on cognition, particularly in the context of HIV is not clear, as extant research shows mixed findings. Objective: To determine associations between current and cumulative exposure to marijuana and changes in cognitive processing speed and flexibility in 788 HIV-seropositive (HIV+) and 1,132 HIV-seronegative (HIV−) men followed for up to 17 years in the Multicenter AIDS Cohort Study. Results: Among HIV+ men only, current daily marijuana use compared to none-use, was significantly associated with a greater annual percentage decline in cognitive processing speed assessed with the Trail Making Test A (TMTA) (β=−0.41, 95% confidence interval (CI): −0.88, −0.03, p=0.03)] and Symbol Digit Modalities Test (SDMT) (β= −0.14, 95% CI: −0.28, −0.01, p=0.04). Further, monthly marijuana use was associated with greater annual percentage decline in cognitive flexibility assessed with the Trail Making Test B (TMTB) (β= −0.70, 95% CI: −1.34, −0.05; p=0.03] and cognitive processing speed (SDMT) (β= −0.21, 95% CI: −0.40, −0.01, p=0.03). Among the HIV− men only, each 5-marijuana use-years (equivalent to 5-years of daily marijuana use) was significantly associated with a 0.17 annual percentage decline in cognitive processing speed only (TMTA) (β= −0.18, 95% CI: −0.36, −0.01; p=0.04). Conclusions: Our findings suggest that marijuana use, particularly current use, may be associated with worse cognitive processing speed, but the magnitude of the estimates was not clinically meaningful. [ABSTRACT FROM AUTHOR]

Background: People living with HIV-infection (PLWH) have higher prevalence and earlier onset of cardiovascular disease (CVD), compared to uninfected populations. It is unclear how alcohol consumption is related to CVD among PLWH.Objectives: To summarize the current literature and strength of evidence regarding alcohol consumption as a risk factor for CVD among PLWH, to generate summary estimates for the effect of alcohol consumption on CVD outcomes, and to make recommendations for clinical practice and future research based on the findings and limitations of existing studies.Methods: A systematic review was conducted using Pubmed/Medline to identify relevant peer-reviewed articles published between 1 January 1999 and 1 January 2014. After critical review of the literature, 13 studies were identified. Risk ratios were extracted or calculated and sample size weighted summary estimates were calculated.Results: The prevalence of a CVD diagnosis or event ranged from 5.7-24.0%. The weighted pooled crude effect sizes were 1.75 (95% CI 1.06, 3.17) for general and 1.78 (95% CI 1.09, 2.93) for heavy alcohol use on CVD. The pooled adjusted effect size was 1.37 (95% CI 1.02, 1.84) for heavy alcohol use on CVD. Pooled estimates differed by CVD outcome and alcohol measure; alcohol consumption was most significant for cerebral/ischemic events.Conclusion: HIV clinicians should consider risk factors that are not included in the traditional risk factor framework, particularly heavy alcohol consumption. Neglect of this risk factor may lead to underestimation of risk, and thus under-treatment among PLWH. [ABSTRACT FROM AUTHOR]