The Opioid Epidemic: Impact on Inflammation and Cardiovascular Disease Risk in HIV

Hileman, Corrilynn Olesky; McComsey, Grace A.

doi:10.1007/s11904-019-00463-4

Cited by 12 publications

(6 citation statements)

References 100 publications

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“…Alcohol use, which is associated with a higher level of cirrhosis biomarkers in HIV-hepatitis C co-infected individuals, and smoking, a major risk factor of COPD, have also been found more prevalent among PLWH [68][69][70][71]. Additionally, among PLWH, our findings bolster the growing body of literature [72][73][74][75], and underline the merit of considering sex differences and history of injection drug use in formulating appropriate chronic disease interventions in this population. PLOS GLOBAL PUBLIC HEALTH Among BC's PLWH, we estimated an increasing trend in DALYs associated with cancers through 2020, where annual DALY estimates per 1000 people in our population were consistently double those in Canada's general population [76].…”

Section: Discussionsupporting

confidence: 67%

Disability-adjusted life years associated with chronic comorbidities among people living with and without HIV: Estimating health burden in British Columbia, Canada

Nanditha

Zhu

Wang

et al. 2022

PLOS Glob Public Health

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Life span of people living with HIV (PLWH) has increased dramatically with the advent of modern antiretroviral therapy. As a result, comorbidities have emerged as a significant concern in this population. To describe the burden of chronic comorbidities among PLWH and HIV-negative individuals in British Columbia (BC), Canada, we estimated disability-adjusted life years (DALYs) related to these comorbidities. Based on a population-based cohort in BC, antiretroviral-treated adult PLWH and 1:4 age-sex-matched HIV-negative controls were followed for ≥1 year during 2001–2012. DALYs combined years of life lost to premature mortality (YLLs) and due to disability (YLDs), and were estimated following the Global Burden of Diseases’ approaches. DALYs associated with non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, dementia, cardiovascular (CVD), kidney, liver and chronic obstructive pulmonary diseases were each measured for 2008–2012. Among PLWH, DALYs attributed to non-AIDS-related cancers were also estimated for 2013–2020. We observed that at baseline, our matched cohort consisted of 82% males with a median age of 40 years (25th-75th percentiles: 34–47). During 2008–2012, 7042 PLWH and 30,640 HIV-negative individuals were alive, where PLWH experienced a twofold higher DALYs associated with chronic comorbidities (770.2 years/1000 people [95% credible intervals: 710.2, 831.6] vs. 359.0 [336.0, 382.2]). Non-AIDS-defining cancers and CVD contributed the highest DALYs in both populations, driven by YLLs rather than YLDs. Among PLWH, we estimated increasing DALYs attributable to non-AIDS-defining cancers with 91.7 years/1000 people (77.4, 106.0) in 2013 vs. 97.6 (81.0, 115.2) in 2020. In this study, we showed that PLWH experience a disproportionate burden of chronic comorbidities compared to HIV-negative individuals. The observed disparities may relate to differential health behaviors, residual HIV-related inflammation, and ART-related toxicities. As aging shapes future healthcare needs, our findings highlight the need to enhance prevention and management of comorbidities as part of HIV care.

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Section: Discussionsupporting

confidence: 67%

Disability-adjusted life years associated with chronic comorbidities among people living with and without HIV: Estimating health burden in British Columbia, Canada

Nanditha

Zhu

Wang

et al. 2022

PLOS Glob Public Health

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“…Perlman and Jordan, for instance, highlight the complex inter-relationships among opioid misuse and overdose, hepatitis C, and HIV as a syndemic with disproportionately adverse results for individuals at heightened risk [36]. These concurrent conditions may further problematize the treatment of OUD and, indeed, may contribute to a myriad of downstream metabolic comorbidities although much remains unknown [37]. In addition, our findings regarding individuals referred by the criminal justice system are consistent with the literature regarding the relatively low uptake of pharmacotherapy for opioid use disorder among incarcerated individuals [38], a subgroup which has exhibited a heightened risk of opioid overdose mortality following post-release [39].…”

Section: Discussionmentioning

confidence: 99%

Differences in receipt of opioid agonist treatment and time to enter treatment for opioid use disorder among specialty addiction programs in the United States, 2014-17

2019

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BackgroundAccess to adequate treatment for opioid use disorder (OUD) has been a high priority among American policymakers. Elucidation of the sociodemographic and institutional differences associated with the use, or lack thereof, of opioid agonist therapy (OAT) provides greater clarity on who receives OAT. Timely access to care is a further consideration and bears scrutiny as well.MethodsWe draw upon data from the Treatment Episode Data Set—Admissions (TEDS-A) to analyse the relationship between sociodemographic and institutional characteristics and the receipt of opioid agonist treatments and time waiting to enter treatment.ResultsEstimates from logistic regression models highlight certain groups which show lower odds of receipt of OAT, including those in precarious housing arrangements, those unemployed or not otherwise in the labor force, and those referred by drug abuse care providers, educational institutions, employers, and the criminal justice system. Groups which showed higher odds of waiting over a week to enter treatment included those who were separated, divorced, or widowed, those working part-time, and those referred by drug abuse care providers, employers, and the criminal justice system.ConclusionGiven the efficacy of OAT and the adverse outcomes associated with long waiting times, coordinated effort is needed to understand why these differences persist and how they may be addressed through appropriate policy responses.

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“…In the context of OATH, opioid use can impair and suppress the immune system, whereas there is mixed evidence regarding marijuana as it may have both pro-and anti-inflammatory properties [25,51,52]. Studies on substance use and frailty are extremely limited among PWH, however, adverse health outcomes associated with opioid use, such as cardiovascular disease, have been noted [53]. Further research on the consequences of substance use has been suggested, particularly to investigate the impact of substance use treatment.…”

Section: Discussionmentioning

confidence: 99%

Development of Frail RISC-HIV: a Risk Score for Predicting Frailty Risk in the Short-term for Care of People with HIV

Ruderman¹,

Nance²,

Drumright³

et al. 2023

Aids

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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.

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The Opioid Epidemic: Impact on Inflammation and Cardiovascular Disease Risk in HIV

Cited by 12 publications

References 100 publications

Disability-adjusted life years associated with chronic comorbidities among people living with and without HIV: Estimating health burden in British Columbia, Canada

Disability-adjusted life years associated with chronic comorbidities among people living with and without HIV: Estimating health burden in British Columbia, Canada

Differences in receipt of opioid agonist treatment and time to enter treatment for opioid use disorder among specialty addiction programs in the United States, 2014-17

Development of Frail RISC-HIV: a Risk Score for Predicting Frailty Risk in the Short-term for Care of People with HIV

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