Objective.\p=m-\Todetermine the incidence and mortality rates of patients with bacteremic infecti... more Objective.\p=m-\Todetermine the incidence and mortality rates of patients with bacteremic infections with Streptococcus pneumoniae, and to determine the sero-types and antimicrobial susceptibilities of the pneumococcal isolates. Design.\p=m-\Prospectivecase ascertainment and ...
Objective: Marijuana, tobacco and alcohol use are prevalent among people with HIV and may adverse... more Objective: Marijuana, tobacco and alcohol use are prevalent among people with HIV and may adversely affect kidney function in this population. We determined the association of use of these substances with estimated glomerular filtration rate (eGFR) among women with HIV (WWH) and women without HIV. Design: We undertook a repeated measures study of 1043 WWH and 469 women without HIV within the United States Women's Interagency HIV Study, a multicenter, prospective cohort of HIV-seropositive and HIV-seronegative women. Methods: We quantified substance exposures using semi-annual questionnaires. Using pooled eGFR data from 2009 to 2019, we used linear regression models with multivariable generalized estimating equations to ascertain associations between current and cumulative substance use exposures with eGFR, adjusting for sociodemographics, chronic kidney disease risk factors and HIV-related factors. Results: Marijuana use of 1–14 days/month versus 0 days/month was associated with 3.34 ml/min per 1.73 m2 [95% confidence interval (CI) −6.63, −0.06] lower eGFR and marijuana use of >0.02–1.6 marijuana-years versus 0–0.2 marijuana-years was associated with 3.61 ml/min per 1.73 m2 (95% CI −5.97, −1.24) lower eGFR. Tobacco use was not independently associated with eGFR. Alcohol use of seven or more drinks/week versus no drinks/week was associated with 5.41 ml/min per 1.73 m2 (95% CI 2.34, 8.48) higher eGFR and alcohol use of >0.7–4.27 drink-years and >4.27 drink-years versus 0–0.7 drink-years were associated with 2.85 ml/min per 1.73 m2 (95% CI 0.55, 5.15) and 2.26 ml/min per 1.73 m2 (95% CI 0.33, 4.20) higher eGFR, respectively. Conclusion: Among a large cohort of WWH and women without HIV, marijuana use was associated with a lower eGFR while alcohol use was associated with a higher eGFR.
Journal of Acquired Immune Deficiency Syndromes, Sep 1, 2019
BackgroundMental health (MH) conditions are common among persons with HIV (PWH). An understanding... more BackgroundMental health (MH) conditions are common among persons with HIV (PWH). An understanding of factors associated with prescription medication use for these conditions and clinical impact of the prescription medications may improve care of MH disorders in PWH.MethodsPsychotropic medication use was examined among PWH within the AIDS Clinical Trials Group A5322 (HAILO) study. Multivariable logistic models and Cox regression models estimated the association between psychotropic medications (any/none) with baseline and incident slow gait (>1 sec/m) and neurocognitive impairment (NCI) over 4 years.ResultsOf 1,035 participants, the median age was 51. 81% were men, 30% black, non-Hispanic, and 20% Hispanic. Psychotropic medication use was similar between men (34%) and women (38%; p=0.19). PWH using psychotropic medications had greater odds of baseline slow gait (OR 1.61, [95% CI 1.23–2.10]; p<0.001). Men but not women using psychotropic medications had an increased risk of developing slow gait (hazard ratio 1.85; [1.29–2.65] vs 0.77; [CI 0.35–1.68], p interaction=0.045). The sex-specific ORs for medication use and NCI were qualitatively but not statistically different (men: 1.79; [1.14–2.80]; women: 1.27; [0.56–2.90]; p interaction = 0.47). Psychotropic medication use was associated with an increased risk of incident NCI (HR 2.18; [95% CI 1.23–3.84], p=0.007) in both men and women.ConclusionsPsychotropic medications are associated with impairment in functional outcomes of aging, with a greater risk of baseline NCI and incident slow gait among men. Further investigation is needed to optimize outcomes in PWH and prescription of psychotropic medications among both men and women.
Objective.\p=m-\Todetermine the incidence and mortality rates of patients with bacteremic infecti... more Objective.\p=m-\Todetermine the incidence and mortality rates of patients with bacteremic infections with Streptococcus pneumoniae, and to determine the sero-types and antimicrobial susceptibilities of the pneumococcal isolates. Design.\p=m-\Prospectivecase ascertainment and ...
Objective: Marijuana, tobacco and alcohol use are prevalent among people with HIV and may adverse... more Objective: Marijuana, tobacco and alcohol use are prevalent among people with HIV and may adversely affect kidney function in this population. We determined the association of use of these substances with estimated glomerular filtration rate (eGFR) among women with HIV (WWH) and women without HIV. Design: We undertook a repeated measures study of 1043 WWH and 469 women without HIV within the United States Women's Interagency HIV Study, a multicenter, prospective cohort of HIV-seropositive and HIV-seronegative women. Methods: We quantified substance exposures using semi-annual questionnaires. Using pooled eGFR data from 2009 to 2019, we used linear regression models with multivariable generalized estimating equations to ascertain associations between current and cumulative substance use exposures with eGFR, adjusting for sociodemographics, chronic kidney disease risk factors and HIV-related factors. Results: Marijuana use of 1–14 days/month versus 0 days/month was associated with 3.34 ml/min per 1.73 m2 [95% confidence interval (CI) −6.63, −0.06] lower eGFR and marijuana use of &gt;0.02–1.6 marijuana-years versus 0–0.2 marijuana-years was associated with 3.61 ml/min per 1.73 m2 (95% CI −5.97, −1.24) lower eGFR. Tobacco use was not independently associated with eGFR. Alcohol use of seven or more drinks/week versus no drinks/week was associated with 5.41 ml/min per 1.73 m2 (95% CI 2.34, 8.48) higher eGFR and alcohol use of &gt;0.7–4.27 drink-years and &gt;4.27 drink-years versus 0–0.7 drink-years were associated with 2.85 ml/min per 1.73 m2 (95% CI 0.55, 5.15) and 2.26 ml/min per 1.73 m2 (95% CI 0.33, 4.20) higher eGFR, respectively. Conclusion: Among a large cohort of WWH and women without HIV, marijuana use was associated with a lower eGFR while alcohol use was associated with a higher eGFR.
Journal of Acquired Immune Deficiency Syndromes, Sep 1, 2019
BackgroundMental health (MH) conditions are common among persons with HIV (PWH). An understanding... more BackgroundMental health (MH) conditions are common among persons with HIV (PWH). An understanding of factors associated with prescription medication use for these conditions and clinical impact of the prescription medications may improve care of MH disorders in PWH.MethodsPsychotropic medication use was examined among PWH within the AIDS Clinical Trials Group A5322 (HAILO) study. Multivariable logistic models and Cox regression models estimated the association between psychotropic medications (any/none) with baseline and incident slow gait (>1 sec/m) and neurocognitive impairment (NCI) over 4 years.ResultsOf 1,035 participants, the median age was 51. 81% were men, 30% black, non-Hispanic, and 20% Hispanic. Psychotropic medication use was similar between men (34%) and women (38%; p=0.19). PWH using psychotropic medications had greater odds of baseline slow gait (OR 1.61, [95% CI 1.23–2.10]; p<0.001). Men but not women using psychotropic medications had an increased risk of developing slow gait (hazard ratio 1.85; [1.29–2.65] vs 0.77; [CI 0.35–1.68], p interaction=0.045). The sex-specific ORs for medication use and NCI were qualitatively but not statistically different (men: 1.79; [1.14–2.80]; women: 1.27; [0.56–2.90]; p interaction = 0.47). Psychotropic medication use was associated with an increased risk of incident NCI (HR 2.18; [95% CI 1.23–3.84], p=0.007) in both men and women.ConclusionsPsychotropic medications are associated with impairment in functional outcomes of aging, with a greater risk of baseline NCI and incident slow gait among men. Further investigation is needed to optimize outcomes in PWH and prescription of psychotropic medications among both men and women.
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Papers by Susan Koletar