Trends in Comorbidities Among Human Immunodeficiency Virus-Infected Hospital Admissions in New York City from 2006-2016.

BACKGROUND: Due to the advent and success of antiretroviral therapy, the number of people living and aging with human immunodeficiency virus (HIV) has grown substantially. Although people living with HIV (PLHIV) are experiencing longer life expectancies, this achievement may be undermined by increasing and disproportionate chronic disease burden among PLHIV. METHODS: This study is a retrospective analysis of adult (≥18 years) inpatient hospital discharges from a large hospital system in the New York City, New York metropolitan area, between 1 January 2006 and 31 December 2016. We aimed to investigate (1) changes in the prevalence of Charlson-defined comorbidities among PLHIV hospitalized between 2006 and 2016 and (2) changes in the unadjusted prevalence ratio (PR) of comorbidities in HIV-positive versus HIV-negative admissions over time. RESULTS: Of 898 139 hospital admissions from 2006-2016, 19 039 (2.1%) were HIV positive. Across all admissions during the study period, the greatest comorbidity disparities between HIV-positive and HIV-negative admissions were mild liver disease (PR, 4.9 [95% confidence interval, 4.8-5.1]), moderate or severe liver disease (PR, 2.2 [2.0-2.4]), and chronic pulmonary disease (PR, 1.8 [1.8-1.8]). CONCLUSIONS: The prevalence and relative burden of comorbidities among hospitalized PLHIV are changing over time. Careful monitoring and intensive discharge planning may be effective strategies for addressing the evolving health needs of PLHIV.

Barriers to optimal antiretroviral therapy adherence among HIV-infected formerly incarcerated individuals in New York City.

In the United States (U.S.), the HIV infection rate is disproportionately high among incarcerated individuals. HIV-infected individuals typically receive antiretroviral therapy (ART) to suppress HIV and reduce the threat of transmission. Although HIV-infected individuals are generally ART-adherent while incarcerated, the public health benefits experienced during incarceration are often lost as HIV-infected individuals struggle to maintain optimal adherence post-incarceration. While the importance of maintaining adherence in the post-incarceration period has been acknowledged, research on barriers to ART adherence during this period is limited. To better understand post-release barriers to ART adherence, we conducted in-depth interviews with 20 HIV-infected formerly incarcerated individuals in New York City; we also followed up with 18 (90%) participants after three months to explore whether their adherence challenges changed over time. Viral load testing results from their most recent physician visit were also recorded at each interview. Interviews were transcribed using transcription software and reviewed for accuracy by a researcher. Thematic coding based on discussion guide prompts were then used to identify commonly mentioned barriers to adherence. The results identified four overarching themes that affected study participants' efforts to adhere to their ART regimen: medication burden, forgetfulness, mental health and emotional difficulties, and perceived conflict between substance use and medication adherence. These barriers were the most commonly cited and largely persisted at three-month follow-up. The results suggest that interventions addressing these challenges are essential for promoting ART adherence among HIV-infected formerly incarcerated individuals. Effective interventions may include mobile-based text messaging reminders and those that facilitate patient-provider communication. Additionally, interventions or programs that integrate substance use and mental health treatment into HIV-related care, along with other types of behavioral health support, may also be beneficial for this population. Such interventions should be a routine part of discharge planning and support for incarcerated individuals returning to the community.

Length of hospitalization and hospital readmissions among patients with substance use disorders in New York City, NY USA.

INTRODUCTION: In the United States, the number of patients with substance use disorders is steadily increasing. Individuals with a substance use disorder may be more likely to experience negative hospital outcomes, including lengthier hospital stays and frequent readmissions, which is extremely costly to patients and to the government. While there are established associations between substance use disorder and hospital readmissions, the impact of substance use disorder on other outcomes such as length of stay remain unclear. We assessed whether hospital admissions diagnosed with substance use disorders experienced longer hospital stays and readmissions compared to patients without a substance use disorder diagnosis. METHODS: This is a retrospective study of hospital readmissions rates in three hospitals in the New York City, New York area. Data were examined over a 10-year period (from 2007 to 2016, n = 768,219). We used multilevel multivariable regression models to compare the hospital length of stay, time-to-hospital readmission, and 30-day hospital readmission among admissions with substance use disorder compared to admissions without the disorder. RESULTS: As compared to those who did not have a substance use disorder, admissions with substance use disorder had longer hospital length of stay (Regression coefficient (b) = 1.24; 95% CI: 1.15-1.33), were more likely to experience hospital readmission at any point in time (HR = 1.24; 95 % CI: 1.22-1.25), and were more likely to have a 30-day hospital readmission (RR = 1.16; 95 % CI: 1.13-1.19). CONCLUSIONS: Hospital settings could potentially serve as useful venues for substance use-related interventions and could benefit from strong coordination with outpatient providers and more targeted discharge planning.

"It's like I was out there by myself": The receipt of reentry support among HIV-infected formerly incarcerated individuals in New York City.

BACKGROUND: In the U.S., approximately one in seven HIV-infected individuals experience incarceration at least once in their lifetime. While HIV-infected individuals experience positive health outcomes during periods of incarceration, they tend to experience treatment disruption as they return to their community after custody which results in poor health outcomes. The purpose of this study was to explore the transitional support received from the Department of Corrections during the reentry period. METHODS: We conducted in-depth interviews with 20 HIV-infected formerly incarcerated individuals in New York City. Interviews were audio recorded and transcribed. Three researchers performed line-by-line reading of the transcripts to identify dominant codes and themes that emerged. A mixture of deductive and inductive techniques was used to identify patterns that emerged in the data. RESULTS: Most of the participants were male and racial and ethnic minorities. There were five dominant themes that emerged during our analysis: 1) variations in the quantity of antiretroviral medication received during transition; 2) linkages to community-based physical health care providers was not well-coordinated; 3) insufficient housing and social resources; 4) structural and social challenges to post-release well-being; and 5) family as a source of resilience. CONCLUSIONS: Discharge support planning should include sufficient medication to prevent treatment disruption and a more comprehensive approach to linkage to community-based healthcare services. Such planning should also include thorough pre-release assessments to identify appropriate levels of support needed, including employment and housing assistance, which will be useful for resource allocation. Broadening public health partnerships may also increase availability and promote accessibility to the most appropriate healthcare services and programs, which may provide better opportunities to receive coordinated care and ensure continuity of care. Finally, ties to family members and other loved ones should be leveraged to help facilitate the achievement of optimal health outcomes among this population.

Perturbed neurogenesis in the adult hippocampus associated with presenilin-1 A246E mutation.

In addition to its well-established role in gamma-secretase cleavage, presenilin (PS) also plays a role in regulating the stability of cytosolic beta-catenin, a protein involved in Wnt signaling. Several familial Alzheimer's disease-associated PS1 mutations have been shown to increase the stability of the signaling pool of beta-catenin, correlating with enhanced cell proliferation. Accordingly, we hypothesized that in the setting of PS1 mutations, abnormal activation of Wnt/beta-catenin signaling leads to increased cell division. We tested this hypothesis by examining whether there is evidence of increased neurogenesis in the hippocampus of adult transgenic mice that overexpress the PS1 A246E mutation. In PS1/PS2-deficient fibroblasts, expression of PS1 A246E Familial AD mutation failed to restore the rapid turnover of beta-catenin compared with wild-type PS1. We then examined whether the same mutation enhanced neurogenesis in vivo in adult hippocampus of PS1-deficient mice when restored by wild-type human PS1 (PS1(-/-)WT) or A246E PS1 mutation (PS1(-/-)AE). The PS1 A246E mutation stimulated the proliferation of progenitor cells in the dentate gyrus of adult mice, as assessed by 5-bromo-2-deoxyuridine incorporation, but did not influence their survival or differentiation. These observations suggest that the PS1 A246E mutation influences cell growth putatively via abnormal beta-catenin signaling in vivo.