Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Resultados 1 - 20 de 64
Filtrar
1.
J Infect Dis ; 227(Suppl 1): S30-S37, 2023 03 17.
Artículo en Inglés | MEDLINE | ID: mdl-36930636

RESUMEN

In this fifth decade of the human immunodeficiency virus (HIV) epidemic, central nervous system (CNS) complications including cognitive impairment and mental health remain a burden for people with HIV (PWH) on antiretroviral therapy. Despite the persistence of these complications, which often co-occur, the underlying pathophysiology remains elusive and consequently treatments remain limited. To continue to grow our understanding of the underlying mechanisms of CNS complications among PWH, there is a need to reexamine our current approaches, which are now more than 2 decades old. At the 2021 National Institutes of Health-sponsored meeting on Biotypes of CNS Complications in PWH, the Neurobehavioral Working Group addressed the following: (1) challenges inherent to determining CNS complications; (2) heterogeneity in CNS complications; and (3) problems and solutions for examining integrated biotypes. The review below provides a summary of the main points presented and discussed by the Neurobehavioral Working Group at the meeting.


Asunto(s)
Infecciones por VIH , VIH , Humanos , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Sistema Nervioso Central
2.
Psychosom Med ; 84(8): 904-913, 2022 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-35980777

RESUMEN

OBJECTIVE: Despite considerable research documenting how stress affects brain and neurobehavioral outcomes, few studies have assessed stressor exposure occurring over the entire life span, and no studies have investigated these associations in people living with HIV (PLWH), despite the high stress and disease burden experienced by this population. To address this issue, we examined how cumulative lifetime chronic stressor exposure related to cognition and brain integrity (i.e., gray matter volume) in White and African American PLWH and HIV-uninfected (HIV-) adults. METHOD: Participants were 91 community-dwelling adults (47.3% PLWH) who completed a comprehensive interview assessing lifetime stressor exposure using the Stress and Adversity Inventory and underwent neuropsychological testing and structural magnetic resonance imaging. Regional brain volumes were derived from T1-weighted images processed through Freesurfer. RESULTS: As hypothesized, greater lifetime chronic stressor exposure was related to worse global cognition ( b = -0.06, standard error [SE] = 0.03, p = .032), processing speed ( b = -0.04, SE = 0.14, p = .041), and executive functioning ( b = -0.06, SE = 0.02, p = .02), and smaller prefrontal cortex (PFC) volume ( b = -16.20, SE = 5.78, p = .007). HIV status did not moderate any of these associations. Moreover, results from mediation analyses demonstrated that the relationship between lifetime chronic stressor exposure and processing speed was fully mediated by PFC volume. CONCLUSIONS: These results highlight the critical role of the PFC in the maintenance of processing speed abilities and its vulnerability to cumulative stressor exposure. Specifically, the negative impact of lifetime chronic stressor exposure on cognition-particularly functions reliant on frontal lobe integrity-may be partly driven by smaller volumes in the PFC.


Asunto(s)
Infecciones por VIH , Corteza Prefrontal , Adulto , Encéfalo , Cognición , Función Ejecutiva , Sustancia Gris/diagnóstico por imagen , Sustancia Gris/patología , Infecciones por VIH/complicaciones , Humanos , Imagen por Resonancia Magnética/métodos , Pruebas Neuropsicológicas , Corteza Prefrontal/diagnóstico por imagen
3.
Psychosom Med ; 83(3): 218-227, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33793453

RESUMEN

OBJECTIVE: This cross-sectional study examined the effects of socioeconomic status (SES) mobility from childhood to adulthood on psychological and cognitive well-being in African American and non-Hispanic White HIV-positive (HIV+) and HIV-seronegative (HIV-) adults who are part of an ongoing study investigating psychosocial and neurobehavioral effects of HIV. METHODS: Participants (N = 174, 24.1% female, 59.2% African American, 67.8% HIV+) were categorized into four groups (upward mobility, downward mobility, stable-not-poor, chronic-poverty) based on self-reported childhood and current community SES (which were correlated with objective measures of SES and proxies of childhood SES). SES groups were compared on self-report measures of psychological well-being, subjective executive functioning ratings, and performance across six cognitive domains. Primary analyses were stratified by HIV status. RESULTS: For the HIV+ group, SES mobility was associated with psychological well-being (chronic burden of stress: F(7,101) = 3.17, mean squared error [MSE] = 49.42, p = .030, η2 = 0.14; depressive symptoms: F(7,101) = 4.46, MSE = 70.49, p = .006,η2 = 0.14), subjective ratings of executive dysfunction (F(7,101) = 6.11, MSE = 114.29, p = .001,η2 = 0.18), and objective performance in executive functioning (F(9,99) = 3.22, MSE = 249.52, p = .030, η2 = 0.15) and learning (F(9,99) = 3.01, MSE = 220.52, p = .034, η2 = 0.13). In the control group, SES mobility was associated with chronic stress burden (F(5,49) = 4.677, p = .025, η2 = 0.15); however, no other relationships between SES mobility and outcomes of interest were observed (all p values > .20). In general, downward mobility and chronic poverty were associated with worse ratings across psychological well-being measures and cognitive performance. CONCLUSIONS: Findings within the HIV+ group are consistent with previous studies that report downward mobility to be associated with poor psychological outcomes. People living with HIV may be particularly vulnerable to the adverse effects of socioeconomic instability.


Asunto(s)
Infecciones por VIH , Clase Social , Adulto , Cognición , Estudios Transversales , Femenino , Humanos , Masculino , Población Blanca , Adulto Joven
4.
J Int Neuropsychol Soc ; 27(4): 365-381, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33161930

RESUMEN

OBJECTIVES: Mounting evidence indicates that vascular risk factors (VRFs) are elevated in HIV and play a significant role in the development and persistence of HIV-associated neurocognitive disorder. Given the increased longevity of people living with HIV (PLWH), there is a great need to better elucidate vascular contributions to neurocognitive impairment in HIV. This systematic review and meta-analysis examine relationships between traditional VRFs, cardiovascular disease (CVD), and cognition in PLWH in the combination antiretroviral therapy era. METHODS: For the systematic review, 44 studies met inclusion criteria and included data from 14,376 PLWH and 6,043 HIV-seronegative controls. To better quantify the contribution of VRFs to cognitive impairment in HIV, a robust variance estimation meta-analysis (N = 11 studies) was performed and included data from 2139 PLWH. RESULTS: In the systematic review, cross-sectional and longitudinal studies supported relationships between VRFs, cognitive dysfunction, and decline, particularly in the domains of attention/processing speed, executive functioning, and fine motor skills. The meta-analysis demonstrated VRFs were associated with increased odds of global neurocognitive impairment (odds ratio [OR ]= 2.059, p = .010), which remained significant after adjustment for clinical HIV variables (p = .017). Analyses of individual VRFs demonstrated type 2 diabetes (p = .004), hyperlipidemia (p = .043), current smoking (p = .037), and previous CVD (p = .0005) were significantly associated with global neurocognitive impairment. CONCLUSIONS: VRFs and CVD are associated with worse cognitive performance and decline, and neurocognitive impairment in PLWH. Future studies are needed to examine these relationships in older adults with HIV, and investigate how race/ethnicity, gender, medical comorbidities, and psychosocial factors contribute to VRF-associated cognitive dysfunction in HIV.


Asunto(s)
Diabetes Mellitus Tipo 2 , Infecciones por VIH , Anciano , Cognición , Estudios Transversales , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Factores de Riesgo
5.
BMC Public Health ; 21(1): 179, 2021 01 21.
Artículo en Inglés | MEDLINE | ID: mdl-33478469

RESUMEN

BACKGROUND: Youth living with HIV (YLHIV) in Sub-Saharan African (SSA) are less likely to adhere to antiretroviral therapy (ART) and other health-related regimens. As a consequence, YLHIV are not only at risk for health problems and mental health comorbidities, but are also at risk for cognitive deficits, including in areas of memory and executive functioning. The Suubi+Adherence study followed 702 adolescents (10-16 years of age) receiving bolstered standard of care and a family economic empowerment intervention comprising an incentivized youth financial savings account (YSA) augmented with financial literacy training (FLT) and peer mentorship. The study findings pointed to superior short-term viral suppression and positive adolescent health and mental health functioning among participants receiving the intervention. The original group of adolescents who received Suubi+Adherence are now transitioning into young adulthood. This paper presents a protocol for the follow-up phase titled Suubi+Adherence Round 2. METHODS: The original cohort in Suubi+Adherence will be tracked for an additional five years (2020-2025). Specifically, the long term follow-up will allow to: 1) ascertain the extent to which the short term outcomes identified in the first 6 years of the intervention are maintained as the same group transitions through young adulthood; and 2) address new scientific questions regarding ART adherence; HIV care engagement; protective health behaviors; and the potential of FEE to mitigate the development of HIV-associated neurocognitive disorders in YLHIV. Additionally, the team examines the potential mechanisms through which the observed long-term outcomes happen. Moreover, the Suubi+Adherence-Round 2 adds a qualitative component and extends the cost effectiveness component. DISCUSSION: Guided by asset and human development theories, Suubi+Adherence-R2 will build on the recently concluded Suubi+Adherence study to conduct one of the largest and longest running studies of YLHIV in SSA as they transition into young adulthood. The study will address new scientific questions regarding long-term ART adherence, HIV care engagement, protective health behaviors, and the potential of FEE to mitigate the development of HIV-associated neurocognitive disorders in YLHIV. The findings may inform efforts to improve HIV care among Uganda's YLHIV, with potential replicability in other low-resource countries. TRIAL REGISTRATION: ClinicalTrials.gov , ID: NCT01790373.


Asunto(s)
Infecciones por VIH , Adolescente , Salud del Adolescente , Adulto , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Cumplimiento de la Medicación , Cumplimiento y Adherencia al Tratamiento , Uganda/epidemiología , Adulto Joven
6.
Hum Brain Mapp ; 40(15): 4370-4380, 2019 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-31271489

RESUMEN

Recent evidence suggests the aging process is accelerated by HIV. Degradation of white matter (WM) has been independently associated with HIV and healthy aging. Thus, WM may be vulnerable to joint effects of HIV and aging. Diffusion-weighted imaging (DWI) was conducted with HIV-seropositive (n = 72) and HIV-seronegative (n = 34) adults. DWI data underwent tractography, which was parcellated into 18 WM tracts of interest (TOIs). Functional Analysis of Diffusion Tensor Tract Statistics (FADTTS) regression was conducted assessing the joint effect of advanced age and HIV on fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) along TOI fibers. In addition to main effects of age and HIV on WM microstructure, the interactive effect of age and HIV was significantly related to lower FA and higher MD, AD, and RD across all TOIs. The location of findings was consistent with the clinical presentation of HIV-associated neurocognitive disorders. While older age is related to poorer WM microstructure, its detrimental effect on WM is stronger among HIV+ relative to HIV- individuals. Loss of WM integrity in the context of advancing age may place HIV+ individuals at increased risk for brain and cognitive compromise.


Asunto(s)
Envejecimiento/patología , Imagen de Difusión Tensora , Infecciones por VIH/patología , Sustancia Blanca/patología , Complejo SIDA Demencia/patología , Adulto , Anciano , Anisotropía , Estudios de Casos y Controles , Progresión de la Enfermedad , Femenino , Seronegatividad para VIH , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Adulto Joven
7.
Hum Brain Mapp ; 39(6): 2532-2540, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29488278

RESUMEN

OBJECTIVE: HIV infection and aging are both associated with neurodegeneration. However, whether the aging process alone or other factors associated with advanced age account for the progression of neurodegeneration in the aging HIV-positive (HIV+) population remains unclear. METHODS: HIV+ (n = 70) and HIV-negative (HIV-, n = 34) participants underwent diffusion tensor imaging (DTI) and metrics of microstructural properties were extracted from regions of interest (ROIs). A support vector regression model was trained on two independent datasets of healthy adults across the adult life-span (n = 765, Cam-CAN = 588; UiO = 177) to predict participant age from DTI metrics, and applied to the HIV dataset. Predicted brain age gap (BAG) was computed as the difference between predicted age and chronological age, and statistically compared between HIV groups. Regressions assessed the relationship between BAG and HIV severity/medical comorbidities. Finally, correlation analyses tested for associations between BAG and cognitive performance. RESULTS: BAG was significantly higher in the HIV+ group than the HIV- group F (1, 103) = 12.408, p = .001). HIV RNA viral load was significantly associated with BAG, particularly in older HIV+ individuals (R2 = 0.29, F(7, 70) = 2.66, p = .021). Further, BAG was negatively correlated with domain-level cognitive function (learning: r = -0.26, p = .008; memory: r = -0.21, p = .034). CONCLUSIONS: HIV infection is associated with augmented white matter aging, and greater brain aging is associated with worse cognitive performance in multiple domains.


Asunto(s)
Envejecimiento/patología , Encéfalo/patología , Infecciones por VIH/patología , Sustancia Blanca/patología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Encéfalo/diagnóstico por imagen , Encéfalo/virología , Antígenos CD4/metabolismo , Cognición/fisiología , Femenino , Infecciones por VIH/diagnóstico por imagen , Infecciones por VIH/fisiopatología , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica , Estadísticas no Paramétricas , Carga Viral , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/virología
8.
J Int Neuropsychol Soc ; 24(10): 1038-1046, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30165914

RESUMEN

OBJECTIVES: People living with HIV (PLWH) are more likely to report sleep difficulties and cognitive deficits. While cognitive impairment associated with sleep problems have been found in healthy and medical populations, less is known about the effects of poor sleep health (SH) on cognition among PLWH. This study examined differences in cognitive performance among participants classified based upon their HIV status and reported SH. METHODS: One hundred sixteen (N=116) adults recruited from the Greater Los Angeles community were administered a comprehensive cognitive test battery and completed a questionnaire about SH. Participants were classified into the following HIV/SH groups: [HIV+/good sleep health (SH+; n=34); HIV-/SH+ (n=32); HIV-/poor sleep health (SH-; n=18) and HIV+/SH- (n=32)]. RESULTS: For both HIV+ and HIV- individuals, poor SH was associated with lower cognitive performance, with the domains of learning and memory driving the overall relationship. The HIV+/SH- group had poorer scores in domains of learning and memory compared to the SH+ groups. Additionally, the HIV-/SH- group demonstrated poorer learning compared to the HIV-/SH+ group. CONCLUSIONS: Our findings suggest that sleep problems within medical populations are relevant to cognitive functioning, highlighting the clinical and scientific importance of monitoring sleep health and cognition to help identify individuals at greatest risk of poor health outcomes. Longitudinal investigations using both objective and subjective measures of sleep are needed to determine the robustness of the current findings and the enduring effects of poor SH in the context of chronic disease. (JINS, 2018, 24, 1038-1046).


Asunto(s)
Cognición , Seronegatividad para VIH , Seropositividad para VIH/psicología , Sueño , Adulto , Disfunción Cognitiva , Femenino , Seropositividad para VIH/complicaciones , Seropositividad para VIH/inmunología , Estado de Salud , Humanos , Aprendizaje , Masculino , Memoria , Persona de Mediana Edad , Pruebas Neuropsicológicas , Trastornos del Sueño-Vigilia/etiología , Trastornos del Sueño-Vigilia/psicología , Factores Socioeconómicos , Encuestas y Cuestionarios
9.
Hum Brain Mapp ; 38(2): 1025-1037, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-27778407

RESUMEN

Standard volumetric neuroimaging studies have demonstrated preferential atrophy of subcortical structures among individuals with HIV. However, to our knowledge, no study has investigated subcortical shape alterations secondary to HIV and whether advancing age impacts that relationship. This study employed 3D morphometry to examine the independent and interactive effects of HIV and age on shape differences in nucleus accumbens, amygdala, caudate, hippocampus, pallidum, putamen, and thalamus in 81 participants ranging in age from 24 to 76 including 59 HIV+ individuals and 22 HIV-seronegative controls. T1-weighted MRI underwent a preprocessing pipeline followed by automated subcortical segmentation. Parametric statistical analyses were used to determine independent effects of HIV infection and age on volume and shape in each region of interest (ROI) and the interaction between age and HIV serostatus in predicting volume/shape in each ROI. Significant main effects for HIV were found in the shape of right caudate and nucleus accumbens, left pallidum, and hippocampus. Age was associated with differences in shape in left pallidum, right nucleus accumbens and putamen, and bilateral caudate, hippocampus, and thalamus. Of greatest interest, an age × HIV interaction effect was found in the shape of bilateral nucleus accumbens, amygdala, caudate, and thalamus as well as right pallidum and putamen such that increasing age in HIV participants was associated with greater shape alterations. Traditional volumemetric analyses revealed main effects for both HIV and age but no age × HIV interaction. These findings may suggest that age and HIV infection conferred additional deleterious effects on subcortical shape abnormalities beyond the independent effects of these factors. Hum Brain Mapp 38:1025-1037, 2017. © 2016 Wiley Periodicals, Inc.


Asunto(s)
Envejecimiento/patología , Encéfalo/diagnóstico por imagen , Infecciones por VIH/patología , Imagenología Tridimensional , Imagen por Resonancia Magnética , Adulto , Anciano , Encéfalo/virología , Mapeo Encefálico , Femenino , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Adulto Joven
10.
J Neurovirol ; 23(4): 593-602, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-28560632

RESUMEN

Despite recent advances in treatment, hepatitis C remains a significant public health problem. The hepatitis C virus (HCV) is known to infiltrate the brain, yet findings from studies on associated neurocognitive and neuropathological changes are mixed. Furthermore, it remains unclear if HCV eradication improves HCV-associated neurological compromise. This study examined the longitudinal relationship between neurocognitive and neurophysiologic markers among healthy HCV- controls and HCV+ adults following successful HCV eradication. We hypothesized that neurocognitive outcomes following treatment would be related to both improved cognition and white matter integrity. Participants included 57 HCV+ participants who successfully cleared the virus at the end of treatment (sustained virologic responders [SVRs]) and 22 HCV- controls. Participants underwent neuropsychological testing and, for a nested subset of participants, neuroimaging (diffusion tensor imaging) at baseline and 12 weeks following completion of HCV therapy. Contrary to expectation, group-level longitudinal analyses did not reveal significant improvement in neurocognitive performance in the SVRs compared to the control group. However, a subgroup of SVRs demonstrated a significant improvement in cognition relative to controls, which was related to improved white matter integrity. Indeed, neuroimaging data revealed beneficial effects associated with clearing the virus, particularly in the posterior corona radiata and the superior longitudinal fasciculus. Findings suggest that a subgroup of HCV+ patients experienced improvements in cognitive functioning following eradication of HCV, which appears related to positive changes in white matter integrity. Future research should examine whether any additional improvements in neurocognition and white matter integrity among SVRs occur with longer follow-up periods.


Asunto(s)
Encéfalo/fisiopatología , Función Ejecutiva/fisiología , Hepacivirus/efectos de los fármacos , Hepatitis C Crónica/rehabilitación , Sustancia Blanca/fisiopatología , Adulto , Anisotropía , Encéfalo/diagnóstico por imagen , Estudios de Casos y Controles , Cognición/fisiología , Imagen de Difusión Tensora , Femenino , Hepacivirus/crecimiento & desarrollo , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/virología , Humanos , Masculino , Memoria/fisiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Sustancia Blanca/diagnóstico por imagen
11.
Neurobiol Dis ; 92(Pt B): 175-82, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-26484382

RESUMEN

BACKGROUND: Deficits in lexical retrieval, present in approximately 40% of HIV+ patients, are thought to reflect disruptions to frontal-striatal functions and may worsen with immunosuppression. Coupling frontal-striatal tasks such as lexical retrieval with functional neuroimaging may help delineate the pathophysiologic mechanisms underlying HIV-associated neurological dysfunction. OBJECTIVE: We examined whether HIV infection confers brain functional changes during lexical access and retrieval. It was expected that HIV+ individuals would demonstrate greater brain activity in frontal-subcortical regions despite minimal differences between groups on neuropsychological testing. Within the HIV+ sample, we examined associations between indices of immunosuppression (recent and nadir CD4+ count) and task-related signal change in frontostriatal structures. Method16 HIV+ participants and 12 HIV- controls underwent fMRI while engaged in phonemic/letter and semantic fluency tasks. Participants also completed standardized measures of verbal fluency RESULTS: HIV status groups performed similarly on phonemic and semantic fluency tasks prior to being scanned. fMRI results demonstrated activation differences during the phonemic fluency task as a function of HIV status, with HIV+ individuals demonstrating significantly greater activation in BG structures than HIV- individuals. There were no significant differences in frontal brain activation between HIV status groups during the phonemic fluency task, nor were there significant brain activation differences during the semantic fluency task. Within the HIV+ group, current CD4+ count, though not nadir, was positively correlated with increased activity in the inferior frontal gyrus and basal ganglia. CONCLUSION: During phonemic fluency performance, HIV+ patients recruit subcortical structures to a greater degree than HIV- controls despite similar task performances suggesting that fMRI may be sensitive to neurocompromise before overt cognitive declines can be detected. Among HIV+ individuals, reduced activity in the frontal-subcortical structures was associated with lower CD4+ count.


Asunto(s)
Encéfalo/fisiopatología , Infecciones por VIH/fisiopatología , Infecciones por VIH/psicología , Fonética , Semántica , Habla/fisiología , Encéfalo/diagnóstico por imagen , Mapeo Encefálico , Circulación Cerebrovascular/fisiología , Femenino , Infecciones por VIH/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Oxígeno/sangre
12.
AIDS Care ; 28(5): 628-32, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26694807

RESUMEN

The current study examined the independent and combined effects of HIV and marijuana (MJ) use (no use, light use, and moderate-to-heavy use) on neurocognitive functioning among a convenience sample of HIV-positive (HIV+) and HIV-negative (HIV-) individuals recruited from HIV community care clinics and advertisements in the Greater Los Angeles area. MJ users consisted of individuals who reported regular use of MJ for at least 12 months, with last reported use within the past month. Participants included 89 HIV+ (n = 55) and HIV- (n = 34) individuals who were grouped into non-users, light users, and moderate-to-heavy users based on self-reported MJ use. Participants were administered a brief cognitive test battery and underwent laboratory testing for CD4 count and viral load. HIV+ individuals demonstrated lower performance on neurocognitive testing than controls, and moderate-to-heavy MJ users performed more poorly on neurocognitive testing than light users or non-users. Moderate-to-heavy HIV+ users performed significantly lower on learning/memory than HIV- moderate-to-heavy users (MD = -8.34; 95% CI: -16.11 to -0.56) as well as all other comparison groups. In the domain of verbal fluency, HIV+ light users outperformed HIV- light users (MD = 7.28; 95% CI: 1.62-12.39), but no HIV group differences were observed at other MJ use levels. HIV+ MJ users demonstrated lower viral load (MD = -0.58; 95% CI: -1.30 to 0.14) and higher CD4 count than non-users (MD = 137.67; 95% CI: 9.48-265.85). The current study findings extend the literature by demonstrating the complex relationship between HIV status and MJ use on neurocognitive and clinical outcomes.


Asunto(s)
Disfunción Cognitiva/inducido químicamente , Disfunción Cognitiva/fisiopatología , Infecciones por VIH/fisiopatología , Seronegatividad para VIH , Abuso de Marihuana/complicaciones , Memoria a Corto Plazo/efectos de los fármacos , Adulto , Cannabis , Cognición/efectos de los fármacos , Disfunción Cognitiva/complicaciones , Disfunción Cognitiva/inmunología , Función Ejecutiva/efectos de los fármacos , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/inmunología , Humanos , Los Angeles , Masculino , Fumar Marihuana/efectos adversos , Persona de Mediana Edad , Carga Viral
13.
AIDS Care ; 28(3): 370-5, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26856321

RESUMEN

Researchers often rely on self-report measures to assess sensitive health-risk behaviors in HIV+ individuals, yet the accuracy of self-report has been questioned, particularly when inquiring about behaviors that may be embarrassing, risky, and/or taboo. We compared an anonymous reporting method - the unmatched count technique (UCT) - to direct self-report (DSR) in order to assess reporting differences for several health-risk behaviors related to medication adherence and sexual risk. Contrary to hypotheses, the UCT only produced a significantly higher estimated base rate for one sensitive behavior: reporting medication adherence to one's physician, which may have been contextually primed by our study design. Our results suggest that anonymous reporting methods may not increase disclosure compared to DSR when assessing several health-risk behaviors in HIV+ research volunteers. However, our results also suggest that contextual factors should be considered and investigated further, as they may influence perception of sensitive behavior.


Asunto(s)
Recolección de Datos/métodos , Infecciones por VIH/psicología , Cumplimiento de la Medicación , Asunción de Riesgos , Autoinforme , Adulto , Femenino , Infecciones por VIH/tratamiento farmacológico , Conductas Relacionadas con la Salud , Humanos , Masculino , Conducta Sexual , Encuestas y Cuestionarios
14.
J Biomed Inform ; 60: 162-8, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26707455

RESUMEN

OBJECTIVES: An estimated 25% of type two diabetes mellitus (DM2) patients in the United States are undiagnosed due to inadequate screening, because it is prohibitive to administer laboratory tests to everyone. We assess whether electronic health record (EHR) phenotyping could improve DM2 screening compared to conventional models, even when records are incomplete and not recorded systematically across patients and practice locations, as is typically seen in practice. METHODS: In this cross-sectional, retrospective study, EHR data from 9948 US patients were used to develop a pre-screening tool to predict current DM2, using multivariate logistic regression and a random-forests probabilistic model for out-of-sample validation. We compared (1) a full EHR model containing commonly prescribed medications, diagnoses (as ICD9 categories), and conventional predictors, (2) a restricted EHR DX model which excluded medications, and (3) a conventional model containing basic predictors and their interactions (BMI, age, sex, smoking status, hypertension). RESULTS: Using a patient's full EHR or restricted EHR was superior to using basic covariates alone for detecting individuals with diabetes (hierarchical X(2) test, p<0.001). Migraines, depot medroxyprogesterone acetate, and cardiac dysrhythmias were associated negatively with DM2, while sexual and gender identity disorder diagnosis, viral and chlamydial infections, and herpes zoster were associated positively. Adding EHR phenotypes improved classification; the AUC for the full EHR Model, EHR DX model, and conventional model using logistic regression, were 84.9%, 83.2%, and 75.0% respectively. For random forest machine learning out-of-sample prediction, accuracy also was improved when using EHR phenotypes; the AUC values were 81.3%, 79.6%, and 74.8%, respectively. Improved AUCs reflect better performance for most thresholds that balance sensitivity and specificity. CONCLUSIONS: EHR phenotyping resulted in markedly superior detection of DM2, even in the face of missing and unsystematically recorded data, based on the ROC curves. EHR phenotypes could more efficiently identify which patients do require, and don't require, further laboratory screening. When applied to the current number of undiagnosed individuals in the United States, we predict that incorporating EHR phenotype screening would identify an additional 400,000 patients with active, untreated diabetes compared to the conventional pre-screening models.


Asunto(s)
Diabetes Mellitus Tipo 2/diagnóstico , Registros Electrónicos de Salud , Informática Médica/métodos , Adulto , Anciano , Área Bajo la Curva , Estudios Transversales , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Modelos Logísticos , Aprendizaje Automático , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Fenotipo , Curva ROC , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos
15.
J Transl Med ; 13: 11, 2015 Jan 16.
Artículo en Inglés | MEDLINE | ID: mdl-25592846

RESUMEN

We are currently in the midst of the most aggressive and fulminating outbreak of Ebola-related disease, commonly referred to as "Ebola", ever recorded. In less than a year, the Ebola virus (EBOV, Zaire ebolavirus species) has infected over 10,000 people, indiscriminately of gender or age, with a fatality rate of about 50%. Whereas at its onset this Ebola outbreak was limited to three countries in West Africa (Guinea, where it was first reported in late March 2014, Liberia, where it has been most rampant in its capital city, Monrovia and other metropolitan cities, and Sierra Leone), cases were later reported in Nigeria, Mali and Senegal, as well as in Western Europe (i.e., Madrid, Spain) and the US (i.e., Dallas, Texas; New York City) by late October 2014. World and US health agencies declared that the current Ebola virus disease (EVD) outbreak has a strong likelihood of growing exponentially across the world before an effective vaccine, treatment or cure can be developed, tested, validated and distributed widely. In the meantime, the spread of the disease may rapidly evolve from an epidemics to a full-blown pandemic. The scientific and healthcare communities actively research and define an emerging kaleidoscope of knowledge about critical translational research parameters, including the virology of EBOV, the molecular biomarkers of the pathological manifestations of EVD, putative central nervous system involvement in EVD, and the cellular immune surveillance to EBOV, patient-centered anthropological and societal parameters of EVD, as well as translational effectiveness about novel putative patient-targeted vaccine and pharmaceutical interventions, which hold strong promise, if not hope, to curb this and future Ebola outbreaks. This work reviews and discusses the principal known facts about EBOV and EVD, and certain among the most interesting ongoing or future avenues of research in the field, including vaccination programs for the wild animal vectors of the virus and the disease from global translational science perspective.


Asunto(s)
Fiebre Hemorrágica Ebola/epidemiología , Investigación Biomédica Traslacional , Animales , Ebolavirus/fisiología , Fiebre Hemorrágica Ebola/patología , Fiebre Hemorrágica Ebola/virología , Humanos , Pandemias , Telemedicina
17.
Cultur Divers Ethnic Minor Psychol ; 21(1): 105-13, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25111554

RESUMEN

The current study examined ethnic/racial differences in test-related anxiety and its relationship to neurocognitive performance in a community sample of African American (n = 40) and European American (n = 36) adults. The authors hypothesized the following: (a) Test-anxiety related to negative performance evaluation would be associated with lower neurocognitive performance, whereas anxiety unrelated to negative evaluation would be associated with higher neurocognitive performance. (b) African American participants would report higher levels of anxiety about negative performance evaluation than European Americans. (c) European Americans would report higher levels of anxiety unrelated to negative performance evaluation. The first two hypotheses were supported: Ethnic/racial differences in test-taking anxiety emerged such that African Americans reported significantly higher levels of negative performance evaluation, which was associated with lower cognitive performance. The third hypothesis was not supported: African Americans and European Americans reported similar levels of test-anxiety unrelated to negative evaluation.


Asunto(s)
Ansiedad/etnología , Ansiedad/psicología , Negro o Afroamericano/psicología , Cognición/fisiología , Ansiedad de Desempeño/etnología , Ansiedad de Desempeño/psicología , Población Blanca/psicología , Adulto , Ansiedad/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ansiedad de Desempeño/etiología , Estados Unidos
18.
AIDS Care ; 26(1): 79-86, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23756102

RESUMEN

Effective antiretroviral therapy has led to substantial improvements in health-related outcomes among individuals with HIV. Despite advances in HIV pharmacotherapy, suboptimal medication adherence remains a significant barrier to successful treatment. Although several factors have been associated with medication adherence in the extant literature, study assessing the effects of some of the neurobehavioral features specific to HIV has been limited. Moreover, although there is a growing body of literature measuring medication adherence in HIV prospectively, few employ advanced statistical methodologies suited to handle advanced models with multiple predictors that would strengthen our understanding of medication adherence trajectories in HIV. This study sought to integrate traditionally assessed predictors of medication adherence with neurobehavioral features of HIV in a longitudinal study of medication adherence to combined antiretroviral therapy (cART). The current study used multilevel modeling to examine a wide arrangement of categories of factors - demographic, medication related, psychosocial, and neurobehavioral - on medication adherence. The sample consisted of 235 HIV+ individuals whose medication adherence was monitored over the course of six months using electronic monitoring devices. After controlling for the effects of demographic, medication, and psychosocial factors, neurobehavioral features added predictive validity to the model. In the final model, simultaneously controlling for the effects of each of the predictors within all the categories, age, self-efficacy, executive functioning, apathy, and frequency of stimulant use emerged as unique individual predictors of average medication adherence across the 6-month study. Self-efficacy and irritability predicted changes in medication adherence over time. Adherence behavior is multidetermined. Adequate assessment of these factors, combined with timely intervention, appears to be warranted in order to boost adherence rates.


Asunto(s)
Terapia Antirretroviral Altamente Activa/psicología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Cumplimiento de la Medicación , Modelos Biológicos , Adulto , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Síntomas Conductuales/complicaciones , Depresión/diagnóstico , Depresión/psicología , Quimioterapia Combinada , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Autoeficacia
19.
J Int Neuropsychol Soc ; 19(5): 583-93, 2013 May.
Artículo en Inglés | MEDLINE | ID: mdl-23388089

RESUMEN

The purpose of the current study was to examine the predictive roles of stereotype threat and perceived discrimination and the mediating role of examiner-examinee racial discordance on neuropsychological performance in a non-clinical sample of African American and Caucasian individuals. Ninety-two African American (n = 45) and Caucasian (n = 47) adults were randomly assigned to either a stereotype threat or non-threat condition. Within each condition, participants were randomly assigned to either a same race or different race examiner. All participants underwent neuropsychological testing and completed a measure of perceived discrimination. African Americans in the stereotype threat condition performed significantly worse on global NP (Mz = -.30, 95% confidence interval [CI] [-0.07, -0.67] than African Americans in the non-threat condition (Mz = 0.09, CI [0.15, 0.33]. African Americans who reported high levels of perceived discrimination performed significantly worse on memory tests when tested by an examiner of a different race, Mz = -1.19, 95% CI [-1.78, -.54], than African Americans who were tested by an examiner of the same race, Mz = 0.24, 95% CI [-0.24, 0.72]. The current study underscores the importance of considering the role of contextual variables in neuropsychological performance, as these variables may obscure the validity of results among certain racial/ethnic groups.


Asunto(s)
Cognición/fisiología , Discriminación en Psicología , Etnicidad/psicología , Prejuicio/psicología , Estereotipo , Adulto , Negro o Afroamericano/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Percepción Social , Encuestas y Cuestionarios , Población Blanca/psicología , Adulto Joven
20.
Stress Health ; 39(5): 1058-1071, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36997157

RESUMEN

The ability to maintain functional independence throughout the lifespan may be diminished among medically compromised and chronically stressed populations. People living with HIV are more likely to demonstrate functional impairment and report greater exposure to lifetime and chronic stressors than their seronegative counterparts. It is well-known that exposure to stressors and adversity is associated with functional impairment outcomes. However, to our knowledge, no studies have examined how protective factors such as psychological grit mitigate the negative effects of lifetime and chronic stressor exposure on functional impairment, and how this association differs by HIV-status. To address this issue, we studied associations between lifetime and chronic stressor exposure, grit, and functional impairment in 176 African American and non-Hispanic White HIV-seropositive (n = 100) and HIV-seronegative (n = 76) adults, aged 24-85 (M = 57.28, SD = 9.02). As hypothesised, HIV-seropositive status and lower grit, but not lifetime stressor exposure, were independently associated with more functional impairment. Moreover, there was a significant three-way interaction between HIV-status, grit, and lifetime stressor exposure, b = 0.07, p = 0.025, 95% CI [0.009, 0.135]. Specifically, lifetime stressor exposure was related to more functional impairment for HIV-seronegative-but not HIV-seropositive-adults who reported low levels of grit. These findings suggest that the protective effects of grit may differ across populations at risk for functional impairment.


Asunto(s)
Infecciones por VIH , Resiliencia Psicológica , Adulto , Humanos , Infecciones por VIH/psicología , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años
SELECCIÓN DE REFERENCIAS
Detalles de la búsqueda