Psychosocial Syndemic Classes and Longitudinal Transition Patterns Among Sexual Minority men Living with or Without HIV in the Multicenter AIDS Cohort Study (MACS)

UNC Libraries · 2025-07-26

Syndemic trajectories of heavy drinking, smoking, and depressive symptoms are associated with mortality in women living with HIV in the United States from 1994 to 2017

UNC Libraries · 2025-07-26

A Closer Look at the Perceived Factors Contributing To Late HIV Diagnoses: A Qualitative Study among People with HIV

AIDS and Behavior · 2025-06-02

Examining Survival of People Diagnosed With HIV in Florida Between 2015 and 2021 After a Late, Delayed, or Timely Diagnosis

JAIDS Journal of Acquired Immune Deficiency Syndromes · 2025-12-10

INTRODUCTION: Late HIV diagnosis is a global concern linked to poor health outcomes and is a barrier to ending the HIV epidemic. However, differences in survival outcomes between late and delayed diagnoses remain unclear in the era of effective treatments. This study examined all-cause mortality among individuals with late (CD4 < 200 cells/μL), delayed (200 ≤ CD4 < 350 cells/μL), or timely (CD4 ≥ 350 cells/μL) HIV diagnoses in Florida from 2015 to 2021. SETTING: Using data from the Florida Enhanced HIV/AIDS Reporting System, we included 24,374 individuals with at least 3 CD4 tests. Mortality data were linked through the National Death Index and Social Security Death Index. METHODS: Cox proportional hazards models and Kaplan-Meier curves assessed mortality risk, adjusting for age, year of diagnosis, race/ethnicity, and sex. RESULTS: Among participants (mean age 37.1 years; 20% female; 39% non-Hispanic Black; 34% Hispanic; 25% non-Hispanic White), 895 deaths (4%) occurred. Late and delayed diagnoses accounted for 23% and 18% of cases, respectively. Compared with timely diagnosis, the hazard of death was significantly higher for late (hazard ratio = 2.18, 95% confidence interval: 1.89 to 2.52) and delayed (hazard ratio = 1.25, 95% confidence interval: 1.03 to 1.52) diagnoses. Female sex and older age were associated with increased mortality, whereas Hispanic and non-Hispanic Black individuals had lower mortality risks. CONCLUSIONS: Late and delayed HIV diagnoses were associated with elevated mortality risk, with late diagnosis posing the greatest risk. These findings underscore the need for earlier HIV detection and intervention to improve survival outcomes.

Alcohol reduction strategies among persons with HIV: past attempts, self-reported effectiveness, and future strategies of interest

Addiction Science & Clinical Practice · 2025-07-20

BACKGROUND: Alcohol consumption is associated with poor health outcomes in people with HIV (PWH). Although various alcohol reduction strategies exist, little is known about PWH's past experiences or future preferences. This study describes the previous strategies PWH had used, their perceived effectiveness, among people who ever drank, and the strategies PWH who endorsed heavy drinking would consider trying in the future. It also examines how these experiences and preferences vary by sociodemographic factors and past 12 month drug use. METHODS: A cross-sectional analysis was conducted on data from 453 PWH enrolled in the Florida Cohort Wave III study (2020-2023; mean age 50 years, 60% men). Participants who attempted to reduce or quit drinking (n = 321) were asked about their use of eight alcohol reduction strategies and rated the effectiveness of each on a 4-point Likert scale. Participants reporting heavy drinking (n = 170) were asked about their willingness to try seven strategies in the future. Chi-square and Fisher's exact tests analyzed differences by sex, age, race/ethnicity, and past 12 month drug use. RESULTS: Among the 321 who had ever tried to reduce or quit drinking, endorsed strategies including "on my own"/ complete cessation (80%), prayer (61%), Alcoholics Anonymous (AA) (38%), counseling/therapy (31%), inpatient/outpatient detox (23%), self-monitoring (11%), and medication (7%). The strategies with the highest self-reported effectiveness were for prayer (59%), "on my own"/ complete cessation (58%), and in-patient detox (50%). Prayer was significantly more common among females and non-Hispanic Black or Hispanic participants. Those with past 12 month drug use were significantly more likely to have tried most strategies, except medications or prayer. Among 170 who reported heavy drinking, "on my own"/ complete cessation (43%), AA (24%), and counseling/therapy (21%) were the most endorsed strategies they would try in the future. No significant differences in future preferences were found by demographics, but those with past 12 month drug use showed more interest in formal treatment approaches. CONCLUSION: Commonly used alcohol reduction strategies among PWH were non-medical, easily accessible, and perceived as very effective. Incorporating safe and effective patient-driven methods into treatment guidelines may improve strategy uptake.

Prevalence and characteristics of people with HIV who had late, delayed and timely HIV diagnoses in Florida, 2015–2021

AIDS Care · 2025-04-01 · 1 citations

Different definitions of late HIV diagnosis are used to represent people diagnosed at an advanced stage of their illness. How well varying definitions represent those at risk for poor outcomes is unclear. Our aim was to examine proportions of late, delayed and timely HIV diagnoses in Florida and identify factors associated with diagnosis status. Using the first laboratory test in the Enhanced HIV/AIDS Reporting System, we determined annual proportions of late (CD4 < 200 cells/μL), delayed (200 ≤ CD4 < 350 cells/μL) and timely (CD4 ≥ 350 cells/μL) diagnoses in Florida between 2015 and 2021 and assessed characteristics associated with diagnosis status using multinomial logistic regression models. Among 30,411 individuals (20% female, 39% non-Hispanic Black, 34% Hispanic, mean age 37.1 years), 22% had a late and 17% had a delayed diagnosis. Non-Hispanic Black race, older age, and diagnosis at an inpatient facility were associated with greater odds of having a late or delayed diagnosis compared with having a timely diagnosis. There was no change in the prevalence of late, delayed, and timely diagnoses each year during the study period. Nearly 40% of HIV diagnoses in Florida were late or delayed. Given those with late and delayed diagnoses were similar, strategies to improve timeliness of diagnosis among these groups are needed.

Evaluating Cross-Sectional Associations Between Cannabis Use and Prospective Memory in People with HIV

AIDS and Behavior · 2025-09-12

Prospective memory (PM) deficits are common among people with HIV (PWH) and are linked to poor clinical outcomes. Risk factors for PM deficits in PWH are poorly understood. While cannabis use is associated with worse PM in people without HIV, it is unclear whether this association generalizes to PWH. Three hundred and seven PWH (79% with regular cannabis use) completed the Memory for Intentions Test (MIST). Associations between regular use (vs. no/minimal lifetime use) and MIST score were evaluated. Among participants with regular use, bivariate associations were evaluated between MIST score and self-reported cumulative 30-day THC dose, use frequency, duration of heaviest lifetime use, age of first use, and use motivation (predominantly-recreational, predominantly-therapeutic, or combined). Confounding was addressed with linear regressions adjusted for age and Wechsler Test of Adult Reading. Cannabis use (vs. non-use) was not significantly associated with MIST score in unadjusted or adjusted models (β = - 0.04, 95% CI = - 0.29, 0.21, p = 0.74). After confounder adjustment, no associations between cannabis variables and MIST score reached statistical significance. The largest (albeit nonsignificant) effect in adjusted models was found for use motivation: participants with combined use showed better MIST performance vs. predominantly-recreational use (β = 0.28, 95% - 0.02, 0.57, p = 0.067). Participants reporting predominantly-therapeutic use vs. predominantly-recreational use performed similarly (β = 0.03, 95% CI = - 0.30, 0.37, p = 0.85). PM was not significantly associated with cannabis use in PWH. Associations between motivation for use and PM in PWH warrant further investigation.

Is Abstinence from Alcohol and Smoking Associated with Less Anxiety and Depressive Symptoms Among People with HIV?

AIDS and Behavior · 2024-01-29 · 2 citations

Is Abstinence From Alcohol and Smoking Associated With Better Mood Among People With HIV?

Drug and Alcohol Dependence · 2024-07-01

Associations Between Reductions in Depressive Symptoms and Reductions in Pain and Anxiety Symptoms and Substance Use: Emulation of a Randomized Trial

AJPM Focus · 2024-07-06

Introduction: Depressive symptoms are linked with pain, anxiety, and substance use. Research estimating whether a reduction in depressive symptoms is linked to subsequent reductions in pain and anxiety symptoms and substance use is limited. Methods: Using data from the Veterans Aging Cohort Study, a multisite observational study of U.S. veterans, the authors used a target trial emulation framework to compare individuals with elevated depressive symptoms (Patient Health Questionnaire-9 score ≥ 10) who experienced reductions in depressive symptoms (Patient Health Questionnaire-9 score < 10) with those whose symptoms persisted (Patient Health Questionnaire-9 score ≥ 10) at the next follow-up visit (on average, 1 year later). Using inverse probability of treatment weighting, the authors estimated ORs and 95% CIs for associations between depressive symptom reduction status and improvement on the following: anxiety symptoms, pain symptoms, unhealthy alcohol use, and use of tobacco, cannabis, cocaine, and/or illicit opioids. Results: Reductions in depressive symptoms were associated with reductions in pain symptoms (OR=1.43, 95% CI=1.01, 2.02), anxiety symptoms (OR=2.50, 95% CI=1.63, 3.83), and illicit opioid use (OR=2.07, 95% CI=1.13, 3.81). Depressive symptom reductions were not associated with reductions in unhealthy alcohol use (OR=0.85, 95% CI=0.48, 1.52) or use of tobacco (OR=1.49, 95% CI=0.89, 2.48), cannabis (OR=1.07, 95% CI=0.63, 1.83), or cocaine (OR=1.28, 95% CI=0.73, 2.24). Conclusions: Reducing depressive symptoms may potentially reduce pain and anxiety symptoms and illicit opioid use. Future work should determine whether reductions achieved through antidepressant medications, behavioral therapy, or other means have comparable impact.