RESUMEN

A mixed-methods study was conducted to determine the proportion of HIV-infected children who knew their status, identify characteristics associated with children's knowledge of their status, and describe caregivers' and adolescents' experiences relevant to disclosure in the Dominican Republic (DR). Of 327 patients aged 6-18 years treated in the principal DR pediatric HIV facilities, 74 (22.6 %) knew their status. Patients aged 13 years or older and/or who had participated in non-clinical activities for HIV-infected children were more likely to know their status. Caregivers who had disclosed cited healthcare providers' advice, children's desire to know and concerns that children might initiate sexual activity before knowing or discover their status by accidental or malicious disclosure. Non-disclosing caregivers worried that children would be traumatized by disclosure and/or stigmatized if they revealed it to others. Adolescents supported disclosure by 10-12 years of age, considered withholding of children's HIV diagnosis ill-advised, and recommended a disclosure process focused initially on promoting non-stigmatizing attitudes about HIV.

Asunto(s)

Cuidadores/psicología , Infecciones por VIH/psicología , Personal de Salud/psicología , Revelación de la Verdad , Adolescente , Fármacos Anti-VIH/administración & dosificación , Niño , República Dominicana , Femenino , Grupos Focales , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Motivación , Investigación Cualitativa

RESUMEN

There is a dire need for interventions that will address the multiple factors--poverty, substance use, early sexual debut, and violence--that influence Haitian youth's engagement in risky behaviors. The deteriorating socioeconomic and political state of the country has had a deleterious effect on the sociocultural milieu and on the boundaries that have heretofore kept risky behaviors in check. Historically, the lakou system, a community-based approach that supports the family unit, has disintegrated, leading to the disruption of traditional parenting patterns. The unstable economic system has also led to the increasing use of children from poor families, who through the restavek system, are sent to work as servants in other households. The breakdown of traditional systems, coupled with the increasing economic and political instability, has had a significant effect on Haitian adolescents. Among boys, increased levels of substance use have been associated with multiple sex partnerships and very early sexual debut. Among girls, extremely high rates of sexual abuse and forced sex have led to relatively high levels of HIV. While the majority of them have been exposed to behavior change messages, behavior change itself has lagged because many adolescents do not accurately perceive their risk exposure. This review explores the risks of HIV transmission among Haitian youth, with a focus on vulnerability factors, including substance use, culture, and the socioeconomic context, and provides recommendations for intervention. An ecosystemic approach, designed specifically for Haitian youth and that takes environmental context and culture into account, is needed.

Asunto(s)

Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Asunción de Riesgos , Adolescente , Conducta del Adolescente , Femenino , Infecciones por VIH/economía , Infecciones por VIH/epidemiología , Haití/epidemiología , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino

RESUMEN

According to a survey from the HIV Cost and Services Utilization Study (HCSUS), approximately 53% of HIV-infected patients reported drinking alcohol and 8% were classified as heavy drinkers. The role of alcohol as a risk factor for HIV infection has been widely studied and recent research has found a significant association between heavy alcohol consumption and lower levels of CD4 T cells among HIV-infected alcoholics. Although there is evidence on the role of alcohol as a risk factor for HIV transmission and disease progression, there is a need for population studies to determine the genetic mechanisms that affect alcohol's role in HIV disease progression. One of the mechanisms of interest is the dopaminergic system. To date, the effects of dopamine on HIV neuroimmune pathogenesis are not well understood; however, dopaminergic neural degeneration due to HIV is known to occur by viral invasion into the brain via immune cells, and modulation of dopamine in the CNS may be a common mechanism by which different types of substances of abuse impact HIV disease progression. Although previous studies have shown an association of D(2) dopamine receptor (DRD2) polymorphisms with severity of alcohol dependence, the expression of this allele risk on HIV patients with alcohol dependence has not been systematically explored. In the current study, DRD2 Taq1A and C957T SNP genotyping analyses were performed in 165 HIV-infected alcohol abusers and the results were examined with immune status and CD4 counts.

Asunto(s)

Alcoholismo/complicaciones , Alcoholismo/genética , Infecciones por VIH/complicaciones , Infecciones por VIH/inmunología , Polimorfismo de Nucleótido Simple , Receptores de Dopamina D2/genética , Recuento de Linfocito CD4 , Predisposición Genética a la Enfermedad , Humanos

RESUMEN

This study examined the relationship between antiretroviral therapy use, participants' knowledge of partner's HIV serostatus, number of sex partners, perceived infectivity and HIV disclosure to a main sexual partner among 258 HIV-positive Haitian alcohol users. Only 38.6 % had disclosed their HIV serostatus to sexual partners. Logistic regression analyses revealed that participants who self-reported having an HIV-negative partner (OR = 0.36, 95 % CI 0.13-0.97) or a partner of unknown HIV status (OR = 0.09, 95 % CI 0.04-0.22) were less likely to disclose their HIV serostatus than participants who self-reported having an HIV-positive partner. Participants who had more than one sexual partner in the past 3 months (OR = 0.41, 95 % CI 0.19-0.90) were also less likely to disclose than participants who had one partner. These findings suggest the need for couples-based programs to assist people living with HIV (PLWH) with the disclosure process, especially among PLWH who have more than one sexual partner and/or are in serodiscordant relationships.

Asunto(s)

Consumo de Bebidas Alcohólicas/psicología , Seropositividad para VIH/psicología , Parejas Sexuales/psicología , Revelación de la Verdad , Adolescente , Adulto , Fármacos Anti-VIH/uso terapéutico , Escolaridad , Femenino , Seropositividad para VIH/epidemiología , Haití/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estigma Social

RESUMEN

Information on the association between alcohol use and Latino sexual risk behavior prior to immigrating to the United States is scarce. Given this population's rapid growth, documenting the influence of alcohol use on recent Latino immigrants' (RLI) sexual risk behaviors is essential. Data prior to immigration were retrospectively collected from 527 RLI ages 18-39 years. Quantity and frequency of alcohol use during the 90 days prior to immigration and pre-immigration sexual risk behaviors were measured. Structural equation modeling was used to examine the relationships. Males, single participants, and participants with higher incomes reported more alcohol use. Higher alcohol use was associated with lower condom use frequency, having sex under the influence, and more sexual partners among all participants. Results point to the importance of creating interventions targeting adult RLI men, given their likelihood to engage in alcohol consumption, sex under the influence of alcohol, and sex with multiple partners without using condoms.

Asunto(s)

Consumo de Bebidas Alcohólicas/etnología , Emigrantes e Inmigrantes/psicología , Infecciones por VIH/etnología , Hispánicos o Latinos/estadística & datos numéricos , Asunción de Riesgos , Conducta Sexual/etnología , Adulto , Consumo de Bebidas Alcohólicas/psicología , Condones/estadística & datos numéricos , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Florida/epidemiología , Infecciones por VIH/prevención & control , Humanos , Estudios Longitudinales , Masculino , Factores de Riesgo , Distribución por Sexo , Conducta Sexual/psicología , Encuestas y Cuestionarios

RESUMEN

Congruence in spirituality between HIV+ adolescent (n = 40)/family (n = 40) dyads and psychological adjustment and quality of life were assessed, using the Spiritual Well-Being Scale of the Functional Assessment of Chronic Illness Therapy, Beck Depression Inventory-II, Beck Anxiety Inventory and Pediatric Quality of Life Inventory at baseline and 3-month post-intervention. Adolescents were 60 % female and 92 % African American. Congruence in spirituality between adolescent/surrogate dyads remained unchanged at 3 months. High congruence existed for "having a reason for living"; rejection of "life lacks meaning/purpose" and "HIV is a punishment from God." Adolescents were less likely to forgive the harm others caused them than their families.

Asunto(s)

Familia/psicología , Infecciones por VIH/psicología , Calidad de Vida/psicología , Religión y Medicina , Rol del Enfermo , Espiritualidad , Adaptación Psicológica , Adolescente , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/terapia , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Femenino , Perdón , Infecciones por VIH/congénito , Infecciones por VIH/terapia , Humanos , Masculino , Motivación , Inventario de Personalidad/estadística & datos numéricos , Psicometría , Castigo

RESUMEN

Psychological trauma resulting from natural disasters can negatively affect the health of persons living with HIV/AIDS (PLWH). This study examined relationships of alcohol use and exposure to the 2010 Haiti earthquake on symptoms of posttraumatic stress disorder (PTSD) among HIV-positive adults enrolled in an intervention study. Baseline data were collected from male and female PLWH, 19-56 years old on: alcohol consumption and related harms; anxiety; and coping strategies used to deal with HIV. Two to three months postearthquake, data were collected from 104 of the study participants on PTSD and earthquake-related impacts. Most participants had less than a secondary education (66%) and very low income (92% ≤ H$10,000 or ≤ US$1250/year). Over two-thirds of participants felt at some point that they should cut down on drinking. Fifty-two (50.5%) met criteria for PTSD. More than 83% lost their belongings and 64% had someone close to them hurt or killed during the earthquake. Bivariate analysis showed that women, younger participants, those who lost all belongings, and those with greater overall alcohol impact were more likely to report PTSD symptoms. In the multivariate model, participants more likely to meet PTSD criteria (p<0.05) were those who reported feeling a need to cut down on drinking (OR = 3.14, [CI = 1.16, 8.49]) and participants who used behavioral disengagement as a coping mechanism (OR = 1.49, [CI = 1.15, 1.92]). Following a natural disaster, it is important to address trauma-related mental health needs of PLWH - particularly women and individuals who abuse alcohol.

Asunto(s)

Consumo de Bebidas Alcohólicas/psicología , Desastres , Terremotos , Seropositividad para VIH/psicología , Trastornos por Estrés Postraumático/psicología , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Estudios Transversales , Femenino , Seropositividad para VIH/epidemiología , Haití/epidemiología , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Pobreza , Prevalencia , Factores de Riesgo , Distribución por Sexo , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/etiología

RESUMEN

Haiti has the highest number of individuals living with HIV in the Caribbean. Due to Haiti's resource-poor environment and inadequate mental health and substance abuse services, adherence to antiretroviral therapy (ART) may be especially difficult. This study examined associations among demographics, maladaptive coping, partner conflict, alcohol problems, depression, and negative attitudes about medications and their impact on adherence among 194 HIV-positive Haitians. In a mediated directional structural equation model, depression and negative attitudes about ART directly predicted poorer adherence. Greater partner conflict, maladaptive coping and alcohol problems predicted more depression. Maladaptive coping predicted a negative attitude about ART. Alcohol problems predicted partner conflict and maladaptive coping. Significant indirect effects on adherence mediated through both depression and negative attitudes about ART include negative effects of female gender, alcohol problems and maladaptive coping. Results highlight the importance of integrated care for depression, alcohol use and other psychosocial problems to increase ART adherence.

Asunto(s)

Terapia Antirretroviral Altamente Activa/psicología , Depresión/psicología , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación/psicología , Trastornos Relacionados con Sustancias/psicología , Adaptación Psicológica , Adulto , Antirretrovirales/uso terapéutico , Depresión/complicaciones , Depresión/etnología , Análisis Factorial , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/etnología , Infecciones por VIH/psicología , Haití/epidemiología , Humanos , Entrevistas como Asunto , Modelos Logísticos , Masculino , Cumplimiento de la Medicación/etnología , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/etnología , Encuestas y Cuestionarios , Resultado del Tratamiento , Adulto Joven

RESUMEN

This study identified personality clusters among a community sample of adolescents of Haitian decent and related cluster subgroup membership to problems in the areas of substance abuse, mental and physical health, family and peer relationships, educational and vocational status, social skills, leisure and recreational pursuits, aggressive behavior-delinquency, and to sexual risk activity. Three cluster subgroups were identified: dependent/conforming (N = 68), high pathology (N = 30); and confident/extroverted/conforming (N = 111). Although the overall sample was relatively healthy based on low average endorsement of problems across areas of expressed concern, significant physical health, mental health, relationship, educational, and HIV risk problems were identified in a MACI identified high psychopathology cluster subgroup. A confident/extraverted/conforming cluster subgroup revealed few problems and appears to reflect a protective style.

Asunto(s)

Inventario de Personalidad , Adolescente , Conducta del Adolescente/psicología , Análisis por Conglomerados , Femenino , Florida , Haití/etnología , Humanos , Masculino

RESUMEN

This study examines correlates of non-medical prescription sedative, tranquilizer, and hypnotics use (hereafter NPSU) among a non-clinical, community-based sample of adult Latina mother-daughter dyads. Participants were 316 Latina mothers and daughters enrolled in a study of intergenerational transmission of drug abuse and HIV/AIDS risk behaviors in South Florida. Interviewers administered a questionnaire containing study variables such as age, education, time in the U.S., Spanish language proficiency, health insurance status, wellness behaviors, perceived health condition, alcohol use, NPSU, and other drug use. Correlates of NPSU across mothers and daughters were determined using a dyadic model analysis. Daughters' health status, age, wellness, and illicit drug use were associated with mothers' NPSU. Mothers who reported being uninsured, having higher levels of education, and indicating poorer health statuses reported more NPSU. Daughters' wellness behaviors, age, illicit drug use, and insurance status were associated with their NPSU. Insured mothers and mothers who engaged in illicit drug use had daughters who reported more NPSU. The study's findings provide a modest understanding of family dynamics surrounding NPSU, and it suggests that as women age and their perceived health status worsens, their NPSU may increase.

Asunto(s)

Hipnóticos y Sedantes/administración & dosificación , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Conducta , Femenino , Florida/etnología , Hispánicos o Latinos , Humanos , Persona de Mediana Edad , Relaciones Madre-Hijo , Madres

RESUMEN

Since the introduction of highly active antiretroviral therapy (ART) in 1996, HIV-infected children often survive beyond adolescence. To assess worldwide trends in disclosure since ART was introduced, we reviewed articles that refer to disclosure of their status to HIV-infected children, and which described patient, health care provider and/or caregiver opinions about disclosure and/or reported the proportion of children who knew their diagnosis. Most studies (17 [55%]) were performed in low- or middle-income (LMI) countries. In the 21 articles that included information on whether the children knew their status, the proportion who knew ranged from 1.2 to 75.0% and was lower in LMI (median = 20.4%) than industrialized countries (43%; p = 0.04). LMI country study participants who knew their status tended to have learned it at older ages (median = 9.6 years) than industrialized country participants (median = 8.3 years; p = 0.09). The most commonly reported anticipated risks (i.e. emotional trauma to child and child divulging status to others) and benefits (i.e. improved ART adherence) of disclosure did not vary by the country's economic development. Only one article described and evaluated a disclosure process. Despite recommendations, most HIV-infected children worldwide do not know their status. Disclosure strategies addressing caregiver concerns are urgently needed.

Asunto(s)

Cuidadores/psicología , Infecciones por VIH/diagnóstico , Infecciones por VIH/psicología , Revelación de la Verdad , Terapia Antirretroviral Altamente Activa , Niño , Infecciones por VIH/tratamiento farmacológico , Humanos

RESUMEN

Consistent condom use among high risk groups such as female sex workers (FSWs) remains low. Adolescent female sex workers are especially at higher risk for HIV/STI infections. However, few published studies have compared the sexual risk negotiations among adolescent, emerging adult, and older age groups or the extent a manager's advice about condom use is associated with an FSW's age. Of 1,388 female bar/spa workers surveyed in the southern Philippines, 791 FSW who traded sex in the past 6 months were included in multivariable logistic regression models. The oldest FSWs (aged 36-48) compared to adolescent FSWs (aged 14-17) were 3.3 times more likely to negotiate condoms when clients refused condom use. However, adolescent FSWs received more advice from their managers to convince clients to use condoms or else to refuse sex, compared to older FSWs. Both adolescent and the oldest FSWs had elevated sexually transmitted infections (STIs) and inconsistent condom use compared to other groups. Having a condom rule at the establishment was positively associated with condom negotiation. Factors such as age, the advice managers give to their workers, and the influence of a condom use rule at the establishment need to be considered when delivering HIV/STI prevention interventions.

RESUMEN

Metabolic perturbations associated with HIV and antiretroviral therapies are widespread. Unfortunately, research has predominantly focused in cardiometabolic problems, neglecting other important areas. In fact, the immune-calcium-skeletal interface has been understudied despite its potential relevance in people living with HIV (PLWH). Using a case-control methodology, 200 PLWH receiving medical care were enrolled and stratified according to hazardous vs. non-hazardous alcohol intake (HAU vs. non-HAU) and calcium (Ca) levels by analyzing baseline data. The group was chosen to represent relatively "pure" HAU with minimal drug use and no psychiatric diagnoses. With these narrow parameters in place, we found evidence that HAU significantly increases TNF-α levels compared to Non-HAU (2.8 ± 0.6 vs. 1.9 ± 0.3 pg/ml, p = 0.05) and decreases blood Ca levels (9 ± 0.6 vs. 9.4 ± 0.5, p = 0.03). Our analyses also suggest that chronic inflammation, as indicated by increased TNF-α levels, is associated with hypocalcemia (hypoCa <8.6). Despite the limited prevalence of hypoCa, these findings are clinically significant given that hypoCA PLWH exhibited decreased CD4 (253 ± 224 vs. 417.7 ± 281, p = 0.02), B cells (147 ± 58 vs. 248 ± 151, p = 0.03) and NK cells (146.8 ± 90 vs. 229 ± 148, p = 0.008) and elevated CD8 (902.5 ± 438 vs. 699 ± 510, p = 0.09) compared to those with normal calcium. Furthermore, calcium effects on viral load were also evident with hypoCA exhibiting the highest loads (140,187 ± 111 vs. 35,622 ± 7770 HIV copies, p = 0.01). Multivariate analyses confirmed the significance of hypoCa in predicting viroimmune parameters. This paper provides the first evidence that hypoCa accounts for some of the variation in viroimmune measures in HAART recipients and suggests that hypoCa may be mediating alcohol's deleterious effects.

Asunto(s)

Consumo de Bebidas Alcohólicas/inmunología , Terapia Antirretroviral Altamente Activa/efectos adversos , Hipocalcemia/inmunología , Hipocalcemia/virología , Inmunidad Celular/inmunología , Carga Viral/inmunología , Adulto , Consumo de Bebidas Alcohólicas/efectos adversos , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , Infecciones por VIH/virología , Humanos , Hipocalcemia/inducido químicamente , Inmunidad Celular/efectos de los fármacos , Masculino , Persona de Mediana Edad , Adulto Joven

RESUMEN

The purpose of this study was to examine neurological impairment in combination with information-motivation-behavioral skills (IMB) variables. The study tests the role of IMB variables as mediators of antecedent variables of demographics, life stress, social support, and neurological impairment with outcome measures of HIV preventive and risk behaviors in a sample of HIV-positive, alcohol-using adults (n = 250) with a history of alcohol abuse/dependence. Neurological impairment was measured with the Color Trails Test (CTT). Average performance on the CTT by the sample was substantially worse than established norms. In a directional latent variable model, neurological impairment directly predicted lower transmission knowledge scores and poorer performance on an observational condom skills assessment. Greater neurological impairment was significantly associated with greater age. Future interventions geared toward HIV+ adults who use alcohol should take into consideration HIV-related and age-related neurological functioning which may impede the facilitation of safe sex behaviors.

Asunto(s)

Trastornos Relacionados con Alcohol/psicología , Trastornos del Conocimiento/psicología , Infecciones por VIH/psicología , Motivación , Conducta de Reducción del Riesgo , Asunción de Riesgos , Adulto , Factores de Edad , Trastornos Relacionados con Alcohol/complicaciones , Trastornos del Conocimiento/complicaciones , Condones/estadística & datos numéricos , Análisis Factorial , Femenino , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Conducta Social , Apoyo Social , Encuestas y Cuestionarios

RESUMEN

Among severely mentally ill (SMI) substance abusers, HIV rates are elevated and HIV risk reduction interventions have been shown to be less effective. An enhanced cognitive behavioral HIV risk reduction intervention (E-CB) for SMI was compared to a health promotion condition (HPC) in 222 psychiatric outpatients at 6 months postintervention. Compared to females, males in the E-CB improved on intention to practice safer sex and in condom use skills and in unprotected vaginal sex, but did not differ in HIV knowledge, perceived susceptibility, anxiety, condom attitudes, safer sex self-efficacy, unprotected vaginal sex acts, or sex partners. Across intervention groups, there were improvements in all areas except self-efficacy and number of partners. Risk reduction among SMI may be facilitated by increasing awareness of health related behaviors and HIV-targeted content. However, meaningful changes in critical risk reduction skills and intentions may require a more focused intervention and may vary by gender.

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida/psicología , Cognición , Promoción de la Salud/métodos , Trastornos Mentales/psicología , Conducta de Reducción del Riesgo , Conducta Sexual/psicología , Trastornos Relacionados con Sustancias/psicología , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Adulto , Condones , Femenino , Florida , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Evaluación de Programas y Proyectos de Salud , Distribución por Sexo , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia

RESUMEN

The HIV epidemic in Trinidad and Tobago is primarily heterosexual, fueled by a high level of risky sex, gender inequality, and alcohol and drug use; however, the influence of alcohol and drugs has been neglected in the literature. Research shows that current HIV prevention approaches have failed to substantially impact sexual behavior change. This may be so because they do not incorporate a comprehensive understanding of the sociocultural factors underlying sexual behavior. There is an urgent need to understand how socially accepted patterns of alcohol and drug use contribute to sexual behaviors and HIV risk in Trinidad and Tobago. Moreover, specialized, evidence-based interventions are needed for HIV-infected substance abusers. Using an adaptation of the cognitive behavioral stress management (CBSM) protocol, this intervention project aimed to assess effectiveness in reducing relapse and risky behaviors among recovering HIV-infected substance abusers in Trinidad and Tobago.

Asunto(s)

Consumo de Bebidas Alcohólicas/prevención & control , Terapia Cognitivo-Conductual , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Trastornos Relacionados con Sustancias/prevención & control , Sexo Inseguro/prevención & control , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Trastornos Relacionados con Cocaína/epidemiología , Trastornos Relacionados con Cocaína/psicología , Infecciones por VIH/psicología , Humanos , Drogas Ilícitas , Proyectos Piloto , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Trinidad y Tobago/epidemiología , Sexo Inseguro/psicología

RESUMEN

AIMS: Chronic inflammation has become increasingly recognized as a health threat for people living with HIV, given its associations with multiple diseases. Accordingly, the scientific community has prioritized the need to identify mechanisms triggering inflammation. PARTICIPANTS METHODS: A clinic-based case-control study was designed to elucidate the plausible effects of alcohol use on IL-6. Peripheral blood mononuclear cells for measuring IL-6 culture supernatant and plasma for HIV assessments were collected from 59 hazardous alcohol users and 66 nonhazardous alcohol users, who were matched according to their age, gender and US CDC HIV severity status. RESULTS: Stimulated peripheral blood mononuclear cells produced significantly higher amounts of IL-6 in hazardous alcohol users compared with nonhazardous alcohol users. However, racial status and receiving HAART significantly moderated this effect. Notably, in both HAART and non-HAART scenarios, IL-6 levels were associated with CD4 counts and viral burden. A distinctive IL-6 production pattern across racial/ethnic groups was also evident and showed that, when prescribed HAART, Hispanic hazardous alcohol users have a particularly high risk of morbidity compared with their Caucasian and African-American counterparts. After adjusting for confounders (e.g., sociodemographics and HIV disease status), regression analyses confirmed that chronic inflammation, as indicated by IL-6 levels (log), is associated with alcohol use, race/ethnicity and thrombocytopenia, and tended to be related to concurrent smoking. CONCLUSION: Our data confirm that, despite HAART, people living with HIV still have a persistent inflammatory response that, in our study, was associated with chronic hazardous alcohol use. The data also highlight racial/ethnic disparities in IL-6 that justify further investigations.

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Medios de Comunicación Sociales , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Adolescente , Región del Caribe , Infecciones por VIH/prevención & control , Humanos , Trastornos Relacionados con Sustancias

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Trastornos Relacionados con Sustancias , Región del Caribe , Infecciones por VIH , Humanos

RESUMEN

Our objective is to review and summarize relevant aspects of the literature regarding human papillomavirus (HPV), the most common sexually transmitted infection in the United States, and to compare how the trajectory of HPV may differ in persons who are and who are not co-infected with HIV. This comparison is particularly important because the literature on HPV has been largely based on individuals who are not co-infected with HIV. Also, HPV findings may differ in HIV-uninfected individuals versus HIV-infected individuals. In addition, many reviews ignore gender differences, although in HIV-uninfected individuals, anal cancers are up to 4 times more prevalent in women than men. Clinical decision making may be problematic if such critical factors as HIV status and gender are neglected. Therefore, we will review existing information on how HIV status and gender may affect the manifestation of HPV, particularly focusing on epidemiology, screening, and treatment issues.

Asunto(s)

Neoplasias del Ano/prevención & control , Infecciones por VIH/complicaciones , Factores Sexuales , Alphapapillomavirus/aislamiento & purificación , Neoplasias del Ano/complicaciones , Neoplasias del Ano/virología , Femenino , Vacuna Tetravalente Recombinante contra el Virus del Papiloma Humano Tipos 6, 11 , 16, 18 , Humanos , Masculino , Tamizaje Masivo , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/transmisión , Vacunas contra Papillomavirus/administración & dosificación , Factores de Riesgo