Miami Adult Studies On HIV Research Articles

Substance use moderates relationships between apolipoprotein E genotype, hepatitis C, cognition, and depression in Miami Adult Studies on HIV (MASH) participants.

The impact of APOE on HIV and HCV disease course, cognition, and memory has been understudied in minoritized populations. This study examined whether scores on cognition and depression measures differed by APOE ε4 carrier status while considering HCV and HIV seropositivity and whether these measures were moderated by substance use. A retrospective analysis examined cognitive and psychological data from participants (n = 493) in the Miami Adult Studies on HIV (MASH) cohort. APOE genotyping was performed on banked blood samples. Multiple linear regression was employed to examine differences across participants living with and without HIV and/or HCV and by APOE ε4 genotype. APOE ε4 carriers living with HCV who used cannabis had higher depression scores than non-ε4 carriers, while nonusers had fewer depressive symptoms. APOE ε4 carriers living with HCV had better cognition scores after adjusting for cocaine, opiate, and cannabis use than non-ε4 carriers. Scores on cognitive and depression measures did not differ between APOE ε4 carriers and non-ε4 carriers in participants living with HIV, and substance use did not moderate this relationship. This study was the first of its kind to examine substance use as a moderator for cognition and depression among individuals with HIV and/or HCV stratified by APOE genotype. Findings support further research evaluating the frequency and duration of 1) domains of cognitive functioning impacted by APOE genotype relevant to substance use and 2) the influence of substance use on cognitive and depressive outcomes among adults living with HIV and HCV, HIV, or HCV.

Sex Differences in Gut Integrity in a Sample of Cannabis Users and Non-Users From the Miami Adult Studies on HIV (MASH) Cohort

Sex Differences in Gut Integrity in a Sample of Cannabis Users and Non-Users From the Miami Adult Studies on HIV (MASH) Cohort

Drug use and COVID-19 testing, vaccination, and infection among underserved, minority communities in Miami, Florida.

The Coronavirus Disease 2019 (COVID-19) pandemic has disproportionately impacted people who use drugs (PWUD). This study explored relationships between drug use, COVID-19 testing, vaccination, and infection. This cross-sectional study was conducted in Miami, Florida between March 2021 and October 2022 as part of the National Institutes of Health (NIH) Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiative and the Miami Adult Studies on HIV (MASH) cohort. Users of cannabis, cocaine/crack, heroin/fentanyl, methamphetamines, hallucinogens, and/or prescription drug misuse in the previous 12 months were considered PWUD. Sociodemographic data, COVID-19 testing history, and vaccination-related beliefs were self-reported. Vaccinations were confirmed with medical records and positivity was determined with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. Statistical analyses included chi-square tests and logistic regression. Of 1,780 participants, median age was 57 years, 50.7% were male, 50.2% Non-Hispanic Black, and 66.0% reported an annual income less than $15,000. Nearly 28.0% used drugs. PWUD were less likely than non-users to self-report ever testing positive for SARS-CoV-2 (14.7% vs. 21.0%, p = 0.006). However, 2.6% of participants tested positive for SARS-CoV-2, with no significant differences between PWUD and non-users (3.7% vs. 2.2%, p = 0.076). PWUD were more likely than non-users to experience difficulties accessing testing (10.2% vs. 7.1%, p = 0.033), vaccine hesitancy (58.9% vs. 43.4%, p = 0.002) and had lower odds of receiving any dose of a COVID-19 vaccine compared to non-users (aOR, 0.63; 95% CI, 0.49-0.81; p<0.001). PWUD presented with greater difficulties accessing COVID-19 testing, greater vaccine hesitancy, and lower odds of vaccination. Testing and immunization plans that are tailored to the needs of PWUD and consider access, trust-building campaigns, and education may be needed.

Community-Engaged Research: COVID-19 Testing, Infection, and Vaccination among Underserved Minority Communities in Miami, Florida.

Community collaboration is a cornerstone of modern public health efforts. This work aimed to use community-engaged research to explore COVID-19 vaccination, testing, and infection in a minoritized community. This study was conducted in Miami, Florida, from March 2021 to February 2022 in community partner sites and the Miami Adult Studies on HIV (MASH) cohort. Sociodemographic characteristics, vaccination and testing beliefs, and COVID-19 challenges were self-reported. COVID-19 vaccinations were verified with medical records, testing history was self-reported, and severe acute respiratory syndrome coronavirus 2 positivity was determined via real-time reverse transcription-polymerase chain reaction (rt-PCR). Of 1689 participants, the median age was 57, 51% were male, 49% were non-Hispanic Black, 66% reported an income < USD 15,000/year, and 75.9% received at least one dose of a COVID-19 vaccine. Belief that COVID-19 vaccination is effective was associated with lower odds of COVID-19 positivity and was the strongest predictor of vaccination. Challenges accessing health care, housing, food, and transportation were associated with lower odds of vaccination. Employment, health insurance, higher education, and greater perceived test accuracy were associated with greater odds of COVID-19 testing. Social determinants of health and the belief that vaccines are effective and tests are accurate predicted behaviors and thus should be considered during public health crises in vulnerable communities.

P29-005-23 Food Insecurity Is Associated With High CRP and sCD14 in the Miami Adult Studies on HIV (MASH) Cohort

P29-005-23 Food Insecurity Is Associated With High CRP and sCD14 in the Miami Adult Studies on HIV (MASH) Cohort

P30-003-23 The Neutrophil to Lymphocyte Ratio Is Associated With Hs-CRP in a Sample of Underrepresented Individuals From the Miami Adult Studies on HIV(MASH) Cohort

P30-003-23 The Neutrophil to Lymphocyte Ratio Is Associated With Hs-CRP in a Sample of Underrepresented Individuals From the Miami Adult Studies on HIV(MASH) Cohort

Diet Quality and Liver Health in People Living with HIV in the MASH Cohort: A Multi-Omic Analysis of the Fecal Microbiome and Metabolome.

The gut-liver axis has been recognized as a potential pathway in which dietary factors may contribute to liver disease in people living with HIV (PLWH). The objective of this study was to explore associations between dietary quality, the fecal microbiome, the metabolome, and liver health in PLWH from the Miami Adult Studies on HIV (MASH) cohort. We performed a cross-sectional analysis of 50 PLWH from the MASH cohort and utilized the USDA Healthy Eating Index (HEI)-2015 to measure diet quality. A Fibrosis-4 Index (FIB-4) score < 1.45 was used as a strong indication that advanced liver fibrosis was not present. Stool samples and fasting blood plasma samples were collected. Bacterial composition was characterized using 16S rRNA sequencing. Metabolomics in plasma were determined using gas and liquid chromatography/mass spectrometry. Statistical analyses included biomarker identification using linear discriminant analysis effect size. Compared to participants with FIB-4 ≥ 1.45, participants with FIB-4 < 1.45 had higher intake of dairy (p = 0.006). Fibrosis-4 Index score was inversely correlated with seafood and plant protein HEI component score (r = -0.320, p = 0.022). The relative abundances of butyrate-producing taxa Ruminococcaceae, Roseburia, and Lachnospiraceae were higher in participants with FIB-4 < 1.45. Participants with FIB-4 < 1.45 also had higher levels of caffeine (p = 0.045) and related metabolites such as trigonelline (p = 0.008) and 1-methylurate (p = 0.023). Dietary components appear to be associated with the fecal microbiome and metabolome, and liver health in PLWH. Future studies should investigate whether targeting specific dietary components may reduce liver-related morbidity and mortality in PLWH.

Stress Increases the Association between Cigarette Smoking and Mental Disorders, as Measured by the COVID-19-Related Worry Scale, in the Miami Adult Studies on HIV (MASH) Cohort during the Pandemic.

Background: Smoking has been associated with mental disorders (MD). People who smoke are at a higher risk of contracting COVID-19 and experiencing more severe symptoms of the illness. This study aimed to investigate the relationship between cigarette smoking and MD before and during the COVID-19 pandemic and whether it was influenced by COVID-19-related stress in the MASH cohort. Methods: An ambispective design was used with data collected during the pandemic (July/August 2020) by the COVID-19-Related Worry Scale, a parameter for stress, and data collected at the participants’ last cohort visit before the pandemic (December 2019). Results: In our sample of 314 participants, 58.6% were living with HIV, 39.2% had MD, 52.5% smoked before, and 47.8% smoked during the pandemic. Participants with MD were twice as likely to smoke cigarettes both before (aOR = 2.02, 95% CI: 1.21–3.37, p = 0.007) and during the pandemic (aOR = 2.10, 95% CI: 1.24–3.56, p = 0.006); and experienced higher levels of stress measured by the COVID-19-Related Worry Scale (8.59 [5.0–10.0] vs. 7.65 [5.0–10.0]; p = 0.026) compared to those without MD. Participants with MD and high levels of stress smoked more days per month (20.1 [0–30] days) than those with lower levels of stress (9.2 [0–30] days, p = 0.021), and more than those with high levels of stress, but no MD (2.6 [0–30] days, p < 0.001). Conclusions: Cigarette smoking decreased in the MASH cohort during the pandemic, but increased in participants with MD and higher levels of stress.

Cannabis Use and Body Composition in People Living with HIV (PLWH) From the Miami Adult Studies on HIV (MASH) Cohort

ObjectivesCannabis is the most prevalently used substance in the United States and among people living with HIV (PLWH). Underserved minorities living with HIV suffer from high rates of obesity. Yet, little is known about the implications of cannabis use on body composition in PLWH. Thus, we sought to determine the association between cannabis use and body composition PLWH.MethodsIn this cross-sectional study, participants were selected from the ongoing Miami Adult Studies on HIV (MASH) cohort. Cannabis use was self-reported and confirmed with urinalysis for cannabis along with other illicit drugs (American Bio Medica Corp, Kinderhook, NY). Participants were selected if they did not use any illicit drugs and excluded if they used illicit drugs other can cannabis. Informed consent, demographics, and anthropometrics were collected by trained personnel. HIV viral load (VL, copies/mL), and CD4+ cells (cells/mL) were abstracted from medical records. Descriptive statistics were used to analyze demographics, cannabis use, overweight (BMI ≥ 25 kg/m2) and VL (suppressed VL < 50 copies/mL). SPSS 26 was used to analyze the linear association between cannabis use and BMI. Logistic regression calculated the odds ratio (OR) of cannabis use and overweight status. Independent sample t-test compared CD4+ cell count and VL between the cannabis-using and non-using groups.ResultsParticipants’ mean age was 53.6 ± 8.3 years (n = 346), 42.5% were female, 57.5% were Black, and 73.1% had a BMI ≥ 25 kg/m2 (overweight). Cannabis users accounted for 34.1% of the sample. The frequency of participants with a suppressed VL was 80.3%. No significant differences in CD4+ count or VL between the cannabis users and non-users (p > .05). Cannabis use was associated with a lower BMI adjusted for age, sex, race and ethnicity, CD4+ count, and VL (b = −1.8 SE = 0.83, p = .03). Also, cannabis use was associated with reduced odds of being overweight after adjusting for age, sex, race and ethnicity, CD4+ count, and VL (OR: 0.44, 95% CI: 0.23–0.83; p = 0.01).ConclusionsThe use of cannabis was associated with lower BMI and decreased odds of being overweight or obese. Cannabis use did not significantly affect crucial markers of HIV disease progression (CD4+ count and VL) negatively. Longitudinal research is needed to further assess these associations and determine its medicinal efficacy in weight management.Funding SourcesNIDA.

Smoking Is Associated With Microbial Translocation in the Miami Adult Studies on HIV (MASH) Cohort

ObjectivesThe prevalence of cigarette smoking is 2 to 3 times greater among people living with HIV (PLWH) than in the HIV uninfected population. Smoking has also been associated with deleterious effects on the gut leading to potential microbial translocation. Thus, we sought to use CD14 (sCD14) as a surrogate marker of microbial translocation to determine if smoking was associated with changes in microbial translocation.MethodsA cross-sectional analysis was completed with participants from the Miami Adult Studies on HIV (MASH) cohort. Demographic characteristics and cigarette smoking status were self-reported. Levels of sCD14 were analyzed using ELISA kits in Dr. Sherman's laboratory. HIV serostatus and viral load (VL) were abstracted from medical records with the participants’ consent. Statistical analyses included descriptive statistics, T-test, linear regression for sCD14 levels, and logistic regression to calculate the odds of having an sCD14 level above the sample median (1064.3 ng/mL). All analyses were conducted on SPSS 26.ResultsA total of 470 participants were included in the analysis. The mean age was 53 ± 8 years, 42.8% were females and 64.5% were Black. PLWH accounted for 76.8% of participants and 85.1% had a suppressed VL (<50 copies/mL). Smokers had significantly higher mean sCD14 levels than non-smokers (1025.8 ± 429.0 vs. 1183.4 ± 465.7, respectively; P = 0.002). This relationship remained significant after adjusting for sex, age, BMI, and HIV status (β = 166.70, SE = 52.36, P = 0.002). Also, smoking tended to be associated with 1.6 times the odds of having high sCD14 levels, adjusted for BMI, age, sex, and HIV status (β = 1.6, 95% CI = 1.0–2.6, P = 0.051).ConclusionsCigarette smoking appears to contribute to immune activation regards of HIV status which may contribute to microbial translocation, regardless of HIV status. The findings provide further evidence of the deleterious effect of cigarette smoking on physiological functions, including gut health. Further research is needed to determine the long-term effects of smoking on immune activation and microbial translocation.Funding SourcesSupported by the National Institute on Drug Abuse.

Food Insecurity Is Associated With a Lower Quality of Life Among People Living With HIV (PLWH) and HIV Seronegative Individuals, in the Miami Adult Studies on HIV (MASH) Cohort

ObjectivesFood insecurity affects underserved and marginalized populations in the United States, which could lead to a decline in quality of life over time and further worsening health outcomes. This study aims to determine the association between food security and quality of life among people living with and without HIV in Miami, FL. MethodsThis was a cross-sectional analysis of a minority population from the Miami Adult Studies on HIV (MASH) cohort. Demographics, anthropometrics, and fasting blood samples were collected by trained personnel. HIV viral loads (VL, copies/ml) were abstracted from medical records (suppressed viral load < 50 copies/ml) with the participants’ consent. Food security status was assessed using the USDA Household Food Security Module and analyzed as food secure (full) vs. insecure (marginal, low, very low). Quality of Life (QoL) was determined with the Spitzer QoL Index (scores: 0–10). QoL was dichotomized as a high (≥8) or low QoL (<8). All statistical analyses were performed using SPSS 26. ResultsParticipants’ mean age was 54.6 ± 7.9 years (N = 1,034), 58% were male, and 61.1% Black; 46.6% were living with HIV and 90.9% had a suppressed viral load. Food insecurity was reported by 48.4% of individuals. Food secure individuals showed a significantly higher QoL score compared to food insecure individuals (8.68 ± 1.57, 7.84 ± 1.89, respectively; p < 0.001). People living with HIV (PLWH) did not have significantly different QoL scores nor food insecurity compared to HIV-uninfected individuals. A linear regression showed that food security was associated with higher QoL after adjusting for age, sex, race, ethnicity, HIV status, BMI, and annual family income (β = 0.64 SE = 0.11, P = 0.001). Logistic regression found that food insecurity was associated with lower odds of having a high QoL after adjusting for age, sex, race and ethnicity, HIV status, BMI, and annual family income (OR: 0.45; 95% CI: 0.33, 0.62; P < 0.001). ConclusionsFood insecurity negatively affects the quality of life of minorities with and without HIV in the MASH cohort in Miami. Improving the food security of marginalized populations by facilitating their access to high-quality foods could improve their health and quality of life. Funding SourcesNational Institute on Drug Abuse.

Serum Ferritin Is Associated With Elevated ALT Among People Living With HIV and HIV-Seronegative Individuals in the Miami Adult Studies on HIV Cohort

ObjectivesIt has been shown that people living with HIV (PLWH) are vulnerable to liver inflammation and damage. Elevated serum ferritin has been associated with higher incidence of liver damage. This study examined the relationship between serum ferritin levels and liver damage in PLWH.MethodsA cross-sectional analysis of data from participants in the Miami Adult Studies on HIV (MASH) cohort. Informed consent, demographics, Alcohol Use Disorder Identification Test (AUDIT) for hazardous drinking (≥8), and fasting blood samples were collected by trained personnel. HIV status, HIV Viral Load (VL, copies/ml) was abstracted from medical charts with the participants’ consent. LabCorp (Burlington, NC) determined serum ferritin and serum alanine aminotransferase (ALT). Opioid use was analyzed by urinalysis (American Bio Medica Corp; Kinderhook, NY). Statistical analyses were performed using SPSS 26 and included T-test, linear and logistic regression. Elevated serum ferritin levels were defined as ≥150 ng/mL and elevated ALT as ≥5 IU/L.ResultsParticipants’ mean age was 54.6 ± 7.9 years (n = 1,026), 57.9% were male, and 61.2% wereBack; 46.8% were PLWH, 90.9% had an undetectable viral load. Males had significantly higher ALT (29.6 ± 36.2 vs. 20.8 ± 16.4 IU/L) and serum ferritin (156.1 ± 223.0 vs. 98.7 ± 114.9 ng/mL) than females (P < 0.001). Ferritin (148.3 ± 203.3 vs. 117.5 ± 171.1 ng/mL; P = 0.009), but not ALT (25.6 ± 32.078 vs. 26.1 ± 27.7 IU/L; P > 0.05), was significantly higher in PLWH than HIV-uninfected participants. In a linear model, elevated ALT was positively associated with higher serum ferritin levels after adjusting for sex, age, HIV status, and opioid use (β = 163.75 SE = 14.579, p = 0.001). Individuals with elevated ALT had 4.55 greater odds of having elevated ferritin levels (CI: 3.203–6.460, P < 0.001) after adjusting for age, sex and opioid use.ConclusionsAlanine aminotransferase seems to be a good predictor of serum ferritin levels in PLWH. Elevated levels of ferritin have been associated with liver inflammation, chronic kidney disease, acute infections, and therefore deleterious health consequences in PLWH that warrant further examination.Funding SourcesNational Institute on Drug Abuse.

Cocaethylene, simultaneous alcohol and cocaine use, and liver fibrosis in people living with and without HIV

BackgroundThe simultaneous consumption of cocaine and alcohol results in the production of cocaethylene (CE) in the liver, a highly toxic metabolite. Prior research suggests that cocaine use contributes to liver disease and its concomitant use with alcohol may increase its hepatotoxicity, but studies in humans are lacking. We evaluated the role of cocaine, its simultaneous use with alcohol, and CE on liver fibrosis. MethodsWe performed a cross-sectional analysis of the Miami Adult Studies on HIV (MASH) cohort. Cocaine use was determined via self-report, urine screen, and blood metabolites, using liquid chromatography with tandem mass spectrometry. Hazardous drinking was determined with the AUDIT-C and liver fibrosis with the Fibrosis-4 Index (FIB-4). ResultsOut of 649 participants included in this analysis, 281 (43.3%) used cocaine; of those, 78 (27.8%) had CE in blood. Cocaine users with CE had higher concentrations of cocaine metabolites in blood and were more likely to drink hazardously than cocaine users without CE and cocaine non-users. Overall, cocaine use was associated with liver fibrosis. CE in blood was associated with 3.17 (95% CI: 1.61, 6.23; p = 0.0008) times the odds of liver fibrosis compared to cocaine non-users, adjusting for covariates including HIV and HCV infection. The effect of CE on liver fibrosis was significantly greater than that of cocaine or alcohol alone. ConclusionsCE is a reliable marker of simultaneous use of cocaine and alcohol that may help identify individuals at risk of liver disease and aid in the prevention of its development or progression.

Resilience, Anxiety, Stress, and Substance Use Patterns During COVID-19 Pandemic in the Miami Adult Studies on HIV (MASH) Cohort.

We evaluated mental health and substance use during the COVID-19 pandemic in 196 participants from the Miami Adult Studies on HIV (MASH) Cohort. A survey was administered between July–August of 2020, including validated measures of resilience and anxiety, a scale to measure COVID-19-related worry, and self-reported substance use. Compared to HIV-uninfected participants (n = 80), those living with HIV (n = 116) reported fewer anxiety symptoms, less COVID-19-related worry, and higher resilience. Those with more anxiety symptoms and lower resilience engaged in more frequent alcohol consumption, binge drinking, and cocaine use. Alcohol misuse was more common among HIV-uninfected participants. Cocaine use was reported by 21% fewer participants during the pandemic compared with 7.3 ± 1.5 months earlier. Possibly due to their experiences with HIV, PLWH responded with higher resilience and reduced worry and anxiety to the adversities brought by the COVID-19 pandemic.

Soluble CD163 Identifies Those at Risk for Increased Hepatic Inflammation & Fibrosis.

BackgroundLiver disease remains a significant cause of morbidity and mortality in HIV-infected persons. Soluble CD163 is a marker of Kupffer cell activation that is highly associated with development of hepatic fibrosis. The relative contributions of HIV-associated systemic immune activation vs other etiologies of injury are poorly characterized.MethodsWe utilized subjects in the Miami Adult Studies on HIV (MASH) cohort to evaluate 464 participants including 361 people with HIV (PWH) and 103 hepatitis C virus (HCV)/HIV-uninfected controls. Subjects underwent testing for hepatic fibrosis using both magnetic resonance elastography and the Enhanced Liver Fibrosis Index. Steatosis was evaluated by magnetic resonance imaging–derived proton density fat fraction. Immune activation markers and cytokines were quantitated using Luminex methodologies.ResultsParticipants with HIV with or without HCV coinfection had higher levels of sCD163 than uninfected controls (P < .05). Soluble sCD163 was highly associated with elevated alanine aminotransferase, a key marker of inflammation/injury and with hepatic fibrosis. Hepatic steatosis was also associated with a cytokine pattern suggestive of Kupffer cell activation but was not associated with an increase in sCD14 or sCD27.ConclusionsInjury and resultant hepatic fibrosis occur by distinct though overlapping mechanistic pathways. In PWH, sCD163 is highly associated with both injury and fibrosis, suggesting that persistent systemic immune activation is a major contributor to long-term outcomes, adding to damage caused by alcohol, steatosis, and other hepatotoxic drug effects.

Food Insecurity and Cognitive Impairment in the Miami Adult Studies on HIV (MASH) Cohort

Food insecurity is a social determinant of health associated with cognitive impairments in older adults and people living with HIV (PLWH). Few studies have examined this relation longitudinally, and no studies have explored how the frequency of food insecurity over time may impact cognitive impairment. This study aimed to examine the impact of food insecurity on cognitive impairment over a 2-y follow-up period in a cohort of people living with and without HIV. This was a 2-y longitudinal analysis of primarily economically disadvantaged, middle-aged, Black, and Hispanic participants from the Miami Adult Studies on HIV (MASH) cohort. Food insecurity was assessed with the USDA Household Food Security Module at baseline and 12- and 24-mo follow-ups. Food insecurity in all 3 assessments was considered persistent food insecurity. Cognitive impairment was assessed with the Mini-Mental State Examination. Statistical analyses consisted of logistic regressions. A total of 394 participants (247 HIV positive) with 2-y follow-up data were included in this analysis. At baseline, 104 (26.4%) were food-insecure and 58 (14.7%) had cognitive impairment. Very low food security was associated with cognitive impairment at baseline (OR: 3.23; 95% CI: 1.08, 9.65). PLWH not virally suppressed had higher risk for cognitive impairment compared with HIV-uninfected participants (OR: 2.87; 95% CI: 1.15, 7.18). Additionally, baseline food insecurity (OR: 2.28; 95% CI: 1.08, 4.81) and the frequency of food insecurity over time (OR: 1.50 per year; 95% CI: 1.08, 2.10), particularly persistent food insecurity (OR: 3.69; 95% CI: 1.15, 11.83), were associated with cognitive impairment at 2-y follow-up; the results were consistent after excluding cognitively impaired participants at baseline. Food insecurity is a significant risk factor for cognitive impairment, particularly among individuals who experience food insecurity frequently or persistently. Screening for food insecurity and interventions to secure access to sufficient, nutritious foods may help delay cognitive decline among socioeconomically disadvantaged individuals.

Polysubstance use and adherence to antiretroviral treatment in the Miami Adult Studies on HIV (MASH) cohort

ABSTRACT Evidence for a relationship between polysubstance use, depression, and adherence to antiretroviral therapy (ART) is limited. The objectives of this study were to examine the associations of depression, illicit drug, and alcohol use with adherence to ART. People living with HIV (PLHIV) from the Miami Adult Studies on HIV cohort were asked about the number of doses of their ART medication missed to assess ART adherence. Harmful alcohol drinking was evaluated using the Alcohol Use Disorders Identification Test and illicit substance use assessed with self-report and urine screen. The Center for Epidemiologic Studies Depression Scale was used to assess depression symptoms. Of 391 PLHIV, 16.6% missed at least one dose (range:1–4) in the past four days. Cocaine/crack, opiate use, and depression were significantly independently associated with a greater mean number of doses missed. The mean number of doses missed was significantly greater among participants who used alcohol in combination with cocaine/crack, marijuana, and tobacco compared to non-users. In conclusion, polysubstance use increased the risk for poor ART adherence among PLHIV. The use of cocaine/crack or opiates individually and depressive symptoms also promote poor ART adherence. An integrated approach targeting substance disorders and depression may help achieve better ART adherence.

Food insecurity is associated with magnetic resonance–determined nonalcoholic fatty liver and liver fibrosis in low-income, middle-aged adults with and without HIV

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the United States. Food-insecure individuals often depend on low-cost, energy-dense but nutritionally poor foods, resulting in obesity and chronic diseases related to NAFLD. To determine whether food insecurity is associated with NAFLD in a cohort of HIV and hepatitis C virus (HCV) infected and uninfected adults. We conducted a cross-sectional analysis of low-income, middle-aged adults from the Miami Adult Studies on HIV (MASH) cohort without a history of excessive alcohol consumption. Food security was assessed with the USDA's Household Food Security Survey. MRIs were used to assess liver steatosis and fibrosis. Metabolic parameters were assessed from fasting blood, anthropometrics, and vitals. Of the total 603 participants, 32.0% reported food insecurity. The prevalences of NAFLD, fibrosis, and advanced fibrosis were 16.1%, 15.1%, and 4.6%, respectively. For every 5 kg/m2 increase in BMI, the odds of NAFLD increased by a factor of 3.83 (95% CI, 2.37-6.19) in food-insecure participants compared to 1.32 (95% CI, 1.04-1.67) in food-secure participants. Food insecurity was associated with increased odds for any liver fibrosis (OR, 1.65; 95% CI, 1.01-2.72) and advanced liver fibrosis (OR, 2.82; 95% CI, 1.22-6.54), adjusted for confounders. HIV and HCV infections were associated with increased risks for fibrosis, but the relationship between food insecurity and liver fibrosis did not differ between infected and uninfected participants. Among low-income, middle-aged adults, food insecurity exacerbated the risk for NAFLD associated with a higher BMI and independently increased the risk for advanced liver fibrosis. People who experience food insecurity, particularly those vulnerable to chronic diseases and viral infections, may be at increased risk for liver-related morbidity and mortality. Improving access to adequate nutrition and preventing obesity among low-income groups may lessen the growing burden of NAFLD and other chronic diseases.

Heroin use is associated with liver fibrosis in the Miami Adult Studies on HIV (MASH) cohort

BackgroundPeople who use opioids and people living with HIV (PLWH) are at increased risk for liver-related morbidity and mortality. Although animal models suggest that chronic opioid use may cause liver damage, research in humans is limited. We aimed to determine whether opioid use, particularly heroin, was associated with liver fibrosis. MethodsCross-sectional analysis of 679 participants (295 HIV/HCV uninfected, 218 HIV mono-infected, 87 HCV mono-infected, 79 HIV/HCV coinfected) from the Miami Adult Studies on HIV (MASH) cohort. Liver fibrosis was assessed via magnetic resonance elastography (MRE) on a 3 T Siemens MAGNETOM Prisma scanner. ResultsA total of 120 (17.7 %) participants used opioids. Liver fibrosis was present in 99 (14.6 %) participants and advanced liver fibrosis in 31 (4.6 %). Heroin use (N = 46, 6.8 %) was associated with HCV-seropositivity, smoking, misuse of prescription opioids, and polysubstance use. The use of heroin, but not misuse of prescription opioids, was significantly associated with liver fibrosis (OR = 2.77, 95 % CI: 1.18―6.50) compared to heroin non-users, after adjustment for confounders including excessive alcohol consumption, polysubstance use and HIV and HCV infections. Both HIV and HCV infections were associated with liver fibrosis, whether virally suppressed/undetectable or viremic. ConclusionsHeroin use was independently associated with increased risk for liver fibrosis irrespective of the use of other substances and HIV or HCV infections. Both HIV and HCV were associated with higher risk for liver fibrosis, even among those with suppressed or undetectable viral loads. The exact mechanisms for opioid-induced liver fibrosis remain to be fully elucidated.

Cognitive Impairment among People Who Use Heroin and Fentanyl: Findings from the Miami Adult Studies on HIV (MASH) Cohort

ABSTRACT Background: Cognitive impairment is common in people living with HIV (PLWH). Opioid drugs exert direct and indirect effects on cognitive processes, which may contribute to cognitive dysfunction among PLWH. This study was designed to determine if opioid use is associated with cognitive impairment and whether the effect differs between PLWH and HIV-uninfected adults. Other neuropsychiatric symptoms, such as depression and apathy, were also examined. We conducted a cross-sectional analysis of 265 PLWH and 284 HIV-uninfected participants from the Miami Adult Studies on HIV (MASH) cohort. The Mini-Mental State Examination (MMSE) was used to assess cognitive impairment. Substance use was self-reported. Overall, 26.8% of PLWH and 15.1% of HIV-uninfected used opioids. Cognitive impairment was more frequent among people who used heroin and/or fentanyl than those who misused prescription opioids (31.6% vs. 10.5%, p = .005). The use of heroin/fentanyl was associated with increased odds for cognitive impairment (adjusted OR: 2.21, 95% CI 1.05–4.64, p = .036). Among PLWH only, the misuse of opioids was associated with a higher frequency of neuropsychiatric symptoms such as depression and apathy. A higher risk for cognitive impairment was seen among people who used heroin and fentanyl. PLWH who misuse opioids may be at an increased risk for neuropathology, but elucidation of mechanisms for opioid-induced cognitive deficits is needed.