A-078 Examining the Neuropsychological Effects of Opioid Use in the Aging Population of People Living with HIV

Abstract Objective People living with HIV (PLWH) exhibit accelerated and premature cognitive aging in comparison to age-matched, seronegative controls. Although opioid use is elevated among PLWH, literature regarding the neurocognitive effects of opioid use across the lifespan of PLWH is limited. This cross-sectional study examines the neurocognitive effects of opioid use across the mid-older adult lifespan of PLWH. Methods One-hundred fifty-two PLWH (72% Latinx; 71% Male; Mdn(IQR) Age = 47(43, 51) years; M Education = 133 years) completed comprehensive neurocognitive, neuromedical, quality of education (Wide Range Achievement Test- 4 [WRAT-4]), psychiatric/substance-use (Composite International Diagnostic Interview [CIDI]), and urine toxicology assessments. Opioid users were defined by DSM diagnostics for lifetime opioid use disorder. A series of LSR tested the interactive effects of age and opioid use across seven neurocognitive domains. Results After controlling for covariates (e.g., CD4 cell count; WRAT-4; comorbid substance use), a least-squares regression demonstrated significant interactive effects between age and opioid use upon verbal fluency, such that older opioid users exhibited greater verbal fluency scores (F [11] = 4.28, p < .0001, R2 = .33). No significant interactions were detected in other domains. Discussion The moderate observed effect sizes indicate a positive relationship between older age and lifetime opioid use upon verbal fluency among PLWH. These findings may be representative of a selective survival bias among opioid users within this population. Nonetheless, verbal fluency could serve as a marker of greater survivability among PLWH with opioid use histories. Future directions should examine this interaction longitudinally and evaluate differences in the severity/duration of opioid use.

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A-087 Socioeconomic Status Moderates the Neurocognitive Implications of Major Depressive Disorder Among People Living with HIV

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa068.087 ◽

2020 ◽

Vol 35 (6) ◽

pp. 880-880

Author(s):

Fidaleo K ◽

Byrd D ◽

Rivera Mindt M ◽

Aghvinian M ◽

Savin M ◽

...

Keyword(s):

Socioeconomic Status ◽

Working Memory ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Interactive Effects ◽

People Living With Hiv ◽

Least Squares Regression ◽

Major Depressive ◽

Urine Toxicology ◽

Living With Hiv

Abstract Objective While low socioeconomic status (SES) and major depression are highly co-occurring among people living with HIV (PLWH), there is a paucity of literature examining how these factors may influence neurocognition. Thus, this study aimed to identify the interactive effects of SES and lifetime major depressive disorder (MDD) within a diverse sample of PLWH. Method A sample of 119 PLWH (47 with lifetime MDD, 72 without MDD) underwent a comprehensive neurocognitive battery, neuromedical examination, psychiatric/substance use evaluations, and urine toxicology. The Hollingshead Four Factor Index of Social Status served as a proxy for SES. A lifetime MDD diagnosis was determined using the Composite International Diagnostic Interview. After adjusting for covariates (i.e., illicit opiate positive urine toxicology), a series of least squares regression analyses tested the interactive effects of SES and MDD upon seven demographically-adjusted neurocognitive domain T-scores. Results The interactive effects of SES and MDD were significantly associated with the domain of attention/working memory (F(4, 109) = 4.34, p = .003, R2 = .14), such that PLWH and lifetime MDD performed better as SES increased (β = .38, SE = .12, p = .002). SES did not influence performance in attention/working memory among those without MDD. Significant interactive effects were not observed in other domains. Conclusions Those with higher SES and lifetime MDD performed better across tests of attention/working memory, suggesting heightened access to various resources associated with higher SES could be providing neurocognitive benefits to PLWH and MDD. Future directions should examine this interaction longitudinally and evaluate differences in the severity/duration of MDD.

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Substance Use Among Older People Living With HIV: Challenges for Health Care Providers

Frontiers in Public Health ◽

10.3389/fpubh.2019.00094 ◽

2019 ◽

Vol 7 ◽

Cited By ~ 9

Author(s):

Sherry Deren ◽

Tara Cortes ◽

Victoria Vaughan Dickson ◽

Vincent Guilamo-Ramos ◽

Benjamin H. Han ◽

...

Keyword(s):

Health Care ◽

Substance Use ◽

Older People ◽

Health Care Providers ◽

People Living With Hiv ◽

Care Providers ◽

Living With Hiv

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Substance use, Unlike Dolutegravir, is Associated with Mood Symptoms in People Living with HIV

AIDS and Behavior ◽

10.1007/s10461-021-03272-2 ◽

2021 ◽

Author(s):

Lisa Van de Wijer ◽

Wouter van der Heijden ◽

Mike van Verseveld ◽

Mihai Netea ◽

Quirijn de Mast ◽

...

Keyword(s):

Substance Use ◽

Term Treatment ◽

Assessment Tools ◽

Self Report ◽

People Living With Hiv ◽

Antiretroviral Drug ◽

Long Term Treatment ◽

Living With Hiv ◽

Neuropsychiatric Side Effects

AbstractContradictory data have been reported concerning neuropsychiatric side effects of the first-line antiretroviral drug dolutegravir, which may be partly due to lack of control groups or psychiatric assessment tools. Using validated self-report questionnaires, we compared mood and anxiety (DASS-42), impulsivity (BIS-11), and substance use (MATE-Q) between dolutegravir-treated and dolutegravir-naive people living with HIV (PLHIV). We analyzed 194, mostly male, PLHIV on long-term treatment of whom 82/194 (42.3%) used dolutegravir for a median (IQR) of 280 (258) days. Overall, 51/194 (26.3%) participants reported DASS-42 scores above the normal cut-off, 27/194 (13.5%) were classified as highly impulsive, and 58/194 (29.9%) regularly used recreational drugs. Regular substance use was positively associated with depression (p = 0.012) and stress scores (p = 0.045). We observed no differences between dolutegravir-treated and dolutegravir-naive PLHIV. Our data show that depressed and anxious moods and impulsivity are common in PLHIV and associate with substance use and not with dolutegravir use.

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The essential role of physiotherapists in providing rehabilitation services to people living with HIV in South Africa

South African Journal of Physiotherapy ◽

10.4102/sajp.v69i1.368 ◽

2013 ◽

Vol 69 (1) ◽

Cited By ~ 6

Author(s):

S. Cobbing ◽

V. Chetty ◽

J. Hanass-Hancock ◽

J. Jelsma ◽

H. Myezwa ◽

...

Keyword(s):

South Africa ◽

South African ◽

Policy Formulation ◽

People Living With Hiv ◽

Highly Active ◽

Hiv Epidemic ◽

Wide Range ◽

Living With Hiv ◽

Education Courses

Despite increased access to highly active anti-retroviral therapy (HAART) in South Africa, there remains a high risk of people living with HIV (PLHIV) developing a wide range of disabilities. Physiotherapists are trained to rehabilitate individuals with the disabilities related to HIV. Not only can South African physiotherapists play a significant role in improving the lives of PLHIV, but by responding proactively to the HIV epidemic they can reinforce the relevance and value of the profession in this country at a time when many newly qualified therapists are unable to secure employment. This paper offers recommendations that may help to fuel this response. These ideas include enhancing HIV curricula at a tertiary level, designing and attending continuing education courses on HIV and researching Southern African rehabilitation interventions for HIV at all levels of practice. furthermore, it is vital that physiotherapists are at the forefront of directing multi-disciplinary responses to the rehabilitation of PLHIV in order to influence stakeholders who are responsible for health policy formulation. it is hoped that this paper stimulates discussion and further ideas amongst physiotherapists and other health professionals in order to improve the quality and access to care available to PLHIV in South Africa.

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Natural Language Processing of Clinical Notes to Identify Mental Illness and Substance Use Among People Living with HIV: Retrospective Cohort Study (Preprint)

10.2196/preprints.23456 ◽

2020 ◽

Author(s):

Jessica P Ridgway ◽

Arno Uvin ◽

Jessica Schmitt ◽

Tomasz Oliwa ◽

Ellen Almirol ◽

...

Keyword(s):

Mental Illness ◽

Substance Use ◽

Natural Language Processing ◽

Language Processing ◽

Predictive Value ◽

Hiv Care ◽

People Living With Hiv ◽

Clinical Notes ◽

Unstructured Text ◽

Living With Hiv

BACKGROUND Mental illness and substance use are prevalent among people living with HIV and often lead to poor health outcomes. Electronic medical record (EMR) data are increasingly being utilized for HIV-related clinical research and care, but mental illness and substance use are often underdocumented in structured EMR fields. Natural language processing (NLP) of unstructured text of clinical notes in the EMR may more accurately identify mental illness and substance use among people living with HIV than structured EMR fields alone. OBJECTIVE The aim of this study was to utilize NLP of clinical notes to detect mental illness and substance use among people living with HIV and to determine how often these factors are documented in structured EMR fields. METHODS We collected both structured EMR data (diagnosis codes, social history, Problem List) as well as the unstructured text of clinical HIV care notes for adults living with HIV. We developed NLP algorithms to identify words and phrases associated with mental illness and substance use in the clinical notes. The algorithms were validated based on chart review. We compared numbers of patients with documentation of mental illness or substance use identified by structured EMR fields with those identified by the NLP algorithms. RESULTS The NLP algorithm for detecting mental illness had a positive predictive value (PPV) of 98% and a negative predictive value (NPV) of 98%. The NLP algorithm for detecting substance use had a PPV of 92% and an NPV of 98%. The NLP algorithm for mental illness identified 54.0% (420/778) of patients as having documentation of mental illness in the text of clinical notes. Among the patients with mental illness detected by NLP, 58.6% (246/420) had documentation of mental illness in at least one structured EMR field. Sixty-three patients had documentation of mental illness in structured EMR fields that was not detected by NLP of clinical notes. The NLP algorithm for substance use detected substance use in the text of clinical notes in 18.1% (141/778) of patients. Among patients with substance use detected by NLP, 73.8% (104/141) had documentation of substance use in at least one structured EMR field. Seventy-six patients had documentation of substance use in structured EMR fields that was not detected by NLP of clinical notes. CONCLUSIONS Among patients in an urban HIV care clinic, NLP of clinical notes identified high rates of mental illness and substance use that were often not documented in structured EMR fields. This finding has important implications for epidemiologic research and clinical care for people living with HIV.

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Prescription Opioid Use is Associated with Virologic Failure in People Living with HIV

AIDS and Behavior ◽

10.1007/s10461-017-1842-2 ◽

2017 ◽

Vol 22 (4) ◽

pp. 1323-1328 ◽

Cited By ~ 7

Author(s):

John Flores ◽

Yuanyuan Liang ◽

Norma S. Ketchum ◽

Barbara J. Turner ◽

Delia Bullock ◽

...

Keyword(s):

Virologic Failure ◽

Prescription Opioid ◽

People Living With Hiv ◽

Opioid Use ◽

Living With Hiv ◽

Prescription Opioid Use

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Potential Influences of the COVID-19 Pandemic on Drug Use and HIV Care Among People Living with HIV and Substance Use Disorders: Experience from a Pilot mHealth Intervention

AIDS and Behavior ◽

10.1007/s10461-020-02976-1 ◽

2020 ◽

Author(s):

Karli R. Hochstatter ◽

Wajiha Z. Akhtar ◽

Sarah Dietz ◽

Klaren Pe-Romashko ◽

David H. Gustafson ◽

...

Keyword(s):

Substance Use ◽

Drug Use ◽

Substance Use Disorders ◽

Hiv Care ◽

People Living With Hiv ◽

Mhealth Intervention ◽

Living With Hiv

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1318. Examining Multimorbidity as a Moderating Effect on the Relationship Between Substance Use and Viral Suppression Among People Living with HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1181 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S476-S476

Author(s):

Timothy N Crawford ◽

Alice Thornton

Keyword(s):

Substance Use ◽

Viral Load ◽

Chronic Conditions ◽

Viral Suppression ◽

Moderating Effect ◽

Multiple Chronic Conditions ◽

People Living With Hiv ◽

Substance Users ◽

Living With Hiv ◽

The Relationship

Abstract Background Substance use and multimorbidity (≥2 chronic conditions) are highly prevalent among people living with HIV (PLWH). However, their impact on achieving viral suppression are not well understood. The purpose of this study was to examine the relationship between substance use and viral suppression and the potential moderating effect of multimorbidity. Methods A retrospective cohort study was conducted at an academic Ryan White Funded clinic in central Kentucky. Individuals were included if they were diagnosed with HIV, seeking care between 2010 and 2014, had at least one year of follow-up, and did not have a chronic condition at the time they entered care. The primary independent variable was substance use which included alcohol, nicotine use, and/or illicit drug use; the moderating variable was multimorbidity (0, 1, ≥2 chronic conditions); and outcome was viral suppression (≤50 copies/mL). A logistic regression model was developed to examine the interaction between substance use and multimorbidity on achieving viral load suppression. The model controlled for medication adherence, insurance status, age, and CD4+ cell counts. Results A total of 941 individuals were included in the study, with an average age of 43.9 ± 11.7 years. Approximately 67.0% reported substance use; 54% had ≥2 chronic conditions diagnosed. The three most prevalent conditions diagnosed were hypertension (34.6%), mental health (33.9%), and diabetes (21.5%) Approximately 61.0% of substance users had ≥2 conditions. Those with viral suppression were less likely to be substance users, but were more likely to have ≥2 conditions compared with their counterparts. There was a significant interaction between substance use and multimorbidity (P = 0.037). Stratified by multimorbidity, substance use was associated with unsuppressed viral loads; among those with ≥2 chronic conditions substance users had lower odds of achieving viral suppression compared with nonusers (OR=0.24; 95% CI=0.10–0.55). Conclusion Substance use may impede the opportunity for PLWH to achieve viral suppression, increasing their risk of transmission and progression of disease. More research is needed to understand the role substance use plays in impacting viral load, specifically among those with multiple chronic conditions. Disclosures All authors: No reported disclosures.

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