Falls among middle-aged women in the Women’s Interagency HIV Study

To determine the frequency and risk factors for falls among middle-aged HIV+ and HIV− women in the Women's Interagency HIV Study (WIHS)

Primary esophageal lymphoma: a diagnostic challenge in acquired immunodeficiency syndrome--two case reports and review

Although extranodal presentation occurs in the majority of cases of acquired immunodeficiency syndrome-associated non-Hodgkin lymphoma, the esophagus is only rarely affected. We discuss two patients with acquired immunodeficiency syndrome who presented with dysphagia and weight loss, who were found to have human immunodeficiency virus-associated primary esophageal lymphoma. Both patients died within a few weeks of diagnosis, reflecting the poor prognosis associated with this malignancy. Primary esophageal lymphoma should be considered in the differential diagnosis in a human immunodeficiency virus-seropositive patient presenting with dysphagia

Impaired Cognition Predicts Falls Among Women With and Without HIV Infection

Objective: To determine whether domain-specific neurocognitive (NC) impairments predict falls in HIV+ compared with HIV- women. Design: Cross-sectional data analysis from 825 HIV+ and 392 HIV- women in the Women\u27s Interagency HIV Study with NC testing within 2 years before falls surveys. Methods: NC impairment (T score \u3c40) was assessed in 7 domains: executive function, psychomotor speed, attention, learning, memory, fluency, and fine motor function. For domains associated with any fall within 6 months in simple logistic regression (P \u3c 0.05), hierarchical regression models evaluated associations between NC impairment and odds of falling, adjusting for: (1) study site and HIV, (2) demographics, (3) comorbid conditions, (4) substance use/central nervous system active medications, and HIV-specific factors. Results: Median age was higher in HIV+ than HIV- women (51 vs. 48 yrs); prevalence of falls was similar (19% HIV+, 16% HIV-). Overall, executive function [OR (odds ratio) = 1.82, 95% CI (confidence interval): 1.21 to 2.74; P = 0.004], psychomotor speed (OR = 1.59, 95% CI: 1.05 to 2.42, P = 0.03), and fine motor (OR 1.70, 95% CI: 1.11 to 2.61, P = 0.02) impairments were associated with greater odds of falls in fully adjusted models. In fully adjusted models, associations of executive function, psychomotor speed, and fine motor were nonsignificant among HIV+ women; conversely, among HIV- women, associations with impaired executive and fine motor functions were strengthened and remained significant. Conclusions: Cognitive impairment was associated with falls among middle-aged HIV- but not HIV+ women. Additional studies should elucidate mechanisms by which domain-specific NC impairment impacts fall risk among older HIV+ and HIV- women and how different factors modify relationships between cognition and falls

Longitudinal Study of Falls among HIV-infected and Uninfected Women: The Role of Cognition

BACKGROUND: Although fracture rates are higher in HIV+ than HIV- women, whether HIV infection increases risk of falls is unclear. We determined the longitudinal occurrence and risk factors for falls in the Women\u27s Interagency HIV Study (WIHS), and explored associations with cognitive complaints. METHODS: Recent (prior 6 months) self-reported falls were collected in 1,816 (1,250 HIV+; 566 HIV-) women over 24 months. Generalized estimating equation models using stepwise selection determined odds of any fall (versus none). RESULTS: HIV+ women were older than HIV- women (median 49 versus 47 years; P=0.0004), more likely to report neuropathy (20% versus 16%; P=0.023), and had greater central nervous system (CNS) medication use. At least one fall was reported in 41% HIV+ versus 42% HIV- women, including \u3e/=2 falls in 25% HIV+ and 24% HIV- (overall P=0.30). Cognitive complaints were associated with falls among HIV+ (odds ratio [OR] 2.38; 95% CI 1.83, 3.09) and HIV- women (OR 3.43; 95% CI 2.37, 4.97); in adjusted models, cognitive complaints remained significant only in HIV- women (adjusted [aOR] 2.26; 95% CI 1.46, 3.48). Factors associated with any fall in adjusted analyses included: depressive symptoms and neuropathy (both HIV+ and HIV-); age, marijuana use, multiple CNS medications, and HCV infection (HIV+ only); and cognitive complaints, quality of life, hypertension and obesity (HIV- only). CONCLUSIONS: Middle-aged HIV+ and HIV- women had similar fall rates. Among HIV+ women, factors affecting cognition such as age, depressive symptoms, marijuana use and multiple CNS medications were important predictors of falls, however, cognitive complaints were not

Falls among middle-aged women in the Women’s Interagency HIV Study

OBJECTIVE: To determine the frequency and risk factors for falls among middle-aged HIV+ and HIV− women in the Women's Interagency HIV Study (WIHS). METHODS: We quantified self-report of any and multiple (≥2 falls) in the prior 6 months among 1,412 HIV+ and 650 HIV− women with mean age 48 years. Logistic regression was used to evaluate associations of demographics, behavioral factors, comorbid conditions, and medications with odds of any fall (vs. none) and multiple falls (vs. ≤1 fall). RESULTS: At least one fall was reported in 263 HIV+ (19%) vs. 119 HIV− (18%) women, and ≥2 falls reported in 133 HIV+ (9%) vs. 65 HIV− (10%) women. HIV infection was not associated with falls in multivariate analyses. Factors independently associated with any fall included age (aOR 1.71, 95% CI:1.17-2.49 age 50-59 vs. <39y; aOR 2.26, 95% CI:1.38-3.71 age ≥60 vs. <39), current marijuana use (aOR 2.19, 95% CI:1.53-3.13) depressive symptoms (aOR 1.57, 95% CI:1.21-2.05 for CES-D ≥16), subjective cognitive complaints (aOR 2.19, 95% CI:1.56-3.08), neuropathy (aOR 1.59, 95% CI:1.19-2.13), obesity (aOR 1.39, 95% CI:1.08-1.80), number of CNS active agents (aOR 2.98, 95% CI:1.90-4.68 for ≥3 agents vs. 0) and WIHS site. Factors associated with ≥2 falls included age, marijuana use, number of CNS active agents, subjective cognitive complaints, depressive symptoms, neuropathy, and study site. CONCLUSIONS: Falls were associated with factors affecting cognition, but not HIV status in this large cohort of women. Longitudinal studies are needed to determine the incidence and consequences of falls by HIV status as women age

African Mitochondrial DNA Haplogroup L2 Is Associated With Slower Decline of β-cell Function and Lower Incidence of Diabetes Mellitus in Non-Hispanic, Black Women Living With Human Immunodeficiency Virus

Susceptibility to metabolic diseases may be influenced by mitochondrial genetic variability among people living with human immunodeficiency virus (HIV; PLWH), but remains unexplored in populations with African ancestry. We investigated the association between mitochondrial DNA (mtDNA) haplogroups and the homeostatic model assessments of β-cell function (HOMA-B) and insulin resistance (HOMA-IR), as well as incident diabetes mellitus (DM), among Black women living with or at risk for HIV. Women without DM who had fasting glucose (FG) and insulin (FI) data for ≥2 visits were included. Haplogroups were inferred from genotyping data using HaploGrep. HOMA-B and HOMA-IR were calculated using FG and FI data. Incident DM was defined by a combination of FG ≥ 126 mg/dL, the use of DM medication, a DM diagnosis, or hemoglobin A1c ≥ 6.5%. We compared HOMA-B, HOMA-IR, and incident DM by haplogroups and assessed the associations between HOMA-B and HOMA-IR and DM by haplogroup. Of 1288 women (933 living with HIV and 355 living without HIV), PLWH had higher initial HOMA-B and HOMA-IR than people living without HIV. PLWH with haplogroup L2 had a slower decline in HOMA-B per year (Pinteraction = .02) and a lower risk of incident DM (hazard ratio [HR], 0.51; 95% confidence interval [CI], .32-.82) than PLWH with other haplogroups after adjustments for age, body mass index, combination antiretroviral therapy use, CD4 cell counts, and HIV RNA. The impact of HOMA-IR on incident DM was less significant in those with haplogroup L2, compared to non-L2 (HR, 1.28 [95% CI, .70-2.38] vs 4.13 [95% CI, 3.28-5.22], respectively; Pinteraction < .01), among PLWH. Mitochondrial genetic variation is associated with β-cell functions and incident DM in non-Hispanic, Black women with HIV and alters the relationship between insulin resistance and DM

Cognitive trajectories over 4 years among HIV-infected women with optimal viral suppression

To determine whether persistent viral suppression alters cognitive trajectories among HIV-infected (HIV+) women on combination antiretroviral therapy (cART) by investigating performance longitudinally in uninfected (HIV-) and 3 groups of HIV+ women: those with consistent viral suppression after continuous cART use (VS), those without consistent virologic suppression despite continuous cART use (NVS), and those without consistent virologic suppression after intermittent cART use (Int NVS). Two hundred thirty-nine VS, 220 NVS, 172 Int NVS, and 301 HIV- women from the Women's Interagency HIV Study (WIHS) completed neuropsychological testing every 2 years for 3 visits between 2009 and 2013. Mixed-effects regressions were used to examine group differences on continuous T scores and categorical measures of impairment (T score <40). On global function, VS women demonstrated lower scores and were more likely to score in the impaired range than HIV- women ( = 0.01). These differences persisted over time (group × time, > 0.39). VS women demonstrated lower learning and memory scores than HIV- women ( < 0.05) and lower attention/working memory and fluency scores than HIV- and NVS women ( < 0.05). Group differences in scores persisted over time. Categorically, VS women were more likely to be impaired on attention/working memory and executive function than HIV- women ( < 0.05). On motor skills, VS and NVS women showed a greater decline and were more likely to be impaired than HIV- women ( < 0.05). Cognitive difficulties remain among HIV+ women despite persistent viral suppression. In some instances, VS women are worse than NVS women, reinforcing the need for novel adjunctive therapies to attenuate cognitive problems

Patterns and Predictors of Cognitive Function Among Virally Suppressed Women With HIV

Cognitive impairment remains frequent and heterogeneous in presentation and severity among virally suppressed (VS) women with HIV (WWH). We identified cognitive profiles among 929 VS-WWH and 717 HIV-uninfected women from 11 Women's Interagency HIV Study sites at their first neuropsychological (NP) test battery completion comprised of: Hopkins Verbal Learning Test-Revised, Trail Making, Symbol Digit Modalities, Grooved Pegboard, Stroop, Letter/Animal Fluency, and Letter-Number Sequencing. Using 17 NP performance metrics (T-scores), we used Kohonen self-organizing maps to identify patterns of high-dimensional data by mapping participants to similar nodes based on T-scores and clustering those nodes. Among VS-WWH, nine clusters were identified (entropy = 0.990) with four having average T-scores ≥45 for all metrics and thus combined into an “unimpaired” profile ( n = 311). Impaired profiles consisted of weaknesses in: (1) sequencing ( Profile-1 ; n = 129), (2) speed ( Profile-2 ; n = 144), (3) learning + recognition ( Profile-3 ; n = 137), (4) learning + memory ( Profile-4 ; n = 86), and (5) learning + processing speed + attention + executive function ( Profile-5 ; n = 122). Sociodemographic, behavioral, and clinical variables differentiated profile membership using Random Forest models. The top 10 variables distinguishing the combined impaired vs. unimpaired profiles were: clinic site, age, education, race, illicit substance use, current and nadir CD4 count, duration of effective antiretrovirals, and protease inhibitor use. Additional variables differentiating each impaired from unimpaired profile included: depression, stress-symptoms, income ( Profile-1 ); depression, employment ( Profile 2 ); depression, integrase inhibitor (INSTI) use ( Profile-3 ); employment, INSTI use, income, atazanavir use, non-ART medications with anticholinergic properties ( Profile-4 ); and marijuana use ( Profile-5 ). Findings highlight consideration of NP profile heterogeneity and potential modifiable factors contributing to impaired profiles

Prevalence of stroke survival in rural communities living in northern Peru. S1 Data

BACKGROUND AND PURPOSE: Stroke is the leading cause of neurological impairment in the South American Andean region. However, the epidemiology of stroke in the region has been poorly characterized. METHODS: We conducted a staged three-phase population-based study applying a validated eight-question neurological survey in 80 rural villages in Tumbes, northern Peru, then confirmed presence or absence of stroke through a neurologist's examination to estimate the prevalence of stroke. RESULTS: Our survey covered 90% of the population (22,278/24,854 individuals, mean age 30±21.28, 48.45% females), and prevalence of stroke was 7.05/1,000 inhabitants. After direct standardization to WHO's world standard population, adjusted prevalence of stroke was 6.94/1,000 inhabitants. Participants aged ≥85 years had higher stroke prevalence (>50/1000 inhabitants) compared to other stratified ages, and some unusual cases of stroke were found among individuals aged 25-34 years. The lowest age reported for a first stroke event was 16.8 years. High blood pressure (aPR 4.2 [2.7-6.4], p>0.001), and sedentary lifestyle (aPR 1.6 [1.0-2.6], p = 0.045) were more prevalent in people with stroke. CONCLUSIONS: The age-standardized prevalence of stroke in this rural coastal Peruvian population was slightly higher than previously reported in studies from surrounding rural South American settings, but lower than in rural African and Asian regions. The death rate from stroke was much higher than in industrialized and middle-income countries