An Investigation of HIV Treatments and Body Mass Index (BMI) on HIV-Infected Patients’ Cardio-Metabolic Profiles and Quality of Life

Thesis (Ph.D.)--University of Rochester. School of Medicine & Dentistry. Dept. of Public Health Sciences, 2016.Background: Within developed nations, the HIV-infected population has seen increases in life expectancy and non-AIDS related causes of morbidity including excess body mass index (BMI). There is some support for associations between highly active antiretroviral therapy (HAART) and short-term BMI change, but long-term associations remain unclear. It is also possible for BMI to interact with HAART regimens to further increase the risk for diabetes, hypertension, and dyslipidemia. Excess BMI could further negatively affect characteristics including quality of life (QoL) similar to the general population. Objectives: Assess whether long-term HAART use impacts cardiometabolic risk, including but not limited to excess BMI, and does the presence of excess BMI further impact the development of other cardiometabolic risk factors (CVD risk factors) and QoL among HIV-infected patients. Methods: Participants were identified via an HIV registry (n=733) or directly recruited (n=153) at Strong Memorial Hospital in Rochester, NY. Longitudinal analyses assessed trends in CVDRF markers, the relationships between HAART and BMI, and the presence of an interaction on changes in diabetes, hypertension, and dyslipidemia markers. The relationship between excess BMI and QoL was examined with linear regression and accounted for body image. Results: Since 1996, the average BMI has been consistently above the normal range (18.5-24.9). Though BMI changes were significant during short and long-term treatment periods, the difference in this change was not significant after controlling for patient demographics and health. The interaction between BMI and HAART regimens was also significantly associated with changes in blood pressure and cholesterol levels. Additionally, elevated BMI was significantly associated with lower QoL prior to accounting for body image. All findings showed variations across racial/ethnic groups. Conclusion: HAART regimens do not appear to be the driving factor of BMI change during the first two years of treatment. The interactions between BMI and HAART regimens on changes in markers for hypertension and dyslipidemia fail to yield clinically significant results. In addition, the QoL assessment identified a complex relationship between QoL, BMI, and body image, which should be accounted for during the development of weight loss/management interventions for the HIV-infected population

Childhood and Adulthood Stress Exposures in Relation to Late-Life Cognitive Function: A Life Course Perspective

Thesis (Ph.D.)--University of Rochester. School of Medicine & Dentistry. Dept. of Public Health Sciences, 2017.Background: Chronic stress exposures are believed to cause alterations in neurobiological systems as wells as structural atrophy in specific brain regions. Because of this dysregulation, stress exposures are associated with a wide range of health outcomes, in particular, cognitive function. Principles of life course epidemiology are needed to understand how stress exposures in different developmental periods are interrelated and how these processes may influence late-life cognitive function. Methods: Data from the publicly available 2008, 2010, and 2012 Health and Retirement Study (HRS) were used to address Specific Aims 1 and 2. Participants who received the psychosocial lifetime questionnaire that included items on stress exposures will be identified. The HRS measured global cognitive function using the Telephone Interview for Cognitive Status (TICS). Bivariate analyses will compare mean TICS scores and the distributions of potential confounders across stress exposures in childhood and adulthood. Subsequently, multivariable analyses including mixed-effects linear regression models and marginal structural equation models for mediation will be used to assess the relationships between childhood and adulthood stress exposures and late-life cognitive function. Specific Aim 3 imputed domain specific cognitive function scores for HRS participants applying data fusion that will use the National Health and Nutrition Examination Survey III as the donor file. Linear regression models evaluated the association between childhood stress exposures and late-life domain specific cognitive function and whether these relationships are modified by social support. Results: A total of 3,433 participants met inclusion criteria. Both childhood and adulthood stress exposures were associated with late-life cognitive function. Only the childhood (and not the adulthood or total score) was associated with late-life cognitive function. Death of a child mediated the relationship between the childhood cumulative score and late-life cognitive function. Conclusions: Childhood stress exposures, in particular they accumulate, have the most detrimental effect on late-life cognitive function. Future endeavors may apply results from this dissertation to investigate biological mechanisms that may explain etiologic pathways that link stress exposures to cognitive disorders such as dementia and Alzheimer’s diseas