Try a new search

Format these results:

Searched for:

person:es29

Total Results:

88


Links between inflammation, mood, and physical function among older adults with HIV

Derry, Heather M; Johnston, Carrie D; Burchett, Chelsie O; Brennan-Ing, Mark; Karpiak, Stephen; Zhu, Yuan-Shan; Siegler, Eugenia L; Glesby, Marshall J
OBJECTIVES/OBJECTIVE:People living with HIV (PLWH) treated with antiretrovirals have lifespans similar to their HIV-negative peers. Yet, they experience elevated inflammation-related multi-morbidity. Drawing on biopsychosocial determinants of health may inform interventions, but these links are understudied in older PLWH. We investigated cross-sectional relationships between psychosocial factors (mood, loneliness, and stigma), inflammatory markers, and age-related health outcomes among 143 PLWH ages 54 to 78 years. METHODS:Participants provided blood samples for serum cytokines and C-reactive protein (CRP), completed surveys assessing psychosocial factors and health, and completed frailty assessments. Regression models tested relationships between key psychosocial, inflammation, and age-related health variables, adjusting for relevant sociodemographic and clinical factors. RESULTS:Participants with more depressive symptoms had higher composite cytokine levels than those with fewer depressive symptoms (ß=0.22, t(126)=2.71, p=0.008). Those with higher cytokine levels were more likely to be prefrail or frail (adjusted OR=1.72, 95% CI=1.01 to 2.93) and reported worse physical function (ß= -0.23, t(129)= -2.64, p=0.009) and more cognitive complaints (ß= -0.20, t(129)= -2.16, p=0.03) than those with lower cytokine levels. CRP was not significantly related to these outcomes; six-month fall history was not significantly related to inflammatory markers. DISCUSSION/CONCLUSIONS:Novel approaches are needed to manage comorbidities and maximize quality of life among older PLWH. Illustrating key expected biopsychosocial links, our findings highlight several factors (e.g., depressive symptoms, poorer physical function) that may share bidirectional relationships with chronic inflammation, a key factor driving morbidity. These links may be leveraged to modify factors that drive excessive health risk among older PLWH.
PMID: 33580236
ISSN: 1758-5368
CID: 4786252

Urine Cell-Free Mitochondrial DNA as a Marker of Weight Loss and Body Composition in Older Adults with HIV

Johnston, Carrie D; Siegler, Eugenia L; Rice, Michelle C; Derry, Heather M; Hootman, Katie C; Zhu, Yuan-Shan; Burchett, Chelsie O; Gupta, Samir K; Choi, Mary E; Glesby, Marshall J
BACKGROUND:Older adults with HIV (OAH) experience more comorbidities and geriatric syndromes than their HIV-negative peers, perhaps due to chronic inflammation. Cell-free mitochondrial DNA (cfmtDNA) released from cells undergoing necrosis-mediated cell death potentially acts as both a mediator and marker of inflammatory dysregulation. We hypothesized that urinary cfmtDNA would be associated with frailty, body composition and fall history in OAH. METHODS:OAH completed frailty testing, a psychosocial survey, body composition assessment, and measurement of urine cfmtDNA and urine albumin:creatinine in this cross-sectional study. Urine cfmtDNA was measured by qPCR and normalized to urinary creatinine. RESULTS:Across 150 participants, the mean age was 61 years (SD 6 years), half identified as Black, one-third were female, and 93% had HIV-1 viral load <200 copies/ml. Two-thirds met criteria for a pre-frail or frail state. Those with unintentional weight loss had higher urine cfmtDNA concentrations (p=0.03). Higher urine cfmtDNA was inversely associated with skeletal muscle index (SMI) (β =-0.19, p<0.01) and fat mass index (FMI) (β =-0.08, p=0.02) in separate multiple linear regression models adjusted for age, sex, and presence of moderate-severe albuminuria. CONCLUSIONS:In this cross-sectional study of OAH, higher levels of urine cfmtDNA were more common in subjects with less robust physical condition, including unintentional weight loss and less height-scaled body mass of fat and muscle. These findings suggest urine cfmtDNA may reflect pathophysiologic aging processes in OAH, predisposing them to geriatric syndromes. Longitudinal investigation of urine cfmtDNA as a biomarker of geriatric syndromes is warranted.
PMID: 34285158
ISSN: 1944-7884
CID: 4948182

Current Considerations for Clinical Management and Care of People with HIV: Findings from the 11th Annual International HIV and Aging Workshop

Kamkwalala, Asante R; Garg, Ankita; Roy, Upal; Matthews, Avery; Castillo-Mancilla, Jose; Lake, Jordan E; Sebastiani, Giada; Yin, Michael; Brown, Todd T; Kamer, Angela R; Jabs, Douglas A; Ellis, Ronald J; Boffito, Marta; Greene, Meredith; Schmalzle, Sarah; Siegler, Eugenia; Erlandson, Kristine M; Moore, David J
The number of people with HIV (PWH) aged 50 years or older continues to steadily increase. The convergence of age- and HIV-related complications in these individuals presents a challenge for both patients and clinicians alike. New findings continue to emerge, as numerous researchers evaluate the combined impact of these two factors on quality of life, physiological systems, and mental health in PWH. Since its first occurrence in 2009, the International Workshop on HIV and Aging has served as a multidisciplinary meeting to share basic biomedical data, clinical trial results, treatment strategies, and epidemiological recommendations, toward better understanding and outcomes among like-minded scientific professionals. In this article, we share a selection of key findings presented in plenary talks at the 11th Annual International Workshop on HIV and Aging, held virtually from September 30, 2020 to October 2, 2020. We will also address the future directions of HIV and aging research, to further assess how the aging process intersects with chronic HIV.
PMID: 34405689
ISSN: 1931-8405
CID: 5061052

Childhood sexual abuse history amplifies the link between disease burden and inflammation among older adults with HIV

Derry, Heather M; Johnston, Carrie D; Brennan-Ing, Mark; Karpiak, Stephen; Burchett, Chelsie O; Zhu, Yuan-Shan; Siegler, Eugenia L; Glesby, Marshall J
As they age, people living with HIV (PLWH) experience greater rates of inflammation-related health conditions compared to their HIV-negative peers. Because early life adversity can exaggerate proinflammatory effects of later physiological challenges, inflammation may be higher among PLWH with these combined risks, which could inform intervention approaches to mitigate multimorbidity. In this cross-sectional analysis, we investigated individual and combined effects of childhood sexual abuse (CSA) history and physiological burden (Veterans Aging Cohort Study Index scores) on serum cytokine and C-reactive protein (CRP) levels among PLWH. Participants (n ​= ​131; age 54 and older) were patients at an outpatient HIV clinic who completed a psychosocial survey and biomedical research visit as part of a larger study. 93% were virally suppressed, and 40% reported experiencing sexual abuse in childhood. Composite cytokine levels (summarizing IL-6, TNF-α, IFN-γ), CRP, and disease burden did not differ significantly between those who had a history of CSA and those who did not. Participants with greater disease burden had higher composite cytokine levels (r ​= ​0.29, p ​= ​0.001). The disease burden by CSA interaction effect was a significant predictor of composite cytokine levels (but not CRP), and remained significant after controlling for age, sex, race, BMI, anti-inflammatory medication use, selective serotonin reuptake inhibitor use, depressive symptoms, and smoking status (F(1, 114) ​= ​5.68, p ​= ​0.02). In follow-up simple slopes analysis, greater disease burden was associated with higher cytokine levels among those with CSA history (b ​= ​0.03, SE ​= ​0.008, p<0.001), but not among those without CSA history. Further, in the context of greater disease burden, individuals with a CSA history tended to have higher cytokine levels than those without a CSA history (b ​= ​0.38, SE ​= ​0.21, p ​= ​0.07). These data suggest that the physiological sequelae of childhood trauma may persist into older age among those with HIV. Specifically, links between physiological burden and inflammation were stronger among survivors of CSA in this study. The combined presence of CSA history and higher disease burden may signal a greater need for and potential benefit from interventions to reduce inflammation, an area for future work.
PMCID:8474623
PMID: 34589822
ISSN: 2666-3546
CID: 5139382

Aging-Related Concerns of People Living with HIV Referred for Geriatric Consultation

Siegler, Eugenia L; Moxley, Jerad H; Glesby, Marshall J
Purpose/UNASSIGNED:People with HIV (PWH) are living longer lives and likely experiencing accentuated aging. Comprehensive geriatric assessment (CGA) has been proposed as a way to identify and help meet each individual patient's needs. Patients and Methods/UNASSIGNED:We performed a retrospective review of the results of CGA in an HIV clinic in New York City. CGA included assessment of basic and instrumental activities of daily living, screens for depression, anxiety, frailty, cognition, and quality of life, along with general discussion of concerns and goals. We compared the group of PWH referred for CGA to those of comparable age who were not referred to determine the factors that were associated with referral. We carried out a descriptive analysis of those undergoing CGA, along with regression to determine factors associated with poorer PHQ-2 depression scores and higher VACS score. Results/UNASSIGNED:A total of 105 patients underwent full CGA during the study period. Mean age of referred patients was 66.5 years, ranging from 50 to 84 years (SD 7.99). More than 92% were virally suppressed. Compared with their non-referred counterparts over 50, referred patients were older and had more functional comorbidities like cerebrovascular disease, neuropathy, and urinary incontinence. More than half complained of fatigue, and 2/3 noted poor memory. Almost 60% were frail or prefrail. Ninety patients were asked about their goals, and the most commonly cited were related to health or finances; fifteen patients were unable to articulate any goals. Having fewer goals and noting weight loss or fatigue were predictive of higher scores on the PHQ-2 depression screen. Conclusion/UNASSIGNED:Although most older PWH undergoing CGA can manage their ADL, many have concerns and deficits beyond their comorbidities. CGA offers an important window into the psychosocial concerns and needs of older PWH.
PMCID:8096415
PMID: 33958897
ISSN: 1179-1373
CID: 4859002

Hyperactive Delirium Requires More Aggressive Management in Patients with COVID-19: Temporarily Rethinking "Low and Slow"

Sanders, Barton J; Bakar, Melissa; Mehta, Sonal; Reid, M Carrington; Siegler, Eugenia L; Abrams, Robert C; Adelman, Ronald D; Lachs, Mark S
Delirium is a common symptom in patients admitted to our hospital with COVID-19, and in cases of hyperactive delirium we have frequently observed behaviors that pose a significant risk of disease transmission to health care providers. Managing this symptom has emerged as an important challenge, as our local health care system has been strained by providers becoming sick or quarantined. Preventative and non-pharmacologic interventions remain critical for managing delirium in such patients, though occasionally pharmacologic treatment is required. When use of an antipsychotic medication is indicated, we recommend that providers consider foregoing the lowest common dose and instead start with the next incrementally higher dose to more quickly and reliably ensure the safety of both patients and providers. We do not recommend initiating prophylactic treatment or escalating doses in a manner that conflicts with currently accepted guidelines without carefully considering the risks and benefits.
PMCID:7239778
PMID: 32445904
ISSN: 1873-6513
CID: 4451392

Gait Speed Is Associated with Cognitive Function among Older Adults with HIV

Derry, Heather M; Johnston, Carrie D; Burchett, Chelsie O; Siegler, Eugenia L; Glesby, Marshall J
Objectives: To determine links between objectively and subjectively measured physical function and cognitive function among HIV-positive older adults, a growing yet understudied group with elevated risk for multimorbidity. Methods: At a biomedical research visit, 162 participants completed objective tests of gait speed (4-m walk), grip strength (dynamometer), and cognitive function (Montreal Cognitive Assessment, MoCA) and reported their well-being (Medical Outcomes Study-HIV survey). Results: Those with faster gait speed had better overall cognitive function than those with slower gait speed (b = 3.98, SE = 1.30, p = .003) in an adjusted regression model controlling for age, sex, race, height, preferred language, and assistive device use. Grip strength was not significantly associated with overall cognitive function. Self-rated cognitive function was weakly related to MoCA scores (r = .26) and gait speed (r = .14) but was strongly associated with emotional well-being (r = .53). Discussion: These observed, expected connections between physical and cognitive function could inform intervention strategies to mitigate age-related declines for older adults with HIV.
PMID: 32697615
ISSN: 1552-6887
CID: 4532402

Using Focus Group Feedback to Identify Patient-Centered Initiatives for Older Persons with HIV

Burchett, Chelsie O; Shen, Megan Johnson; Freeman, Ryann; Seidel, Liz; Karpiak, Stephen; Brennan-Ing, Mark; Siegler, Eugenia L
OBJECTIVES/OBJECTIVE:This study assessed how few community-based programs target older people living with HIV. METHODS:We conducted four focus groups comprised of people 50 and older with HIV (N = 32; gay/bisexual men, heterosexual men, women, and Spanish-speakers) to inform HIV program development by exploring the services in which participants were actively involved, along with the services they wanted to receive. RESULTS:Using inductive thematic qualitative analysis, four themes were identified pertaining to program development: (a) types of currently utilized HIV service organizations; (b) dissatisfaction with HIV programming and services; (c) participants' preferred programming, courses, groups, or activities; and (d) desire to serve as peer mentors. CONCLUSIONS:Results highlight the need for community-based organizations to address social engagement and isolation among older people living with HIV. CLINICAL IMPLICATIONS/CONCLUSIONS:These findings exemplify the need for programs to be specifically designed for OPH, and created with the primary goals of socialization and helping develop social support networks.
PMID: 32497461
ISSN: 1545-2301
CID: 4469312

Challenges and Responsibilities in Caring for the Most Vulnerable during the COVID-19 Pandemic [Letter]

Siegler, Eugenia L
PMID: 32311068
ISSN: 1532-5415
CID: 4396862

Elevated cardiac risk score by Atherosclerotic Cardiovascular Disease calculation is associated with albuminuria in older people living with HIV

Johnston, Carrie D; Ifeagwu, Kene-Chukwu C; Siegler, Eugenia L; Derry, Heather; Burchett, Chelsie O; Rice, Michelle C; Gupta, Samir K; Choi, Mary E; Glesby, Marshall J
: Globally, the proportion of older people living with HIV (PLWH) is growing and the burden of noncommunicable diseases, including cardiac and renal disease, is increasing. There are few studies of renal disease and cardiac risk in older PLWH. This study investigates the relationship between albuminuria and cardiac risk as estimated by the Atherosclerotic Cardiovascular Disease 10-year risk calculator. We report that albuminuria is associated with a higher Atherosclerotic Cardiovascular Disease risk score in both diabetic and nondiabetic older PLWH.
PMID: 32271253
ISSN: 1473-5571
CID: 4377612