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Biomedical subjects

Anita Palepu

Publications and source records attributed to Anita Palepu.

At least 19 recordsLinked to original sources
PubMed2006

Aboriginal status is a prognostic factor for mortality among antiretroviral naïve HIV-positive individuals first initiating HAART.

BACKGROUND: Although the impact of Aboriginal status on HIV incidence, HIV disease progression, and access to treatment has been investigated previously, little is known about the relationship between Aboriginal ethnicity and outcomes associated with highly active antiretroviral therapy (HAART). We undertook the present analysis to determine if Aboriginal and non-Aboriginal persons respond differently to HAART by measuring HIV plasma viral load response, CD4 cell response and time to all-cause mortality. METHODS: A population-based analysis of a cohort of antiretroviral therapy naïve HIV-positive Aboriginal men and women 18 years or older in British Columbia, Canada. Participants were antiretroviral therapy naïve, initiated triple combination therapy between August 1, 1996 and September 30, 1999. Participants had to complete a baseline questionnaire as well as have at least two follow-up CD4 and HIV plasma viral load measures. The primary endpoints were CD4 and HIV plasma viral load response and all cause mortality. Cox proportional hazards models were used to determine the association between Aboriginal status and CD4 cell response, HIV plasma viral load response and all-cause mortality while controlling for several confounder variables. RESULTS: A total of 622 participants met the study criteria. Aboriginal status was significantly associated with no AIDS diagnosis at baseline (p = 0.0296), having protease inhibitor in the first therapy (p = 0.0209), lower baseline HIV plasma viral load (p < 0.001), less experienced HIV physicians (P = 0.0133), history of IDU (p < 0.001), not completing high school (p = 0.0046), and an income of less than $10,000 per year (p = 0.0115). Cox proportional hazards models controlling for clinical characteristics found that Aboriginal status had an increased hazard of mortality (HR = 3.12, 95% CI: 1.77-5.48) but did not with HIV plasma viral load response (HR = 1.15, 95% CI: 0.89-1.48) or CD4 cell response (HR = 0.95, 95% CI: 0.73-1.23). CONCLUSION: Our study demonstrates that HIV-infected Aboriginal persons accessing HAART had similar HIV treatment response as non-Aboriginal persons but have a shorter survival. This study highlights the need for continued research on medical interventions and behavioural changes among HIV-infected Aboriginal and other marginalized populations.

Journal Article↗
PubMed2006

Antiretroviral adherence and HIV treatment outcomes among HIV/HCV co-infected injection drug users: the role of methadone maintenance therapy.

OBJECTIVE: We examined the association of methadone maintenance therapy (MMT) with highly active antiretroviral therapy (HAART) adherence and HIV treatment outcomes among a cohort of HIV/HCV co-infected injection drug users (IDUs). METHODS: We obtained demographic, drug use, and addiction care history from the Vancouver Injection Drug User Study (VIDUS), which is an open cohort study of IDUs. The questionnaires were longitudinally linked to the British Columbia HIV/AIDS Drug Treatment Program to obtain HAART adherence and HIV treatment outcome data. There were 278 VIDUS participants who accessed HAART from August 1, 1996 to November 24, 2003. We constructed longitudinal logistic models using generalized estimating equations to examine the independent associations between methadone maintenance therapy and the following outcomes: HAART adherence; plasma HIV-1 RNA suppression; and CD4 cell rise of 100cells/mm(3). RESULTS: Among participants who reported at least weekly heroin use, MMT was independently associated with lower odds of subsequent weekly heroin use during the follow-up period (adjusted odds ratio; 95% confidence interval [AOR; 95% CI]: 0.24; 0.14-0.40). We also found that MMT was positively associated with adherence (AOR 1.52; 95% CI 1.16-2.00), HIV-1 RNA suppression (AOR 1.34; 95% CI 1.00-1.79), and CD4 cell count rise (AOR 1.58; 95% CI 1.26-1.99). CONCLUSIONS: Among HIV/HCV co-infected IDUs on HAART, enrollment in MMT was associated with reduced heroin use, and improved adherence, HIV-1 RNA suppression and CD4 cell count response. Integrating opiate addiction care and HIV care may provide improved health outcomes for this vulnerable population and should be further explored.

Adult↗
PubMed2005

Slower uptake of HIV antiretroviral therapy among Aboriginal injection drug users.

OBJECTIVES: We examined the time to antiretroviral therapy (ART) use among antiretroviral naïve HIV infected injection drug users participating in a prospective cohort study in Vancouver, Canada. METHODS: Time to the initiation of ART was evaluated using Kaplan-Meier methods and Cox proportional hazards regression. The cohort was stratified based on Aboriginal and non-Aboriginal (primarily Caucasian) ethnicity. RESULTS: Between May 1996 and May 2003, 312 HIV-infected individuals were enrolled into the cohort. At 24 months after enrollment, the rate of ART use was 29.2% among Aboriginal participants and was 53.7% among non-Aboriginal participants (log-rank P=0.023), and lower uptake of ART persisted in multivariate analyses (relative hazard = 0.37 [95% CI: 0.15-0.93]; P = 0.035). CONCLUSIONS: These findings demonstrate lower uptake of HIV/AIDS care among Aboriginal injection drug users and demonstrate the need for interventions to improve access to HIV care among indigenous populations.

Anti-Retroviral Agents↗
PubMed2005

Injection Drug Use Quality of Life scale (IDUQOL): a validation study.

BACKGROUND: Existing measures of injection drug users' quality of life have focused primarily on health and health-related factors. Clearly, however, quality of life among injection drug users is impacted by a range of unique cultural, socioeconomic, medical, and geographic factors that must also be considered in any measure. The Injection Drug User Quality of Life (IDUQOL) scale was designed to capture the unique and individual circumstances that determine quality of life among injection drug users. The overall purpose of the present study was to examine the validity of inferences made from the IDUQOL by examining the (a) dimensionality, (b) reliability of scores, (c) criterion-related validity evidence, and (d) both convergent and discriminant validity evidence. METHODS: An exploratory factor analysis using principal axis factoring in SPSS 12.0 was conducted to determine whether the use of a total score on the IDUQOL was advisable. Reliability of scores from the IDUQOL was obtained using internal consistency and one-week test-retest reliability estimates. Criterion-related validity evidence was gathered using variables such as stability of housing, sex trade involvement, high-risk injection behaviours, involvement in treatment programs, emergency treatment or overdose over the previous six months, hospitalization and emergency treatment over the subsequent six month period post data collection. Convergent and discriminant validity evidence was gathered using measures of life satisfaction, self-esteem, and social desirability. RESULTS: The sample consisted of 241 injection drug users ranging in age from 19 to 61 years. Factor analysis supports the use of a total score. Both internal consistency (alpha = .88) and one-week test-retest reliability (r = .78) for IDUQOL total scores were good. Criterion-related, convergent, and discriminant validity evidence supports the interpretation of IDUQOL total scores as measuring a construct consistent with quality of life. CONCLUSION: The findings from this study provide initial evidence to support the use of the IDUQOL total score. The results of the study also suggest the IDUQOL could be further strengthened with additional attention to how some IDUQOL domains are described and satisfaction is measured.

Adult↗
PubMed2005

Impact of accessing methadone on the time to initiating HIV treatment among antiretroviral-naive HIV-infected injection drug users.

We examined the impact of methadone maintenance therapy (MMT) on subsequent antiretroviral therapy (ART) use in a prospective cohort of injection drug users. At 24 months after enrollment, the rate of ART use was 69.7% among those who were on MMT at baseline and 44.4% among those not on MMT (log-rank P = 0.001). In a Cox model, the use of MMT was independently associated with an elevated rate of ART use.

Anti-Retroviral Agents↗
PubMed2005

Substance abuse treatment and risk behaviors among HIV-infected persons with alcohol problems.

We examined the association of substance abuse treatment with sexual and drug use risk behaviors among 349 HIV-infected persons with a history of alcohol problems using a standardized questionnaire regarding sexual and drug use risk behaviors, demographics, substance use, and use of substance abuse treatment. We defined substance abuse treatment services as any of the following in the past 6 months: 12 weeks in a half-way house or residential facility; 12 visits to a substance abuse counselor or mental health professional; day treatment for at least 30 days; or participation in any methadone maintenance program. Our three outcome variables of high-risk behavior were the Risk Assessment Battery sex-risk and drug-risk scores and high-risk sex behavior which included any of the following: inconsistent condom use; having more than one sexual partner; and exchanging sex for money or drugs. Although sexual risk was high (51%) in our HIV-infected cohort, engagement in substance abuse treatment was not independently associated with lower frequency of any of our measures of high- risk behaviors. Although the opportunity exists to address HIV risk behaviors in the setting of substance abuse treatment, effective institutionalization of this challenging behavior change effort has not yet been realized.

Adult↗
PubMed2005

Sociodemographic disparities in access to addiction treatment among a cohort of Vancouver injection drug users.

Vancouver's explosive HIV epidemic among injection drug users (IDUs) has received international attention due to the presence of a large needle exchange program. The role of addiction treatment has not been evaluated in this setting. We evaluated factors associated with use of addiction treatment among a prospective cohort of Vancouver IDUs. Addiction treatment was negatively associated with Aboriginal ethnicity and unstable housing, both of which have been associated with HIV infection in previous studies. These findings demonstrate low levels of addiction treatment among Vancouver IDUs and suggest that programs may need to be targeted towards specific populations with poor access.

Adult↗
PubMed2005

Substance abuse treatment and hospitalization among a cohort of HIV-infected individuals with alcohol problems.

BACKGROUND: We examined the association of substance abuse treatment services on hospitalization among participants in the HIV-Alcohol Longitudinal Cohort (HIV-ALC) study of HIV-infected individuals with a history of alcohol problems. METHODS: A standardized questionnaire that inquired about demographics, substance use, use of substance abuse treatment services, and hospitalization was administered to 349 HIV-ALC participants. We defined substance abuse treatment services as any of the following in the past 6 months: 12 weeks in a half-way house or residential facility, 12 visits to a substance abuse counselor or mental health professional, or participation in any methadone maintenance program. RESULTS: Almost one third of this cohort were hospitalized in the past 6 months. Substance abuse treatment was not significantly associated with hospitalization [adjusted odds ratio (AOR) 1.0; 95% confidence interval (CI) 0.7-1.5), whereas homelessness (AOR 2.3; 95% CI 1.5-3.6), injection drug use (AOR 1.7; 95% CI 1.0-2.7), severity of alcohol dependence (AOR 1.02; 95% CI 1.00-1.05), CD4 cell count (AOR 0.999; 95% CI 0.998-1.00), and HIV RNA (AOR 1.1; 95% CI 1.0-1.2) were independently associated with increased odds of hospitalization over time. CONCLUSIONS: Engagement in substance abuse treatment was not associated with a decrease in hospital use by HIV-infected individuals with a history of alcohol problems. The period of substance abuse treatment may present an opportunity to address health care utilization patterns of HIV-infected individuals.

Adult↗
PubMed2004

Special considerations in the initiation and management of antiretroviral therapy in individuals coinfected with HIV and hepatitis C.

BACKGROUND: Although hepatitis C (HCV) treatment efficacy has improved in recent years, the majority of HIV/HCV-coinfected individuals may not enjoy the full benefits of these treatments and appropriate HIV management is crucial. Evidence is accumulating regarding the impact of HIV/HCV coinfection on the response to, and safety and tolerability of, antiretroviral therapy (ART) in this population. METHODS: Computerized, English-language literature searches of MEDLINE and PubMed databases (January 1985 to May 2004) for studies of HIV and HCV infection in humans to examine critically (a) the impact of HCV on the HIV virologic and immunologic response to ART; (b) the safety and tolerability of ART in coinfected individuals; and (c) the relationship between immune suppression and immune restoration on hepatic injury. RESULTS: Three key messages emerged regarding the use of ART in HIV/HCV-coinfected individuals: (a) although HCV appeared to have no impact on HIV virologic response, the data are equivocal regarding immunologic response; (b) morbidities associated with HCV infection, such as insulin resistance, diabetes, mitochondrial dysfunction, and liver inflammation, are also associated toxicities of ART, and (c) both immune suppression and restoration can contribute to the onset and acceleration of HCV-related liver disease. CONCLUSIONS: The CD4 cell count threshold for initiating ART in HIV/HCV-coinfected patients may be higher because of the impact of immune suppression and restoration on the onset of HCV-associated liver disease and the possibility of a blunted immune response to ART at lower CD4 cell counts. Further, overlapping morbidity between HCV-related mitochondrial and metabolic disease manifestations and ART toxicities warrant careful attention by clinicians.

AIDS-Related Opportunistic Infections↗
PubMed2004

Factors influencing quality of life in patients with active tuberculosis.

BACKGROUND: With effective treatment strategies, the focus of tuberculosis (TB) management has shifted from the prevention of mortality to the avoidance of morbidity. As such, there should be an increased focus on quality of life (QoL) experienced by individuals being treated for TB. The objective of our study was to identify areas of QoL that are affected by active TB using focus groups and individual interviews. METHODS: English, Cantonese, and Punjabi-speaking subjects with active TB who were receiving treatment were eligible for recruitment into the study. Gender-based focus group sessions were conducted for the inner city participants but individual interviews were conducted for those who came to the main TB clinic or were hospitalized. Facilitators used open-ended questions and participants were asked to discuss their experiences of being diagnosed with tuberculosis, what impact it had on their lives, issues around adherence to anti-TB medications and information pertaining to their experience with side effects to these medications. All data were audio-recorded, transcribed verbatim, and analyzed using constant comparative analysis. RESULTS: 39 patients with active TB participated. The mean age was 46.2 years (SD 18.4) and 62% were male. Most were Canadian-born being either Caucasian or Aboriginal. Four themes emerged from the focus groups and interviews. The first describes issues related to the diagnosis of tuberculosis and sub-themes were identified as 'symptoms', 'health care provision', and 'emotional impact'. The second theme discusses TB medication factors and the sub-themes identified were 'adverse effects', 'ease of administration', and 'adherence'. The third theme describes social support and functioning issues for the individuals with TB. The fourth theme describes health behavior issues for the individuals with TB and the identified sub-themes were "behavior modification" and "TB knowledge." CONCLUSION: Despite the ability to cure TB, there remains a significant impact on QOL. Since much attention is spent on preventative or curative mechanisms, the impact of this condition on QoL is often not considered. Attention to the issues experienced by patients being treated for TB may optimize adherence and treatment success.

Adult↗
PubMed2004

HIV-positive injection drug users who leave the hospital against medical advice: the mitigating role of methadone and social support.

BACKGROUND: Leaving the hospital against medical advice has been associated with increased morbidity and readmission. Factors associated with the risk of leaving against medical advice among HIV/AIDS patients or injection drug users have not been examined in detail. OBJECTIVES: To examine the clinical and social factors associated with leaving against medical advice (AMA) from a specialized HIV/AIDS ward among patients who reported a history of injection drug use. METHODS: All patients with a history of injection drug use admitted to the HIV/AIDS ward at St. Paul's Hospital, Vancouver, British Columbia (the largest specialized HIV/AIDS hospital ward in Canada) between April 1997 and October 2000 were reviewed retrospectively. A multivariate logistic regression model utilizing a generalized estimating equation algorithm identified factors associated with leaving the hospital AMA. RESULTS: Of the 1056 hospital admissions to the HIV/AIDS ward by patients with a history of injection drug use, 263 (24.9%) resulted in leaving the hospital AMA. Independent positive predictors of leaving AMA included recent injection drug use (adjusted odds ratio [AOR] = 2.08, 95% confidence interval [CI]: 1.41-3.07) and aboriginal ethnicity (AOR = 1.55, 95% CI: 1.05-2.28). Discharge AMA was also more likely to occur on weekends (AOR = 2.27, 95% CI: 1.49-3.48) and on days when social assistance payments were issued (AOR = 2.95, 95% CI: 1.70-5.10). Factors that independently reduced the odds of hospital discharge AMA included in-hospital methadone use (AOR = 0.49, 95% CI: 0.32-0.76), social support (AOR = 0.33, 95% CI: 0.21-0.51), and older age (per 10-year increment, AOR = 0.56, 95% CI: 0.43-0.73). CONCLUSIONS: Among HIV-positive patients with a history of injection drug use, the odds of leaving the hospital AMA were reduced for subjects who received inpatient methadone treatment, were of older age, or had social supports. Addiction treatment and interventions that enhance social supports in marginalized populations at risk for hospital discharge AMA should be further explored.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Alcohol consumption and antiretroviral adherence among HIV-infected persons with alcohol problems.

BACKGROUND: Alcohol abuse has been associated with poor adherence to highly active antiretroviral therapy (HAART). We examined the relative importance of varying levels of alcohol consumption on adherence in HIV-infected patients with a history of alcohol problems. METHODS: We surveyed 349 HIV-infected persons with a history of alcohol problems at 6-month intervals. Of these subjects, 267 were taking HAART at one or more time periods during the 30-month follow-up period. Interviews assessed recent adherence to HAART and past month alcohol consumption, defined as "none", "moderate", and "at risk". We investigated the relationship between adherence to HAART and alcohol consumption at baseline and at each subsequent 6-month follow-up interval using multivariable longitudinal regression models, while controlling for potential confounders. RESULTS: Among the 267 HIV-infected persons with a history of alcohol problems who were receiving HAART, alcohol consumption was the most significant predictor of adherence (p < 0.0001), with better adherence being associated with recent abstinence from alcohol, compared with at-risk level usage (odds ratio = 3.6, 95% confidence interval = 2.1-6.2) or compared with moderate usage (odds ratio = 3.0, 95% confidence interval = 2.0-4.5). CONCLUSIONS: Any alcohol use among HIV-infected persons with a history of alcohol problems is associated with worse HAART adherence. Addressing alcohol use in HIV-infected persons may improve antiretroviral adherence and ultimately clinical outcomes.

Adult↗
PubMed2004

Uptake and adherence to highly active antiretroviral therapy among HIV-infected people with alcohol and other substance use problems: the impact of substance abuse treatment.

AIM: We examined the association of substance abuse treatment with uptake, adherence and virological response to highly active antiretroviral therapy (HAART) among HIV-infected people with a history of alcohol problems. DESIGN: Prospective cohort study. METHODS: A standardized questionnaire was administered to 349 HIV-infected participants with a history of alcohol problems regarding demographics, substance use, use of substance abuse treatment and uptake of and adherence to HAART. These subjects were followed every 6 months for up to seven occasions. We defined substance abuse treatment services as any of the following in the past 6 months: 12 weeks in a half-way house or residential facility; 12 visits to a substance abuse counselor or mental health professional; or participation in any methadone maintenance program. Our outcome variables were uptake of antiretroviral therapy, 30-day self-reported adherence and HIV viral load suppression. FINDINGS: At baseline, 59% (205/349) of subjects were receiving HAART. Engagement in substance abuse treatment was independently associated with receiving antiretroviral therapy (adjusted OR; 95% CI: 1.70; 1.03-2.83). Substance abuse treatment was not associated with 30-day adherence or HIV viral load suppression. More depressive symptoms (0.48; 0.32-0.78) and use of drugs or alcohol in the previous 30 days (0.17; 0.11-0.28) were associated with worse 30-day adherence. HIV viral load suppression was positively associated with higher doses of antiretroviral medication (1.29; 1.15-1.45) and older age (1.04; 1.00-1.07) and negatively associated with use of drugs or alcohol in the previous 30 days (0.51; 0.33-0.78). CONCLUSION: Substance abuse treatment was associated with receipt of HAART; however, it was not associated with adherence or HIV viral load suppression. Substance abuse treatment programs may provide an opportunity for HIV-infected people with alcohol or drug problems to openly address issues of HIV care including enhancing adherence to HAART.

Adult↗
PubMed2004

Psychosocial determinants of adherence to highly active antiretroviral therapy among injection drug users in Vancouver.

BACKGROUND: Sub-optimal adherence to highly active antiretroviral therapy (HAART) among injection drug users (IDUs) is a significant concern. As such, there is an urgent need to identify psychosocial determinants of adherence that can be incorporated into interventions designed to promote optimal adherence. OBJECTIVE: To identify psychosocial determinants of adherence to HAART, as well as self-reported reasons for missing doses of HAART among HIV-infected IDUs. METHODS: We developed an eight-item adherence self-efficacy scale comprised of two sub-scales: adherence efficacy and self-regulatory efficacy. We examined correlates between adherence self-efficacy, outcome expectations, socio-demographic characteristics, drug use and risk behaviours, social support and HAART adherence among 108 HIV-infected participants in the Vancouver Injection Drug Users Study (VIDUS). Pharmacy-based adherence to HAART was obtained through a confidential record linkage to the province of British Columbia's HIV/AIDS Drug Treatment Program. Participants were defined as adherent if they picked-up 95% of their HAART prescriptions. Participants were also asked to indicate reasons for missing doses of HAART. Logistic regression was used to identify the factors independently associated with adherence to HAART. RESULTS: Seventy-one (66%) HIV-infected IDUs were less than 95% adherent. Forgetting was the most frequently cited reason (27%) for missing doses of HAART. Factors independently associated with adherence to HAART included adherence efficacy expectations [OR=1.8 (95% CI: 1.0-3.1); P=0.039] and negative outcome expectations [OR=0.8 (95% CI: 0.7-0.9); P=0.027]. CONCLUSIONS: We found low rates of adherence to HAART among IDUs. Psychological constructs derived from self-efficacy theory are highly germane to the understanding of adherence behaviour, and interventions that address these constructs should be developed and tested among HIV-infected drug users.

Adult↗
PubMed2004

Initiating highly active antiretroviral therapy and continuity of HIV care: the impact of incarceration and prison release on adherence and HIV treatment outcomes.

OBJECTIVE: To examine the effect of incarceration within 12 months of initiating highly active antiretroviral therapy (HAART) on non-adherence and HIV-1 RNA suppression. METHODS: We compared the adherence and virological outcomes among participants in a population-based HIV/AIDS Drug Treatment Program in British Columbia, Canada, by history of incarceration in a provincial prison. Participants who were HIV-infected, naive to HAART and who were prescribed treatment between 1 July 1997 and 1 March 2002 were eligible for this study. Logistic regression was used to determine the factors associated with non-adherence and Cox proportional hazards modelling was used to determine the factors associated with HIV-1 RNA suppression adjusting for age, gender, history of drug use, baseline HIV-1 RNA, baseline CD4 cell count, type of antiretroviral regimen [two nucleosides + protease inhibitor (PI) vs two nucleosides + non-nucleoside reverse transcriptase inhibitor (NNRTI)], physician's HIV-related experience for each subject and adherence as measured by pharmacy refill compliance. RESULTS: There were 1746 subjects (101 incarcerated/1645 non-incarcerated) who started antiretroviral therapy between 1 July 1997 and 1 March 2002. Of those incarcerated, 50 initiated HAART while in prison and 27 subjects were released but returned to prison in the follow-up period. Subjects received antiretroviral therapy while incarcerated for a median number of 4 months [interquartile range (IQR): 2-10]. Multiple logistic regression results showed that a history of incarceration within 12 months of initiating HAART independently increased the odds of non-adherence [adjusted odds ratio (AOR): 2.40; 95% confidence interval (95% CI): 1.54-3.75]. A history of injected drug use was also associated with non-adherence (AOR: 1.49; 95% CI: 1.17-1.90). The following factors were negatively associated with non-adherence: older age (AOR: 0.81; 95% CI: 0.72-0.91), male sex (AOR: 0.50; 95% CI: 0.38-0.65) and higher physician HIV-related experience (AOR: 0.97; 95% CI: 0.96-0.98). In addition, a history of incarceration within 12 months of initiating HAART reduced the odds of achieving HIV-1 RNA suppression [adjusted hazards ratio (AHR): 0.68; 95% CI: 0.51-0.89]. Other factors negatively associated with viral suppression included a history of drug injection (AHR: 0.79; 95% CI: 0.69-0.91), two nucleosides + PI vs two nucleosides + NNRTI (AHR: 0.77; 95% CI: 0.69-0.87), higher baseline HIV-1 RNA (AHR: 0.66; 95% CI: 0.62-0.70). Higher adherence was positively associated with viral suppression (AHR: 1.38; 95% CI: 1.34-1.42). Among the 101 subjects who were incarcerated in the first year of starting HAART, the time spent in jail was positively associated with HIV-1 RNA suppression (HR: 1.06; 95% CI: 1.02-1.10). CONCLUSION: HIV-infected subjects with a history of incarceration within 12 months of initiating HAART have higher odds of non-adherence and, consequently, lower probability of achieving HIV-1 RNA suppression. The longer their sentence, however, the higher the probability of virological suppression. The British Columbian provincial prison system provided a structured setting for HAART but subjects are unable to continue this level of adherence upon release. Strategies to ensure continuation of HIV/AIDS care for HIV-infected individuals leaving the criminal justice system must be a public health priority.

Adult↗