TY - JOUR
T1 - Associations between At-Risk Alcohol Use, Substance Use, and Smoking with Lipohypertrophy and Lipoatrophy among Patients Living with HIV
AU - Noorhasan, Marisela
AU - Drozd, Daniel R.
AU - Grunfeld, Carl
AU - Merrill, Joseph O.
AU - Burkholder, Greer A.
AU - Mugavero, Michael J.
AU - Willig, James H.
AU - Willig, Amanda L.
AU - Cropsey, Karen L.
AU - Mayer, Kenneth H.
AU - Blashill, Aaron
AU - Mimiaga, Matthew
AU - McCaul, Mary E.
AU - Hutton, Heidi
AU - Chander, Geetanjali
AU - Mathews, William C.
AU - Napravnik, Sonia
AU - Eron, Joseph J.
AU - Christopoulos, Katerina
AU - Fredericksen, Rob J.
AU - Nance, Robin M.
AU - Delaney, Joseph Chris
AU - Crane, Paul K.
AU - Saag, Michael S.
AU - Kitahata, Mari M.
AU - Crane, Heidi M.
N1 - Funding Information:
This work was supported by the National Institutes of Alcohol Abuse and Alcoholism (NIAAA) at the National Institutes of Health [U24AA020801, U01AA020793 and U01AA020802]. Additional support came from the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health [CNICS R24 AI067039, UW CFAR NIAID Grant P30 AI027757; UNC CFAR grant P30 AI50410, and UAB CFAR grant P30 AI027767].
Publisher Copyright:
© 2017, Mary Ann Liebert, Inc.
PY - 2017/6
Y1 - 2017/6
N2 - To examine associations between lipohypertrophy and lipoatrophy and illicit drug use, smoking, and at-risk alcohol use among a large diverse cohort of persons living with HIV (PLWH) in clinical care. 7,931 PLWH at six sites across the United States completed 21,279 clinical assessments, including lipohypertrophy and lipoatrophy, drug/alcohol use, physical activity level, and smoking. Lipohypertrophy and lipoatrophy were measured using the FRAM body morphology instrument and associations were assessed with generalized estimating equations. Lipohypertrophy (33% mild, 4% moderate-to-severe) and lipoatrophy (20% mild, 3% moderate-to-severe) were common. Older age, male sex, and higher current CD4 count were associated with more severe lipohypertrophy (p values <.001-.03). Prior methamphetamine or marijuana use, and prior and current cocaine use, were associated with more severe lipohypertrophy (p values <.001-.009). Older age, detectable viral load, and low current CD4 cell counts were associated with more severe lipoatrophy (p values <.001-.003). In addition, current smoking and marijuana and opiate use were associated with more severe lipoatrophy (p values <.001-.03). Patients with very low physical activity levels had more severe lipohypertrophy and also more severe lipoatrophy than those with all other activity levels (p values <.001). For example, the lipohypertrophy score of those reporting high levels of physical activity was on average 1.6 points lower than those reporting very low levels of physical activity (-1.6, 95% CI:-1.8 to-1.4, p <.001). We found a high prevalence of lipohypertrophy and lipoatrophy among a nationally distributed cohort of PLWH. While low levels of physical activity were associated with both lipohypertrophy and lipoatrophy, associations with substance use and other clinical characteristics differed between lipohypertrophy and lipoatrophy. These results support the conclusion that lipohypertrophy and lipoatrophy are distinct, and highlight differential associations with specific illicit drug use.
AB - To examine associations between lipohypertrophy and lipoatrophy and illicit drug use, smoking, and at-risk alcohol use among a large diverse cohort of persons living with HIV (PLWH) in clinical care. 7,931 PLWH at six sites across the United States completed 21,279 clinical assessments, including lipohypertrophy and lipoatrophy, drug/alcohol use, physical activity level, and smoking. Lipohypertrophy and lipoatrophy were measured using the FRAM body morphology instrument and associations were assessed with generalized estimating equations. Lipohypertrophy (33% mild, 4% moderate-to-severe) and lipoatrophy (20% mild, 3% moderate-to-severe) were common. Older age, male sex, and higher current CD4 count were associated with more severe lipohypertrophy (p values <.001-.03). Prior methamphetamine or marijuana use, and prior and current cocaine use, were associated with more severe lipohypertrophy (p values <.001-.009). Older age, detectable viral load, and low current CD4 cell counts were associated with more severe lipoatrophy (p values <.001-.003). In addition, current smoking and marijuana and opiate use were associated with more severe lipoatrophy (p values <.001-.03). Patients with very low physical activity levels had more severe lipohypertrophy and also more severe lipoatrophy than those with all other activity levels (p values <.001). For example, the lipohypertrophy score of those reporting high levels of physical activity was on average 1.6 points lower than those reporting very low levels of physical activity (-1.6, 95% CI:-1.8 to-1.4, p <.001). We found a high prevalence of lipohypertrophy and lipoatrophy among a nationally distributed cohort of PLWH. While low levels of physical activity were associated with both lipohypertrophy and lipoatrophy, associations with substance use and other clinical characteristics differed between lipohypertrophy and lipoatrophy. These results support the conclusion that lipohypertrophy and lipoatrophy are distinct, and highlight differential associations with specific illicit drug use.
KW - Lipoatrophy
KW - alcohol use
KW - lipohypertrophy
KW - physical activity
KW - substance use
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UR - http://www.scopus.com/inward/citedby.url?scp=85020432840&partnerID=8YFLogxK
U2 - 10.1089/aid.2015.0357
DO - 10.1089/aid.2015.0357
M3 - Article
C2 - 28092168
AN - SCOPUS:85020432840
SN - 0889-2229
VL - 33
SP - 534
EP - 545
JO - AIDS Research and Human Retroviruses
JF - AIDS Research and Human Retroviruses
IS - 6
ER -