title: Measures of Physical and Mental Independence Among HIV-Positive Individuals: Impact of Substance Use Disorder.
abstract: With the transition of HIV infection from an acute to a chronic disease after the introduction of antiretroviral medications, there has been an increased focus on long-term neurocognitive and other functional outcomes of HIV patients. Thus, we assessed factors, particularly history of a substance use disorder, associated with time to loss of measures of physical or mental independence among HIV-positive individuals. Data were obtained from the National NeuroAIDS Tissue Consortium. Kaplan-Meier and Cox proportional hazards regression analyses were used to estimate the time since HIV diagnosis to loss of independence, and to identify associated risk factors. HIV-positive participants who self-identified as physically (n = 698) or mentally (n = 616) independent on selected activities of daily living at baseline were eligible for analyses. A history of substance use disorder was associated with a higher hazard of loss of both physical and mental independence [adjusted hazard ratio (HR) = 1.71, 95% confidence interval (95% CI): 1.07-2.78; adjusted HR = 1.67, 95% CI: 1.11-2.52, respectively]. After adjusting for substance use disorder and other covariates, older age at diagnosis and female gender were associated with higher hazards of loss of both physical and mental independence, non-white participants had higher hazards of loss of physical independence, whereas participants with an abnormal neurocognitive diagnosis and fewer years of education had higher hazards of loss of mental independence. In summary, history of substance use disorder was associated with loss of measures of both physical and mental independence. The nature of this link and the means to prevent such loss of independence need further investigation.
authors.affiliation: 1 College of Medicine, University of Nebraska Medical Center , Omaha, Nebraska.
authors.forename: Bianca
authors.initials: B
authors.lastname: Christensen
authors.affiliation: 2 Department of Epidemiology, College of Public Health, University of Nebraska Medical Center , Omaha, Nebraska.
authors.forename: Zijian
authors.initials: Z
authors.lastname: Qin
authors.affiliation: 3 Department of Neurology, Icahn School of Medicine at Mount Sinai , New York, New York.
authors.forename: Desiree A
authors.initials: DA
authors.lastname: Byrd
authors.affiliation: 4 Department of Biostatistics, College of Public Health, University of Nebraska Medical Center , Omaha, Nebraska.
authors.forename: Fang
authors.initials: F
authors.lastname: Yu
authors.affiliation: 3 Department of Neurology, Icahn School of Medicine at Mount Sinai , New York, New York.
authors.forename: Susan
authors.initials: S
authors.lastname: Morgello
authors.affiliation: 5 Department of Pathology, University of Texas Medical Branch , Galveston, Texas.|6 Department of Neuroscience and Cell Biology, University of Texas Medical Branch , Galveston, Texas.
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Gelman
authors.affiliation: 7 Department of Psychiatry, School of Medicine, University of California San Diego , San Diego, California.
authors.forename: David J
authors.initials: DJ
authors.lastname: Moore
authors.affiliation: 7 Department of Psychiatry, School of Medicine, University of California San Diego , San Diego, California.
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
authors.affiliation: 8 Department of Neurology, School of Medicine, University of California Los Angeles , Los Angeles, California.
authors.forename: Elyse J
authors.initials: EJ
authors.lastname: Singer
authors.affiliation: 9 Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center , Omaha, Nebraska.
authors.forename: Howard S
authors.initials: HS
authors.lastname: Fox
authors.affiliation: 2 Department of Epidemiology, College of Public Health, University of Nebraska Medical Center , Omaha, Nebraska.
authors.forename: Lorena
authors.initials: L
authors.lastname: Baccaglini
mesh_terms: D000203:Activities of Daily Living; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D019965:Neurocognitive Disorders / Q000139:chemically induced*; D016016:Proportional Hazards Models; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000523:psychology*
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; activities of daily living; mental independence; neuroAIDS; physical independence; substance abuse