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Men who have sex with men, chronic health, HIV, aging
The purpose of this study was to evaluate the association between HIV status and the presence of chronic health conditions among gay and bisexual men (gbMSM). Most existing on this topic studies fail to account for behavioral factors—such as smoking and alcohol consumption—or focus on the general population without attention to the unique circumstances of gbMSM.
Sexually active gbMSM, aged >16 years, were recruited using respondent-driven sampling (RDS) between February 2012 and February 2015. HIV serology confirmed the HIV status. Chronic health conditions were classified into one of six broader categories (i.e., cardiovascular, cancer, gastrointestinal, respiratory, mental health, and other). Logistic regression models tested whether HIV status was associated with any of the six categories. All these models used an interaction term between HIV status and age, and adjusted for race/ethnicity, annual income, body mass index, daily smoking, and “risky drinking”.
Overall, 223 HIV-positive gbMSM and 551 HIV-negative gbMSM reported histories of cardiovascular disease (16.1%), cancer (5.1%), gastrointestinal illness (7.2%), respiratory problems (16.1%), mental health conditions (49.2%), and “other” co-/morbidities (13.1%). Compared with older HIV-negative gbMSM, those with HIV were more likely to report cardiovascular (aOR=1.15, 95% CI:1.07, 1.24) and respiratory (aOR = 1.08, 95% CI:1.02, 1.14) disease. There were no differences by HIV status for other co-/morbidities.
Findings support the need for increased resources focused on aging, HIV, and cardiovascular and respiratory health among gbMSM aging with HIV.
2. Eyawo O, Franco-Villalobos C, Hull MW, Nohpal A, Samji H, Sereda P, et al. Changes in mortality rates and causes of death in a population-based cohort of persons living with and without HIV from 1996 to 2012. BMC Infect Dis 2017;17. https://doi. org/10.1186/s12879-017-2254-7.
3. Trickey A, May MT, Vehreschild J-J, Obel N, Gill MJ, Crane HM, et al. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: A collaborative analysis of cohort studies. The Lancet HIV 2017;0. https://doi.org/10.1016/ S2352-3018(17)30066-8.
4. Crum NF, Riffenburgh RH, Wegner S, Agan BK, Tasker SA, Spooner KM, et al. Comparisons of causes of death and mortality rates among HIV-infected persons: Analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acquir Immune Defic Syndr 2006;41:194–200.
5. Palella FJ, Baker RK, Moorman AC, Chmiel JS, Wood KC, Brooks JT, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr 2006;43:27–34. https:// doi.org/10.1097/01.qai.0000233310.90484.16.
6. Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV Infection as a Chronic Disease. Lancet 2013;382:1525– 33. https://doi.org/10.1016/S0140-6736(13)61809-7.
7. Rodriguez-Penney AT, Iudicello JE, Riggs PK, Doyle K, Ellis RJ, Letendre SL, et al. Co-morbidities in persons infected with HIV: increased burden with older age and negative effects on health-related quality of life. AIDS Patient Care STDS 2013;27:5– 16. https://doi.org/10.1089/apc.2012.0329.
8. Vance DE, Mugavero M, Willig J, Raper JL, Saag MS. Aging With HIV: A Cross-Sectional Study of Comorbidity Prevalence and Clinical Characteristics Across Decades of Life. Journal of the Association of Nurses in AIDS Care 2011;22:17– 25. https://doi.org/10.1016/j.jana.2010.04.002.
9. Langebeek N, Kooij KW, Wit FW, Stolte IG, Sprangers M a. G, Reiss P, et al. Impact of co-morbidity and aging on health-related quality of life in HIV-positive and HIV-negative individuals. AIDS 2017. https://doi.org/10.1097/QAD.0000000000001511.
10. Sabin CA, Reiss P. Epidemiology of ageing with HIV: What can we learn from cohorts? AIDS 2017;31 Suppl 2:S121–8. https://doi.org/10.1097/ QAD.0000000000001374.
11. Centers for Disease Control and Prevention. HIV Infection Risk, Prevention, and Testing Behaviors among Men Who Have Sex with Men National HIV Behavioral Surveillance 20 U.S. Cities, 2014. Atlanta: Centers for Disease Control and Prevention; 2016.
12. Public Health Agency of Canada. Summary: Estimates of HIV incidence, prevalence and proportion undiagnosed in Canada, 2014. 2015.
13. Coker TR, Austin SB, Schuster MA. The health and health care of lesbian, gay, and bisexual adolescents. Annu Rev Public Health 2010;31:457–77. https://doi. org/10.1146/annurev.publhealth.012809.103636.
14. Caceres BA, Brody A, Luscombe RE, Primiano JE, Marusca P, Sitts EM, et al. A Systematic Review of Cardiovascular Disease in Sexual Minorities. Am J Public Health 2017;107:e13–21. https://doi. org/10.2105/AJPH.2016.303630.
15. Quinn GP, Sanchez JA, Sutton SK, Vadaparampil ST, Nguyen GT, Green BL, et al. Cancer and Lesbian, Gay, Bisexual, Transgender/Transsexual, and Queer/Questioning Populations (LGBTQ). CA Cancer J Clin 2015;65:384–400. https://doi. org/10.3322/caac.21288.
16. Sandfort TGM, Bakker F, Schellevis FG, Vanwesenbeeck I. Sexual Orientation and Mental and Physical Health Status: Findings From a Dutch Population Survey. Am J Public Health 2006;96:1119–25. https://doi.org/10.2105/ AJPH.2004.058891.
17. Brennan DJ, Ross LE, Dobinson C, Velhuizen S, Steele LS. Men’s Sexual Orientation and Health in Canada. Can J Public Health 2010;101:255–8. https://doi.org/10.17269/cjph.101.2361.
18. Pakula B, Shoveller JA. Sexual orientation and self-reported mood disorder diagnosis among Canadian adults. BMC Public Health 2013;13:209. https://doi.org/10.1186/1471-2458-13-209.
19. Meyer I. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull 2003;129:674–97. https://doi. org/10.1037/0033-2909.129.5.674.
20. Singer M, Bulled N, Ostrach B, Mendenhall E. Syndemics and the biosocial conception of health. Lancet 2017;389:941–50. https://doi.org/10.1016/ S0140-6736(17)30003-X.
21. Doyle DM, Molix L. Minority stress and inflammatory mediators: covering moderates associations between perceived discrimination and salivary interleukin-6 in gay men. J Behav Med 2016;39:782– 92. https://doi.org/10.1007/s10865-016-9784-0.
22. Juster R-P, Hatzenbuehler ML, Mendrek A, Pfaus JG, Smith NG, Johnson PJ, et al. Sexual orientation modulates endocrine stress reactivity. Biol Psychiatry 2015;77:668–76. https://doi.org/10.1016/j. biopsych.2014.08.013.
23. Lick DJ, Durso LE, Johnson KL. Minority Stress and Physical Health Among Sexual Minorities. Perspectives on Psychological Science 2013;8:521– 48. https://doi.org/10.1177/1745691613497965.
24. Theuninck AC, Lake N, Gibson S. HIV-related post-traumatic stress disorder: investigating the traumatic events. AIDS Patient Care STDS 2010;24:485–91. https://doi.org/10.1089/apc.2009.0231.
25. Mahajan AP, Sayles JN, Patel VA, Remien RH, Ortiz D, Szekeres G, et al. Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward. AIDS 2008;22:S67–79. https://doi.org/10.1097/01.aids.0000327438.13291.62.
26. Deeks SG, Tracy R, Douek DC. Systemic Effects of Inflammation on Health during Chronic HIV Infection. Immunity 2013;39:633–45. https://doi. org/10.1016/j.immuni.2013.10.001.
27. Hima Bindu A, Naga Anusha P. Adverse Effects of Highly Active Anti-Retroviral Therapy (HAART). Journal of Antivirals & Antiretrovirals 2011;3. https://doi.org/10.4172/jaa.1000037.
28. Astuti N, Maggiolo F. Single-Tablet Regimens in HIV Therapy. Infect Dis Ther 2014;3:1–17. https:// doi.org/10.1007/s40121-014-0024-z.
29. Hughes CA, Robinson L, Tseng A, MacArthur RD. New antiretroviral drugs: A review of the efficacy, safety, pharmacokinetics, and resistance profile of tipranavir, darunavir, etravirine, rilpivirine, maraviroc, and raltegravir. Expert Opin Pharmacother 2009;10:2445–66. https://doi. org/10.1517/14656560903176446.
30. Lohse N. The road to success. Long-term prognosis for persons living with HIV in Denmark - time trends and risk factors. Dan Med J 2016;63.
31. Schouten J, Wit FW, Stolte IG, Kootstra NA, van der Valk M, Geerlings SE, et al. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: The AGEhIV cohort study. Clin Infect Dis 2014;59:1787–97. https://doi. org/10.1093/cid/ciu701.
32. Zlotorzynska M, Spaulding AC, Messina LC, Coker D, Ward K, Easley K, et al. Retrospective cohort study of cancer incidence and mortality by HIV status in a Georgia, USA, prisoner cohort during the HAART era. BMJ Open 2016;6:e009778. https://doi.org/10.1136/bmjopen-2015-009778.
33. Boone MR, Cook SH, Wilson PA. Sexual identity and HIV status influence the relationship between internalized stigma and psychological distress in black gay and bisexual men. AIDS Care 2016;28:764–70. https://doi.org/10.1080/09540121.2 016.1164801.
34. Stall R, Mills TC, Williamson J, Hart T, Greenwood G, Paul J, et al. Association of Co-Occurring Psychosocial Health Problems and Increased Vulnerability to HIV/AIDS Among Urban Men Who Have Sex With Men. Am J Public Health 2003;93:939–42.
35. Pollard A, Nadarzynski T, Llewellyn C. Syndemics of stigma, minority-stress, maladaptive coping, risk environments and littoral spaces among men who have sex with men using chemsex. Culture, Health & Sexuality 2017;20:411–27. https://doi.org/10.1080/ 13691058.2017.1350751.
36. Baum MK, Rafie C, Lai S, Sales S, Page JB, Campa A. Alcohol use accelerates HIV disease progression. AIDS Res Hum Retroviruses 2010;26:511–8. https:// doi.org/10.1089/aid.2009.0211.
37. Carrico AW. Substance use and HIV disease progression in the HAART era: implications for the primary prevention of HIV. Life Sci 2011;88:940–7. https://doi.org/10.1016/j.lfs.2010.10.002.
38. Marshall MM, McCormack MC, Kirk GD. Effect of Cigarette Smoking on HIV Acquisition, Progression, and Mortality. AIDS Educ Prev 2009;21:28–39. https://doi.org/10.1521/aeap.2009.21.3_supp.28.
39. Lachowsky NJ, Dulai JJS, Cui Z, Sereda P, Rich A, Patterson TL, et al. Lifetime Doctor-Diagnosed Mental Health Conditions and Current Substance Use Among Gay and Bisexual Men Living in Vancouver, Canada. Subst Use Misuse 2017;52:785–97. https://doi.org/10.1080/10826084. 2016.1264965.
40. Weinberger AH, Smith PH, Funk AP, Rabin S, Shuter J. Sex Differences in Tobacco Use Among Persons Living With HIV/AIDS: A Systematic Review and Meta-Analysis. J Acquir Immune Defic Syndr 2017;74:439–53. https://doi.org/10.1097/ QAI.0000000000001279.
41. Petoumenos K, Law MG. Smoking, alcohol and illicit drug use effects on survival in HIV-positive persons. Current Opinion in HIV and AIDS 2016;11:514. https://doi.org/10.1097/ COH.0000000000000306.
42. Strategies for Management of Antiretroviral Therapy (SMART) Study Group, El-Sadr WM, Lundgren JD, Neaton JD, Gordin F, Abrams D, et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med 2006;355:2283–96. https://doi.org/10.1056/NEJMoa062360.
43. Anderson JP, Tchetgen Tchetgen EJ, Lo Re V, Tate JP, Williams PL, Seage GR, et al. Antiretroviral therapy reduces the rate of hepatic decompensation among HIV- and hepatitis C virus-coinfected veterans. Clin Infect Dis 2014;58:719–27. https://doi. org/10.1093/cid/cit779.
44. Moore RD, Forney D. Anemia in HIV-infected patients receiving highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2002;29:54–7.
45. Freiberg MS, Chang C-CH, Kuller LH, Skanderson M, Lowy E, Kraemer KL, et al. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med 2013;173:614–22. https://doi. org/10.1001/jamainternmed.2013.3728.
46. Patel P, Hanson DL, Sullivan PS, Novak RM, Moorman AC, Tong TC, et al. Incidence of Types of Cancer among HIV-Infected Persons Compared with the General Population in the United States, 1992–2003. Annals of Internal Medicine 2008;148:728. https://doi. org/10.7326/0003-4819-148-10-200805200-00005.
47. Hagger-Johnson G, Taibjee R, Semlyen J, Fitchie I, Fish J, Meads C, et al. Sexual orientation identity in relation to smoking history and alcohol use at age 18/19: cross-sectional associations from the Longitudinal Study of Young People in England (LSYPE). BMJ Open 2013;3:e002810. https://doi. org/10.1136/bmjopen-2013-002810.
48. Hubach RD, Dodge B, Schick V, Ramos WD, Herbenick D, Li MJ, et al. Experiences of HIV-positive gay, bisexual and other men who have sex with men residing in relatively rural areas. Culture, Health & Sexuality 2015;17:795–809. https://doi.org /10.1080/13691058.2014.994231.
49. Slater LZ, Moneyham L, Vance DE, Raper JL, Mugavero MJ, Childs G. Support, stigma, health, coping, and quality of life in older gay men with HIV. J Assoc Nurses AIDS Care 2013;24:38–49. https://doi.org/10.1016/j.jana.2012.02.006.
50. Makoroka L. Health Service Utilization among Men who Have Sex with Men (MSM) who Live in Toronto: Secondary Analysis of a Cross-sectional Study. McMaster University, 2014.
51. Heckathorn D. Respondent-Driven Sampling: A New Approach to the Study of Hidden Populations*. Society for the Study of Social Problems 1997;44.
52. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction 1993;88:791–804.
53. Petoumenos K, Worm S, Reiss P, de Wit S, d’Ar-minio Monforte A, Sabin C, et al. Rates of car-diovascular disease following smoking cessation in patients with HIV infection: Results from the D:A:D study. HIV Med 2011;12:412–21. https://doi. org/10.1111/j.1468-1293.2010.00901.x.
54. Guaraldi G, Palella FJ. Clinical implications of aging with HIV infection: Perspectives and the future med-ical care agenda. AIDS 2017;31 Suppl 2:S129–35. https://doi.org/10.1097/QAD.0000000000001478.
55. Hawkins KL, Brown TT, Margolick JB, Erlandson KM. Geriatric syndromes: New frontiers in HIV and sarcopenia. AIDS 2017;31 Suppl 2:S137–46. https://doi.org/10.1097/QAD.0000000000001444.
56. Brown J, McGowan JA, Chouial H, Capocci S, Smith C, Ivens D, et al. Respiratory health status is impaired in UK HIV-positive adults with virologically suppressed HIV infection. HIV Med 2017. https://doi.org/10.1111/hiv.12497.
57. van Zoest RA, Wit FW, Kooij KW, van der Valk M, Schouten J, Kootstra NA, et al. Higher Prevalence of Hypertension in HIV-1-Infected Patients on Combination Antiretroviral Therapy Is Associated With Changes in Body Composition and Prior Stavudine Exposure. Clin Infect Dis 2016;63:205– 13. https://doi.org/10.1093/cid/ciw285.
58. Emlet CA, Shiu C, Kim H-J, Fredriksen-Goldsen K. Bouncing Back: Resilience and Mastery Among HIV-Positive Older Gay and Bisexual Men. Gerontologist 2017;57:S40–9. https://doi. org/10.1093/geront/gnw171.
59. Harper GW, Bruce D, Hosek SG, Fernandez MI, Rood BA. Resilience Processes Demonstrated by Young Gay and Bisexual Men Living with HIV: Implications for Intervention. AIDS Patient Care STDS 2014;28:666–76. https://doi.org/10.1089/ apc.2013.0330.
60. Lyons A. Resilience in lesbians and gay men: A review and key findings from a nationwide Australian survey. Int Rev Psychiatry 2015;27:435– 43. https://doi.org/10.3109/09540261.2015.1051517.
61. McParland J, Camic PM. Psychosocial factors and ageing in older lesbian, gay and bisexual people: a systematic review of the literature. J Clin Nurs 2016;25:3415–37. https://doi.org/10.1111/jocn.13251.
62. Longenecker CT, Sullivan C, Baker JV. Immune Activation and Cardiovascular Disease in Chronic HIV Infection. Curr Opin HIV AIDS 2016;11:216–25. https://doi.org/10.1097/COH.0000000000000227.
63. Nou E, Lo J, Grinspoon SK. Inflammation, immune activation, and cardiovascular disease in HIV. AIDS 2016;30:1495–509. https://doi.org/10.1097/ QAD.0000000000001109.
64. Liner KJ, Ro MJ, Robertson KR. HIV, antiretroviral therapies, and the brain. Curr HIV/ AIDS Rep 2010;7:85–91. https://doi.org/10.1007/ s11904-010-0042-8.
65. Feeney ER, Mallon PWG. Insulin resistance in treated HIV infection. Best Pract Res Clin Endocrinol Metab 2011;25:443–58. https://doi. org/10.1016/j.beem.2010.11.002.
66. Lang S, Mary-Krause M, Cotte L, Gilquin J, Partisani M, Simon A, et al. Impact of individual antiretroviral drugs on the risk of myocardial infarction in human immunodeficiency virus-infected patients: A case-control study nested within the French Hospital Database on HIV ANRS cohort CO4. Arch Intern Med 2010;170:1228–38. https:// doi.org/10.1001/archinternmed.2010.197.
67. Sension M, Deckx H. Lipid metabolism and lipodystrophy in HIV-1-infected patients: The role played by nonnucleoside reverse transcriptase inhibitors. AIDS Rev 2015;17:21–36.
68. Campos P, Ortiz A, Soto K. HIV and kidney dis-eases: 35 years of history and consequences. Clin Kidney J 2016;9:772–81. https://doi.org/10.1093/ckj/ sfw104.
69. Chao C, Leyden WA, Xu L, Horberg MA, Klein D, Towner WJ, et al. Exposure to Antiretroviral Therapy and Risk of Cancer in HIV-infected Persons. AIDS 2012;26:2223–31. https://doi. org/10.1097/QAD.0b013e32835935b3.
70. Castel AD, Young H, Akiwumi A-M, Vargas A, Rogers K, West T, et al. Trends in cancer diagnoses and survival among persons with AIDS in a high HIV prevalence urban area. AIDS Care 2015;27:860–9. https://doi.org/10.1080/09540121.20 15.1011074.
71. Huynh KP, Jung J. Subjective health expectations. Journal of Policy Modeling 2015;37:693–711. https:// doi.org/10.1016/j.jpolmod.2015.04.001.
72. Koyama T, McHaffie JG, Laurienti PJ, Coghill RC. The subjective experience of pain: Where expectations become reality. PNAS 2005;102:12950–5. https://doi.org/10.1073/pnas.0408576102.
73. Ursin H, Eriksen HR. Sensitization, subjective health complaints, and sustained arousal. Ann N Y Acad Sci 2001;933:119–29.
74. Heywood W, Lyons A. Change in subjective social status following HIV diagnosis and associated effects on mental and physical health among HIV-positive gay men in Australia. Psychol Health 2017;32:860–75. https://doi.org/10.1080/08870446.2 017.1307374.
75. Mosack KE, Weinhardt LS, Kelly JA, Gore-Felton C, McAuliffe TL, Johnson MO, et al. Influence of Coping, Social Support, and Depression on Subjective Health Status Among HIV-Positive Adults With Different Sexual Identities. Behav Med 2009;34:133–44. https://doi.org/10.3200/ BMED.34.4.133-144.
76. Siziya S, Fylkesnes K. Impact of HIV infection on self-rated health in a high-prevalence population with low awareness of own HIV status. Norsk Epidemiologi 2009;15. https://doi.org/10.5324/nje. v15i2.215.
77. Barrett DC, Pollack LM. Whose Gay Community? Social Class, Sexual Self-Expression, and Gay Community Involvement. Sociological Quarterly 2005;46:437–56. https://doi. org/10.1111/j.1533-8525.2005.00021.x.
78. Green AI. Health and Sexual Status in an Urban Gay Enclave: An Application of the Stress Process Model. Journal of Health and Social Behavior 2008;49:436– 51. https://doi.org/10.1177/002214650804900405.
79. Boehmer U, Miao X, Linkletter C, Clark MA. Health Conditions in Younger, Middle, and Older Ages: Are There Differences by Sexual Orientation? LGBT Health 2014;1:168–76. https:// doi.org/10.1089/lgbt.2013.0033.
80. Ramirez-Valles J, Dirkes J, Barrett HA. GayBy Boomers’ social support: exploring the connection between health and emotional and instrumental support in older gay men. J Gerontol Soc Work 2014;57:218–34. https://doi.org/10.1080/01634372.2 013.843225.