Eric G. Bing

Health-related quality of life among people with HIV disease: results from the multicenter AIDS Cohort Study.

To examine the effect of HIV status, symptomatology and CD4+ lymphocyte level on health-related quality of life, the Medical Outcomes Study Short-Form Health Survey (SF-36) was administered to 2,295 gay men enrolled in the Multicenter AIDS Cohort Study (MACS) in 1994. Distinct physical and mental health factors of the SF-36 were found. Seropositive asymptomatic individuals and seropositive individuals with CD4+ lymphocytes ≥ 500/mm3 scored as well as seronegative participants on all of the mental health domain scales, but lower on the general health perceptions and physical health composite score. Seropositive individuals with at least one symptom or with CD4+ lymphocytes below 200/mm3 scored significantly lower on all of the SF-36 scales and summary scores than seronegative controls. The SF-36 was found to exhibit similar mental and physical health factors for an adult gay male population to that previously seen in general population samples and in patient groups with other diseases. In conclusion, HIV-positive men who are asymptomatic or have CD4+ lymphocytes above 500/mm3 have similar perceived mental health but worse perceived physical health than seronegative men. HIV-positive men who are symptomatic or have CD4+ lymphocytes below 200/mm3 have worse perceived mental and physical health than seronegative men.

Effects of Drug Abuse and Mental Disorders on Use and Type of Antiretroviral Therapy in HIV-infected Persons

AbstractOBJECTIVE: To distinguish the effects of drug abuse, mental disorders, and problem drinking on antiretroviral therapy (ART) and highly active ART (HAART) use. DESIGN: Prospective population-based probability sample of 2,267 (representing 213,308) HIV-infected persons in care in the United States in early 1996. MEASUREMENTS: Self-reported ART from first (January 1997–July 1997) to second (August 1997–January 1998) follow-up interviews. Drug abuse/dependence, severity of abuse, alcohol use, and probable mental disorders assessed in the first follow-up interview. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) estimated from weighted models for 1) receipt of any ART, and 2) receipt of HAART among those on ART. RESULTS: Of our study population, ART was reported by 90% and HAART by 61%. Over one third had a probable mental disorder and nearly half had abused any drugs, but drug dependence (9%) or severe abuse (10%) was infrequent. Any ART was less likely for persons with dysthymia (AOR, 0.74; CI, 0.58 to 0.95) but only before adjustment for drug abuse. After full adjustment with mental health and drug abuse variables, any ART was less likely for drug dependence (AOR, 0.58; CI, 0.34 to 0.97), severe drug abuse (AOR, 0.52; CI, 0.32 to 0.87), and HIV risk from injection drug use (AOR, 0.55; CI, 0.39 to 0.79). Among drug users on ART, only mental health treatment was associated with HAART (AOR, 1.57; CI, 1.11 to 2.08). CONCLUSIONS: Drug abuse-related factors were greater barriers to ART use in this national sample than mental disorders but once on ART, these factors were unrelated to type of therapy.

Functional status and well-being in patients with glaucoma as measured by the Medical Outcomes Study short form-36 questionnaire

PURPOSE This study aimed to determine whether patients with glaucoma have different functional status and well-being than patients without glaucoma. DESIGN Prospective case-control study. PARTICIPANTS The study population was recruited from 2 university-based glaucoma clinical practices and a university-based general ophthalmology clinic and consisted of 121 patients with open-angle glaucoma, 42 with diagnosis of glaucoma suspect, and 135 with no chronic ocular conditions except cataract. INTERVENTION Administration of Medical Outcomes Study 36-item short-form survey (SF-36) was performed. Demographic information, medical history, and responses to the SF-36 questionnaire were elicited by an interviewer. Medical record review was performed to obtain clinical examination data and to substantiate the medical and demographic data obtained by the interviewer. MAIN OUTCOME MEASURES The SF-36 scores by diagnostic group, demographic characteristics, and medical history were examined. Secondary outcome measures were SF-36 scores in patients with glaucoma by visual field impairment and glaucoma medication use. RESULTS Patients with glaucoma consistently had lower scores, control subjects had higher scores, and glaucoma suspects had scores intermediate between the two groups. After adjusting for the possible influence of all the other covariate factors, glaucoma was found to be a strong predictor of lower SF-36 scores. CONCLUSION Patients with glaucoma have lower scores, indicating less-functional status, than patients without glaucoma as tested by the SF-36 survey questionnaire.

Co-occurring Psychiatric Symptoms and Drug Dependence or Heavy Drinking Among HIV-Positive People

Abstract This study sought to establish population-based estimates of the prevalence of co-occurring psychiatric symptoms and either or both drug dependence symptoms or heavy drinking among individuals who test positive for the human immunodeficiency virus (HIV) and to identify the factors associated with such comorbidity. Data from the HIV Cost and Services Utilization Study (HCSUS), a nationally representative sample of HIV-infected adults receiving medical care in the U.S. in 1996 (N = 2,864), were used to estimate the prevalence of comorbidity. Logistic regression was used to identify the independent influences of sociodemographic and HIV-related variables on comorbidity. The authors estimate that 13% of people with HIV receiving care in the U.S. in 1996 had co-occurring psychiatric symptoms and either or both drug dependence symptoms or heavy drinking. The odds of having a comorbid condition were higher for males, heterosexuals, and people with more HIV-related symptoms. The odds were lower for people living with AIDS, African Americans, people who were gay or sexually abstinent, those living with a spouse, those aged 50 years or older, and those with private insurance. Sixty-nine percent of those with a substance-related condition also had psychiatric symptoms; 27% of those with psychiatric symptoms also had a substance-related condition.

Depression in patients with glaucoma as measured by self-report surveys

PURPOSE This study aimed to determine whether patients with glaucoma have more depressive symptoms than patients without glaucoma. DESIGN Prospective case-control study. PARTICIPANTS The study population was recruited from two university-based glaucoma clinical practices and a university-based general ophthalmology clinic and consisted of 121 patients with open-angle glaucoma, 42 with diagnoses of suspected glaucoma, and 135 with no chronic ocular conditions except cataract. INTERVENTION The Center for Epidemiologic Studies Depression Scale (CES-D) and Composite International Diagnostic Interview, Short Form (CIDI-SF) questionnaires were administered to all subjects. Demographic information, medical history, and responses to the questionnaires were elicited by an interviewer. Medical record review was performed to obtain clinical examination data and to substantiate the medical and demographic data obtained by the interviewer. MAIN OUTCOME MEASURES The questionnaire scores by diagnostic group, demographic characteristics, and medical history were examined. Secondary outcome measures were questionnaire scores in patients with glaucoma by visual impairment and glaucoma medication use. RESULTS Depression scores for patients with glaucoma did not differ significantly from scores of control patients. Having past or present mental illness was the only consistent predictor for depression in both questionnaires. Among glaucoma patients, visual acuity level, visual field severity, and use of topical beta-blockers were not predictors for depression. CONCLUSIONS Patients with glaucoma do not report being more depressed than patients without glaucoma as measured by the CES-D and the CIDI-SF questionnaires.

Protease inhibitor use among a community sample of people with HIV disease.

OBJECTIVES Protease inhibitors have become integral to HIV disease management. This paper examines sociodemographic factors affecting patient use and perceived knowledge of protease inhibitors, and the relationship between protease inhibitor use and perceived health. METHODS 1034 people with HIV disease from a large AIDS services organization completed a mailed self-administered survey that assessed sociodemographics, protease inhibitor use and perceived knowledge, and perceived change in health status over the previous year. Multiple logistic regression was used to determine sociodemographic factors independently associated with protease inhibitor use and perceived knowledge, and perceived overall health status. RESULTS Two thirds (66%) of correspondents included in the sample were currently taking protease inhibitors and 52% reported being very knowledgeable about these medications. Adjusting for sociodemographic factors, those who were currently not taking protease inhibitors were more likely to be African American, non-English speaking, earning <

Screening for sexually transmitted diseases in non-traditional settings: a personal view.

9600 U.S. annually, or uninsured. Among protease inhibitor users, those who reported less knowledge about the drugs were more likely to be nonwhite, earning <

Accessing HIV testing and care.

9600 U.S. annually, and not college educated. Protease inhibitor use was independently associated with perceived improved overall health and having been college educated. CONCLUSIONS Further efforts should be directed toward increasing use and knowledge of protease inhibitors among disadvantaged populations.

Increasing HIV Testing Among Latinos by Bundling HIV Testing with Other Tests

We conducted a literature search to review studies that presented quantitative data on sexually transmitted disease (STD) screening in non-traditional settings in the United States. We examined the studies for evidence of the feasibility of screening, population size reached, acceptability, yield, and potential for contributing to STD control. We found 17 studies in jails, eight in emergency room, five in schools and 15 in other community settings. Jail-based and emergency room-based STD screenings have the highest yields and the largest numbers screened and thus hold significant promise as settings for routine STD screening. More research needs to be done in school and community settings to better identify their potential.

The African‐American Health Project (AAHP): Study overview and select findings on high risk behaviors and psychiatric disorders in African American men

&NA;With the many recent improvements in the medical management of HIV, the benefits of early detection of the virus have increased. People found to be HIV‐positive can be offered immediate referrals for medical care and a comprehensive continuum of services. However, it is estimated that, among the 650,000 to 900,000 seropositive persons in the United States, about one third are unaware of their serostatus. Many of those who are tested for HIV do not return for their results. Among those less likely to return for results are young people and black Americans. Many factors at the individual, system and societal levels negatively impact whether individuals at risk for HIV seek HIV testing in the first place, whether they return for their results, and whether they get appropriate care after they are found to be HIV‐positive. Some solutions are offered to improve the identification of new HIV infections. These include social marketing campaigns to encourage individuals to be tested for HIV. Also, more use of the rapid HIV test, which will substantially increase the number of people obtaining their HIV results, is recommended. New computer technologies, such as telemedicine, also have the potential to improve linkages to care for newly diagnosed individuals. In addition, it is essential that HIV care continue to be readily available through the Ryan White Care Act.