Publications

BACKGROUND

Food insecurity is common among HIV-infected individuals and has been associated with poor health. Little longitudinal research has examined the association of food insecurity with HIV clinical outcomes, or the extent to which adherence mediates these associations.

DESIGN

Observational cohort study

METHODS

HIV-infected homeless and marginally housed individuals in the San Francisco Research on Access to Care in the Homeless cohort completed quarterly structured interviews and blood draws. We measured food insecurity using the validated Household Food Insecurity Access Scale. Primary outcomes were: antiretroviral therapy (ART) nonadherence (<90% adherence), incomplete HIV viral load suppression more than 100 copies/ml, and CD4⁺ cell counts less than 200 cells/μl. We estimated model parameters using generalized estimating equations, adjusting for sociodemographic and clinical variables.

RESULTS

From May 2007 to March 2010, we followed 284 participants for a median of 22 months. At baseline 54.6% of participants were food-insecure. Food insecurity was associated with increased odds of ART nonadherence [adjusted odds ratio (AOR) = 1.48; 95% confidence interval (CI), 1.19-1.85], incomplete viral load suppression (AOR = 1.29, 95% CI 1.04-1.61), and CD4⁺ cell counts less than 200 cells/μl (AOR = 1.26, 95% CI 1.01-1.56). When we included ART adherence in adjusted models for incomplete viral suppression and CD4⁺ cell counts less than 200 cells/μl, the magnitude of the effect decreased slightly.

CONCLUSION

Food insecurity was associated with poor HIV outcomes, including nonadherence, in a longitudinal study of US-based HIV-infected unstably housed individuals. Efforts to address food insecurity should be included in HIV-treatment programs, and may help improve health outcomes.

Little is known about the expression of methicillin-resistant Staphylococcus aureus (MRSA) genes during infection conditions. Here, we described the transcriptome of the clinical MRSA strain USA300 derived from human cutaneous abscesses, and compared it with USA300 bacteria derived from infected kidneys in a mouse model. Remarkable similarity between the transcriptomes allowed us to identify genes encoding multiple proteases and toxins, and iron- and peptide-transporter molecules, which are upregulated in both infections and are likely important for establishment of infection. We also showed that disruption of the global transcriptional regulators agr and sae prevents in vivo upregulation of many toxins and proteases, protecting mice from lethal infection dose, and hinting at the role of these transcriptional regulators in the pathology of MRSA infection.

OBJECTIVE

Smoking and alcohol use are highly related; as such the present study investigated whether alcohol use is associated with failure in tobacco cessation attempts. We first examined the self-reported drinking behavior and smoking over the course of a year at a basic level. Next, we addressed two hypotheses to characterize this relationship at a deeper level: (Hypothesis 1) Alcohol use would be lower for those who attempted to quit smoking (quit for one or more days) during the year compared to those who never quit, and (Hypothesis 2) for those who relapsed to smoking after a quit increases in alcohol consumption would be positively associated with increases in smoking.

METHOD

Subjects were participants in two smoking cessation programs. One group of participants (N=139) was part of a smoking cessation study in alcohol dependent smokers in early recovery and the other group of participants (N=163) was drawn from a smoking cessation study for HIV positive smokers. H1 was tested using t-tests. For H2, a time series analysis examined relationships between smoking and alcohol use within person over a one year period. For H1 and for H2, the analyses utilized bivariate time series procedures. Timeline follow-back data allowed for detailed daily reports of both tobacco and alcohol use.

RESULTS

In the overall sample, there was no difference in alcohol use between those who stopped smoking and those who never stopped. However, when broken up by study, a difference was found in the alcohol dependent sample such that mean drinks were higher for those who stopped compared to those who never stopped smoking (H1). The results indicated a high number of positive significant cross-correlations between tobacco and alcohol use such that one substance predicted current, as well as past and future use of the alternate substance. Same-day cross-correlations were the most common, and dissipated with time (H2).

CONCLUSIONS

This analysis provided insights into the proximal influence of one substance on the other. Alcohol is related to relapse in smoking cessation attempts. It is important that smoking cessation efforts in alcohol using populations consider alcohol use in treatment.