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Evan Wood - One of the best experts on this subject based on the ideXlab platform.
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Socioeconomic factors associated with cessation of Injection Drug use among street-involved youth
Substance abuse treatment prevention and policy, 2017Co-Authors: Derek C. Chang, Thomas Kerr, Evan Wood, Scott E. Hadland, Ekaterina Nosova, Kora DebeckAbstract:Although the initiation of Injection Drug use has been well characterized among at-risk youth, factors that support or impede cessation of Injection Drug use have received less attention. We sought to identify socioeconomic factors associated with cessation of Injection Drug use among street-involved youth. From September 2005 to May 2015, data were collected from the At-Risk Youth Study (ARYS), a prospective cohort study of street-involved youth in Vancouver, Canada. Multivariate extended Cox regression was utilized to identify socioeconomic factors associated with cessation of Injection Drug use for six months or longer among youth who were actively injecting. Among 383 participants, 171 (44.6%) youth reported having ceased Injection (crude incidence density 22 per 100 person-years; 95% confidence interval [CI], 19–26) at some point during study follow-up. Youth who had recently dealt Drugs (adjusted hazard ration [AHR], 0.50; 95% CI, 0.29–0.87), engaged in prohibited street-based income generation (AHR, 0.41; 95% CI, 0.24–0.69), and engaged in illegal income generating activities (AHR, 0.19; 95% CI, 0.06–0.61) were significantly less likely to report cessation of Injection Drug use. Our findings suggest that socioeconomic factors, in particular engagement in prohibited street-based and illegal income generating activities, may pose barriers to ceasing Injection Drug use among this population. Effort to improve access to stable and secure income, as well as employment opportunities may assist youth in transitioning away from Injection Drug use. Our study is not a randomized controlled trial; thus the trial registration is not applicable.
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The effect of history of Injection Drug use and alcoholism on HIV disease progression
AIDS care, 2013Co-Authors: Viviane D. Lima, Thomas Kerr, Evan Wood, Robert S. Hogg, Tsubasa Kozai, Kate Salters, Julio S. G. MontanerAbstract:The effectiveness of highly active antiretroviral therapy (HAART) in preventing disease progression can be negatively influenced by the high prevalence of substance use among patients. Here, we quantify the effect of history of Injection Drug use and alcoholism on virologic and immunologic response to HAART. Clinical and survey data, collected at the start of HAART and at the interview date, were based on the study Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) in British Columbia, Canada. Substance use was a three-level categorical variable, combining information on history of alcohol dependence and of Injection Drug use, defined as: no history of alcohol and Injection Drug use; history of alcohol or Injection Drug use; and history of both alcohol and Injection Drug use. Virologic response (pVL) was defined by ≥2 log10 copy/mL drop in a viral load. Immunologic response was defined as an increase in CD4 cell count percent of ≥100%. We used cumulative logit modeling for or...
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Injection Drug use among street-involved youth in a Canadian setting
BMC public health, 2009Co-Authors: Thomas Kerr, Cari L Miller, Brandon D. L. Marshall, Julio S. G. Montaner, Kate Shannon, Ruth Zhang, Evan WoodAbstract:Background Street-involved youth contend with an array of health and social challenges, including elevated rates of blood-borne infections and mortality. In addition, there has been growing concern regarding high-risk Drug use among street-involved youth, in particular Injection Drug use. We undertook this study to examine the prevalence of Injection Drug use and associated risks among street-involved youth in Vancouver, Canada.
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Childhood Trauma and Injection Drug Use Among High-Risk Youth
The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2009Co-Authors: Thomas Kerr, Steffanie A Strathdee, Jo-anne Stoltz, Brandon D. L. Marshall, Calvin Lai, Evan WoodAbstract:Abstract We examined the association between five types of childhood maltreatment and initiation of Injection Drug use among a cohort of high-risk youth in Vancouver, Canada. Among 560 participants, 230 (41.1%) had injected Drugs previously. In multivariate logistic analyses, only physical abuse (adjusted odds ratio=1.91, 95% confidence interval: 1.29–2.83) was associated with Injection Drug use. These findings highlight the impact of childhood physical abuse on subsequent initiation into Injection Drug use among high-risk youth.
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a review of barriers and facilitators of hiv treatment among Injection Drug users
AIDS, 2008Co-Authors: Evan Wood, Thomas Kerr, Mark W. Tyndall, Julio S. G. MontanerAbstract:Globally, Injection Drug use continues to account for a substantial proportion of HIV infections. There have not, however, been any evidence-based reviews of the barriers and facilitators of HIV treatment among Injection Drug users. For this review, published studies were extracted from nine academic databases, with no language or date specified in the search criteria. Existing evidence demonstrates that, although Injection Drug users often have worse outcomes from HIV treatment than non-Injection Drug users, major antiretroviral-associated survival gains still have been observed among this population. Inferior outcomes are explained by a range of barriers to antiretroviral access and adherence, which often stem from the negative influences of illicit Drug policies, as well as issues within medical systems, including lack of physician education about substance abuse. Evidence demonstrates that several under-utilized interventions and novel antiretroviral delivery modalities have helped to greatly address these barriers in several settings, and there is sufficient evidence to support immediate scale-up of these programmes. These interventions include coupling antiretroviral therapy with opioid substitution therapies as well as directly administered antiretroviral therapy programmes. Of particular interest for future evaluation is the coupling of HIV treatment programmes within comprehensive services, which also provide low-threshold (harm reduction) HIV prevention programmes. Scale-up of evidence-based HIV treatment and prevention to Injection Drug users, however, will require increasing political will among both national policy-makers and international public health agencies.
Thomas Kerr - One of the best experts on this subject based on the ideXlab platform.
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Socioeconomic factors associated with cessation of Injection Drug use among street-involved youth
Substance abuse treatment prevention and policy, 2017Co-Authors: Derek C. Chang, Thomas Kerr, Evan Wood, Scott E. Hadland, Ekaterina Nosova, Kora DebeckAbstract:Although the initiation of Injection Drug use has been well characterized among at-risk youth, factors that support or impede cessation of Injection Drug use have received less attention. We sought to identify socioeconomic factors associated with cessation of Injection Drug use among street-involved youth. From September 2005 to May 2015, data were collected from the At-Risk Youth Study (ARYS), a prospective cohort study of street-involved youth in Vancouver, Canada. Multivariate extended Cox regression was utilized to identify socioeconomic factors associated with cessation of Injection Drug use for six months or longer among youth who were actively injecting. Among 383 participants, 171 (44.6%) youth reported having ceased Injection (crude incidence density 22 per 100 person-years; 95% confidence interval [CI], 19–26) at some point during study follow-up. Youth who had recently dealt Drugs (adjusted hazard ration [AHR], 0.50; 95% CI, 0.29–0.87), engaged in prohibited street-based income generation (AHR, 0.41; 95% CI, 0.24–0.69), and engaged in illegal income generating activities (AHR, 0.19; 95% CI, 0.06–0.61) were significantly less likely to report cessation of Injection Drug use. Our findings suggest that socioeconomic factors, in particular engagement in prohibited street-based and illegal income generating activities, may pose barriers to ceasing Injection Drug use among this population. Effort to improve access to stable and secure income, as well as employment opportunities may assist youth in transitioning away from Injection Drug use. Our study is not a randomized controlled trial; thus the trial registration is not applicable.
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The effect of history of Injection Drug use and alcoholism on HIV disease progression
AIDS care, 2013Co-Authors: Viviane D. Lima, Thomas Kerr, Evan Wood, Robert S. Hogg, Tsubasa Kozai, Kate Salters, Julio S. G. MontanerAbstract:The effectiveness of highly active antiretroviral therapy (HAART) in preventing disease progression can be negatively influenced by the high prevalence of substance use among patients. Here, we quantify the effect of history of Injection Drug use and alcoholism on virologic and immunologic response to HAART. Clinical and survey data, collected at the start of HAART and at the interview date, were based on the study Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) in British Columbia, Canada. Substance use was a three-level categorical variable, combining information on history of alcohol dependence and of Injection Drug use, defined as: no history of alcohol and Injection Drug use; history of alcohol or Injection Drug use; and history of both alcohol and Injection Drug use. Virologic response (pVL) was defined by ≥2 log10 copy/mL drop in a viral load. Immunologic response was defined as an increase in CD4 cell count percent of ≥100%. We used cumulative logit modeling for or...
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Injection Drug use among street-involved youth in a Canadian setting
BMC public health, 2009Co-Authors: Thomas Kerr, Cari L Miller, Brandon D. L. Marshall, Julio S. G. Montaner, Kate Shannon, Ruth Zhang, Evan WoodAbstract:Background Street-involved youth contend with an array of health and social challenges, including elevated rates of blood-borne infections and mortality. In addition, there has been growing concern regarding high-risk Drug use among street-involved youth, in particular Injection Drug use. We undertook this study to examine the prevalence of Injection Drug use and associated risks among street-involved youth in Vancouver, Canada.
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Childhood Trauma and Injection Drug Use Among High-Risk Youth
The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2009Co-Authors: Thomas Kerr, Steffanie A Strathdee, Jo-anne Stoltz, Brandon D. L. Marshall, Calvin Lai, Evan WoodAbstract:Abstract We examined the association between five types of childhood maltreatment and initiation of Injection Drug use among a cohort of high-risk youth in Vancouver, Canada. Among 560 participants, 230 (41.1%) had injected Drugs previously. In multivariate logistic analyses, only physical abuse (adjusted odds ratio=1.91, 95% confidence interval: 1.29–2.83) was associated with Injection Drug use. These findings highlight the impact of childhood physical abuse on subsequent initiation into Injection Drug use among high-risk youth.
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a review of barriers and facilitators of hiv treatment among Injection Drug users
AIDS, 2008Co-Authors: Evan Wood, Thomas Kerr, Mark W. Tyndall, Julio S. G. MontanerAbstract:Globally, Injection Drug use continues to account for a substantial proportion of HIV infections. There have not, however, been any evidence-based reviews of the barriers and facilitators of HIV treatment among Injection Drug users. For this review, published studies were extracted from nine academic databases, with no language or date specified in the search criteria. Existing evidence demonstrates that, although Injection Drug users often have worse outcomes from HIV treatment than non-Injection Drug users, major antiretroviral-associated survival gains still have been observed among this population. Inferior outcomes are explained by a range of barriers to antiretroviral access and adherence, which often stem from the negative influences of illicit Drug policies, as well as issues within medical systems, including lack of physician education about substance abuse. Evidence demonstrates that several under-utilized interventions and novel antiretroviral delivery modalities have helped to greatly address these barriers in several settings, and there is sufficient evidence to support immediate scale-up of these programmes. These interventions include coupling antiretroviral therapy with opioid substitution therapies as well as directly administered antiretroviral therapy programmes. Of particular interest for future evaluation is the coupling of HIV treatment programmes within comprehensive services, which also provide low-threshold (harm reduction) HIV prevention programmes. Scale-up of evidence-based HIV treatment and prevention to Injection Drug users, however, will require increasing political will among both national policy-makers and international public health agencies.
David Vlahov - One of the best experts on this subject based on the ideXlab platform.
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Incarceration and Injection Drug use in Baltimore, Maryland.
Addiction (Abingdon England), 2015Co-Authors: Becky L. Genberg, David Vlahov, Gregory D. Kirk, Jacquie Astemborski, Shruti H. MehtaAbstract:Aims There is limited longitudinal research examining incarceration and subsequent changes in Drug use among people who inject Drugs (PWID) in the United States. The objective of the current study was to characterize the frequency of incarceration and estimate the association between incarceration and subsequent Injection Drug use among current and former PWIDs in one US city. Design ALIVE (AIDS Linked to the Intravenous Experience) is a prospective cohort study of current and former PWIDs, with semi-annual follow-up occurring since 1988. Setting Baltimore, Maryland, USA. Participants A total of 3245 participants with 48 738 study visits were included. Participants enrolled from 1988 to 2012 with a median of 13 follow-up visits per participant (Interquartile range = 7–25). Measurements Incarcerations were defined as any self-reported jail or prison stays in the previous 6 months that were ≥7 days or longer. The primary outcome was defined as any self-reported Injection Drug use in the previous 6 months. Findings At baseline, 29% were female, 90% African American and 33% HIV-positive. Fifty-seven per cent of participants experienced at least one incarceration episode. After adjusting for confounders, there was a positive association between incarceration and subsequent Injection Drug use [adjusted odds ratio (AOR) = 1.48, 95% confidence interval (CI) = 1.37–1.59]; however, stratified analysis showed that the effect was restricted to those who were not injecting at the time of incarceration (AOR = 2.11, 95% CI = 1.88–2.37). Conclusions In the United States, incarceration of people who had previously stopped injecting Drugs appears to be associated with an increased risk of subsequent injecting.
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HIV and Proteinuria in an Injection Drug User Population
Clinical journal of the American Society of Nephrology : CJASN, 2010Co-Authors: Elizabeth L. Yanik, David Vlahov, Gregory D. Kirk, Gregory M. Lucas, Shruti H. MehtaAbstract:Background and objectives: Proteinuria is a major determinant of chronic kidney disease. We aimed to characterize the prevalence and correlates of proteinuria in a cohort of HIV-infected and uninfected Injection Drug users. Design, setting, participants, & measurements: A cross-sectional analysis was performed among 902 Injection Drug users (273 HIV-infected) in the AIDS Linked to the Intravenous Experience cohort. The primary outcome was proteinuria defined as having a urine protein/creatinine concentration ratio >200 mg/g. Poisson regression with robust variance was used to determine prevalence ratios. Results: Overall, 24.8% of participants had proteinuria; the prevalence was 2.9 times higher among HIV-infected participants (45%) compared with HIV-uninfected participants (16%). In addition, age, health insurance, employment status, hepatitis B and C serostatus, diabetes, and high BP were associated with proteinuria. Neither antiretroviral therapy nor features of illicit Drug use history were associated with proteinuria. In multivariate analysis, HIV infection, unemployment, increased age, diabetes, hepatitis C infection, and high BP were significantly associated with a higher prevalence of proteinuria. Conclusions: In an aging, predominantly African-American cohort of Injection Drug users, we found a striking burden of proteinuria that was strongly associated with HIV status. In addition to being a pathway to ESRD, proteinuria is a potent risk factor for cardiovascular morbidity and mortality. Evaluation of aggressive screening and disease-modification strategies in this high-risk population is warranted.
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Neighborhood Poverty and Injection Cessation in a Sample of Injection Drug Users
American journal of epidemiology, 2010Co-Authors: Arijit Nandi, David Vlahov, William W. Latimer, Gregory D. Kirk, Thomas A. Glass, Stephen R. Cole, Haitao Chu, Sandro Galea, David D. Celentano, Shruti H. MehtaAbstract:Neighborhood socioeconomic environment may be a determinant of Injection Drug use cessation. The authors used data from a prospective cohort study of Baltimore City, Maryland, Injection Drug users assessed between 1990 and 2006. The study examined the relation between living in a poorer neighborhood and the probability of Injection cessation among active injectors, independent of individual characteristics and while respecting the temporality of potential confounders, exposure, and outcome. Participants' residences were geocoded, and the crude, adjusted, and inverse probability of exposure weighted associations between neighborhood poverty and Injection Drug use cessation were estimated. Weighted models showed a strong association between neighborhood poverty and Injection Drug use cessation; living in a neighborhood with fewer than 10%, compared with more than 30%, of residents in poverty was associated with a 44% increased odds of not injecting in the prior 6 months (odds ratio = 1.44, 95% confidence interval: 1.14, 1.82). Results show that neighborhood environment may be an important determinant of Drug Injection behavior independent of individual-level characteristics.
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Childhood Sexual Abuse and Age at Initiation of Injection Drug Use
Am J Public Health, 2005Co-Authors: Danielle C Ompad, Edward Morse, Carey Maslow, Peter Kerndt, Yingfeng Wu, Susan Bailey, Robin M. Ikeda, Nina Shah, Crystal M Fuller, David VlahovAbstract:Objectives. We examined the relation between childhood sexual abuse and Injection Drug use initiation among young adult Injection Drug users. Methods. We used mixed effect linear models to compare age at first Injection among 2143 young Injection Drug users by first sexual abuse age categories. Results. The participants were predominantly male (63.3%) and White (52.8%). Mean age and age at first Injection were 23.7 and 19.6 years, respectively; 307 participants (14.3%) reported childhood sexual abuse. After adjustment for gender, race/ethnicity, nonInjection Drug use before first Injection Drug use, and recruitment site, childhood sexual abuse was independently associated with younger age at first Injection. Conclusions. Childhood sexual abuse was associated with earlier initiation of Injection Drug use. These data emphasize the need to integrate substance abuse prevention with postvictimization services for children and adolescents.
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Resilient children of Injection Drug users.
Journal of the American Academy of Child and Adolescent Psychiatry, 2004Co-Authors: Daniel J. Pilowsky, Patricia Zybert, David VlahovAbstract:ABSTRACT Objective: To examine associations between resilience in children of Injection Drug users and children's coping strategies, parenting stress, and children's social support. Method: Injection Drug–using parents ( n = 91) and their children aged 6 to 11 ( n = 117) were recruited in Baltimore (1997–1999). Resilience was defined as scoring in the lowest quartile of the Child Behavior Checklist total psychopathology score. Coping strategies used by resilient and nonresilient children, the extent and types of social support that they received, and the level of parenting stress reported by their parents were compared and contrasted. Results: Rates of depressive, anxiety, and disruptive behavior disorders were 15.4%, 22.2%, and 21.4%, respectively, for the entire sample. Compared with the nonresilient, resilient children were less likely to use two avoidance coping strategies (internalizing [ p = .002] and externalizing [ p = .017]). The level of actual support received by resilient and nonresilient children did not differ significantly ( p = .202). Perceived support was greater among resilient children (as reported by their parents; p p = .042). Conclusions: A significant proportion of children of Injection Drug users are in need of clinical care. Interventions to help children of substance-abusing parents modify their coping style merit exploration.
Alex H Kral - One of the best experts on this subject based on the ideXlab platform.
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Seroprevalence of Human Herpesvirus 8 among Injection Drug Users in San Francisco
The Journal of infectious diseases, 2003Co-Authors: Jonnae O. Atkinson, Alex H Kral, Brian R Edlin, Eric A. Engels, Karen H. Seal, Christine J. Gamache, Denise Whitby, Thomas R. O'brienAbstract:The association between Injection Drug use and human herpesvirus 8 (HHV-8) was examined to investigate bloodborne transmission of the virus. In all, 1905 Injection Drug users (IDUs) enrolled in a cross-sectional study were tested for K8.1 antibodies to HHV-8 lytic antigen. Logistic regression was used to adjust for demographic and sexual behavior variables. HHV-8 seroprevalence was 10% among women, 10% among heterosexual men, and 23% among men who have sex with men. In adjusted analyses, HHV-8 seroprevalence increased with longer duration of Injection Drug use for each of these groups (P = .01, P = .03, and P = .049 for trend, respectively). HHV-8 infection is relatively common among IDUs in San Francisco, and longer duration of Injection Drug use is associated with an increase in the risk of HHV-8 infection that is not explained by sexual behavior or demographic differences. These results are consistent with the occurrence of bloodborne transmission of HHV-8 among IDUs.
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the effect of syringe exchange use on high risk Injection Drug users a cohort study
AIDS, 2000Co-Authors: Ricky N. Bluthenthal, Alex H Kral, Lauren Gee, Elizabeth A Erringer, Brian R EdlinAbstract:OBJECTIVE To determine whether syringe exchange program use is associated with cessation of syringe sharing among high-risk Injection Drug users. DESIGN AND METHODS Between 1992 and 1996, street-recruited Injection Drug users were interviewed and received HIV testing and counseling semi-annually, as part of a dynamic cohort study. We examined a cohort of 340 high-risk Injection Drug users for whom two observations, 6-months apart, were available and who reported syringe sharing at the first interview. Multivariate logistic regression analysis was performed to determine the relationship between syringe exchange program use and cessation of syringe sharing, while controlling for confounding factors. RESULTS At follow-up interview, 60% (204 of 340) reported quitting syringe sharing. High-risk Injection Drug users who began using the syringe exchange program were more likely to quit sharing syringes [adjusted odds ratio (AOR), 2.68; 95% confidence interval (CI), 1.35-5.33], as were those who continued using the syringe exchange program (AOR,1.98; 95% CI, 1.05-3.75) in comparison with non-syringe exchange program users, while controlling for confounding factors. CONCLUSIONS The initiation and continuation of syringe exchange program use among high-risk Injection Drug users is independently associated with cessation of syringe sharing. Syringe exchange program use can be an important component in reducing the spread of blood-borne infectious diseases among high-risk Injection Drug users.
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the effect of syringe exchange use on high risk Injection Drug users a cohort study
AIDS, 2000Co-Authors: Ricky N. Bluthenthal, Alex H Kral, Elizabeth A Erringer, Brian R EdlinAbstract:Objective:To determine whether syringe exchange program use is associated with cessation of syringe sharing among high-risk Injection Drug users.Design and methods:Between 1992 and 1996, street-recruited Injection Drug users were interviewed and received HIV testing and counseling semi-annually, as
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HIV seroprevalence among street-recruited Injection Drug and crack cocaine users in 16 US municipalities.
American journal of public health, 1998Co-Authors: Alex H Kral, Ricky N. Bluthenthal, Robert E. Booth, John K. WattersAbstract:OBJECTIVES: This study deter- mined human immunodeficiency virus (HIV) seroprevalence and factors associated with HIV infection among street-recruited Injection Drug users and crack cocaine smokers. METHODS: An analysis was performed on HIV serologies and risk behaviors of 6402 Injection Drug users and 3383 crack smokers in 16 US municipalities in 1992 and 1993. RESULTS: HIV seroprevalence was 12.7% among Injection Drug users and 7.5% among crack smokers. Most high-seroprevalence municipalities (>25%) were located along the eastern seaboard of the United States. In high-seroprevalence municipalities, but not in others, HIV seroprevalence was higher for Injection Drug users than for crack smokers. Among Injection Drug users, cocaine Injection, use of speedballs (cocaine or amphetamines with heroin), and sexual risk behaviors were independently associated with HIV infection. Among crack smokers, sexual risk behaviors were associated with HIV infection. CONCLUSIONS: Injection Drug users and crack smokers are...
Shruti H. Mehta - One of the best experts on this subject based on the ideXlab platform.
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DNA METHYLATION MARKERS ASSOCIATED WITH Injection Drug USE STATUS AND HIV INFECTION AMONG CHRONIC Injection Drug USERS IN THE ALIVE STUDY
European Neuropsychopharmacology, 2019Co-Authors: Chang Shu, Kelly M. Bakulski, Kelly S. Benke, Andrew E. Jaffe, Shao-cheng Wang, Sarven Sabunciyan, Shruti H. Mehta, Gregory D. Kirk, Brion S. MaherAbstract:Background Injection Drug Use (IDU) is associated with biological modification of the genome, i.e., epigenetics marks such as DNA methylation and histone modification. However, the biological mechanisms of how substance use and cessation affects epigenetic outcomes remain largely unknown. Methods In the AIDS Linked to the Intravenous Experience (ALIVE) study, blood was obtained from 288 current IDUs, resampled after cessation and then again after relapse (total samples=774). Blood DNA methylation marks were measured using the Illumina Infinium MethylationEPIC BeadChip. Standard procedures in the minfi R package were used to preprocess raw Illumina image files into noob processed methylation beta values. Differences in DNA methylation at individual probes by current Injection status were tested using generalized linear regression including age, gender, race and cell heterogeneity as covariates. DNA methylation age was estimated for study subjects using the epigenetic clock method developed by Horvath et al. Results DNA methylation at individual loci (cg10801015, p=2.47⁎10^(-11); cg11415166, p=5.15⁎10^(-10); cg03426703, p=2.62⁎10^(-9); cg14977491, p=9.94⁎10^(-8) is significantly associated with current Injection Drug use status after correction for multiple testing. Those CpG sites were near the PDP1, NARFL, DVL2 and PFN2 genes correspondingly. Single-site epigenetic analysis of HIV status was also performed. HIV positive individual's average biological age is about 3 years older than their chronological age, but the biological age among HIV negative individuals, Injection Drug users and non-users is no different from their chronological age. Discussion In a preliminary study, we performed a genome-wide scan of methylation changes in a longitudinal study of Injection Drug use and identified genomic locations exhibiting significant changes in peripheral DNA methylation associated with Injection Drug use status. Individuals with HIV infection's biological age is older than their chronological age, which is consistent with the literature.
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Incarceration and Injection Drug use in Baltimore, Maryland.
Addiction (Abingdon England), 2015Co-Authors: Becky L. Genberg, David Vlahov, Gregory D. Kirk, Jacquie Astemborski, Shruti H. MehtaAbstract:Aims There is limited longitudinal research examining incarceration and subsequent changes in Drug use among people who inject Drugs (PWID) in the United States. The objective of the current study was to characterize the frequency of incarceration and estimate the association between incarceration and subsequent Injection Drug use among current and former PWIDs in one US city. Design ALIVE (AIDS Linked to the Intravenous Experience) is a prospective cohort study of current and former PWIDs, with semi-annual follow-up occurring since 1988. Setting Baltimore, Maryland, USA. Participants A total of 3245 participants with 48 738 study visits were included. Participants enrolled from 1988 to 2012 with a median of 13 follow-up visits per participant (Interquartile range = 7–25). Measurements Incarcerations were defined as any self-reported jail or prison stays in the previous 6 months that were ≥7 days or longer. The primary outcome was defined as any self-reported Injection Drug use in the previous 6 months. Findings At baseline, 29% were female, 90% African American and 33% HIV-positive. Fifty-seven per cent of participants experienced at least one incarceration episode. After adjusting for confounders, there was a positive association between incarceration and subsequent Injection Drug use [adjusted odds ratio (AOR) = 1.48, 95% confidence interval (CI) = 1.37–1.59]; however, stratified analysis showed that the effect was restricted to those who were not injecting at the time of incarceration (AOR = 2.11, 95% CI = 1.88–2.37). Conclusions In the United States, incarceration of people who had previously stopped injecting Drugs appears to be associated with an increased risk of subsequent injecting.
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The association between neighborhood residential rehabilitation and Injection Drug use in Baltimore, Maryland, 2000–2011
Health & place, 2014Co-Authors: Sabriya L. Linton, Carl A. Latkin, Gregory D. Kirk, Jacky M. Jennings, Shruti H. MehtaAbstract:This study utilized multilevel cross-classified models to longitudinally assess the association between neighborhood residential rehabilitation and Injection Drug use. We also assessed whether relocating between neighborhoods of varying levels of residential rehabilitation was associated with Injection Drug use. Residential rehabilitation was categorized into three groups (e.g. low, moderate, high), and lagged one visit to ensure temporality. After adjusting for neighborhood and individual-level factors, residence in a neighborhood with moderate residential rehabilitation was associated with a 23% reduction in Injection Drug use [AOR=0.77; 95% CI (0.67,0.87)]; residence in a neighborhood with high residential rehabilitation was associated with a 26% reduction in Injection Drug use [AOR=0.74; 95% CI (0.61,0.91)]. Continuous residence within neighborhoods with moderate/high rehabilitation, and relocating to neighborhoods with moderate/high rehabilitation, were associated with a lower likelihood of Injection Drug use. Additional studies are needed to understand the mechanisms behind these relationships.
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The longitudinal association between homelessness, Injection Drug use, and Injection-related risk behavior among persons with a history of Injection Drug use in Baltimore, MD.
Drug and alcohol dependence, 2013Co-Authors: Sabriya L. Linton, David D. Celentano, Gregory D. Kirk, Shruti H. MehtaAbstract:Background Few studies have assessed the temporal association between homelessness and Injection Drug use, and Injection-related risk behavior.
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HIV and Proteinuria in an Injection Drug User Population
Clinical journal of the American Society of Nephrology : CJASN, 2010Co-Authors: Elizabeth L. Yanik, David Vlahov, Gregory D. Kirk, Gregory M. Lucas, Shruti H. MehtaAbstract:Background and objectives: Proteinuria is a major determinant of chronic kidney disease. We aimed to characterize the prevalence and correlates of proteinuria in a cohort of HIV-infected and uninfected Injection Drug users. Design, setting, participants, & measurements: A cross-sectional analysis was performed among 902 Injection Drug users (273 HIV-infected) in the AIDS Linked to the Intravenous Experience cohort. The primary outcome was proteinuria defined as having a urine protein/creatinine concentration ratio >200 mg/g. Poisson regression with robust variance was used to determine prevalence ratios. Results: Overall, 24.8% of participants had proteinuria; the prevalence was 2.9 times higher among HIV-infected participants (45%) compared with HIV-uninfected participants (16%). In addition, age, health insurance, employment status, hepatitis B and C serostatus, diabetes, and high BP were associated with proteinuria. Neither antiretroviral therapy nor features of illicit Drug use history were associated with proteinuria. In multivariate analysis, HIV infection, unemployment, increased age, diabetes, hepatitis C infection, and high BP were significantly associated with a higher prevalence of proteinuria. Conclusions: In an aging, predominantly African-American cohort of Injection Drug users, we found a striking burden of proteinuria that was strongly associated with HIV status. In addition to being a pathway to ESRD, proteinuria is a potent risk factor for cardiovascular morbidity and mortality. Evaluation of aggressive screening and disease-modification strategies in this high-risk population is warranted.