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Longitudinal Modeling of Depressive Trajectories Among HIV-Infected Men Using Cocaine

Abstract

Cocaine use is prevalent among HIV-infected individuals. While cross-sectional studies suggest that cocaine users may be at increased risk for depression, long-term effects of cocaine on depressive symptoms remain unclear. This is a longitudinal study of 341 HIV-infected and uninfected men (135 cocaine users and 206 controls) ages 30–60 enrolled in the Multicenter AIDS Cohort Study during 1996–2009. The median baseline age was 41; 73% were African-American. In mixed-effects models over a median of 4.8 years of observation, cocaine use was associated with higher depressive symptoms independent of age, education level, and smoking (n = 288; p = 0.02); HIV infection modified this association (p = 0.03). Latent class mixed models were used to empirically identify distinct depressive trajectories (n = 160). In adjusted models, cocaine use was associated with threefold increased odds of membership in the class with persistent high depressive symptoms (95% confidence interval (CI) 1.38–6.69) and eightfold increased odds (95% CI (2.73–25.83) when tested among HIV-infected subjects only. Cocaine use is a risk factor for chronic depressive symptoms, particularly among HIV-infected men, highlighting the importance of integrating mental health and substance use treatments to address barriers to well-being and successful HIV-care.

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Acknowledgements

The authors are grateful to Drs. Steven Wolinsky, Cecile Proust-Lima, and Dorene Rentz for discussion of primary data and the analysis, and Ms. Elizabeth Carpelan for assistance with manuscript preparation. The data for this manuscript was obtained by the Multicenter AIDS Cohort Study (MACS) with centers at: Baltimore (U01-AI35042): The Johns Hopkins University Bloomberg School of Public Health: Joseph B. Margolick (PI), Jay Bream, Todd Brown, Barbara Crain, Adrian Dobs, Richard Elion, Richard Elion, Michelle Estrella, Lisette Johnson-Hill, Sean Leng, Anne Monroe, Cynthia Munro, Michael W. Plankey, Wendy Post, Ned Sacktor, Jennifer Schrack, Chloe Thio; Chicago (U01-AI35039): Feinberg School of Medicine, Northwestern University, and Cook County Bureau of Health Services: Steven M. Wolinsky (PI), John P. Phair, Sheila Badri, Dana Gabuzda, David Ostrow, Frank J. Palella, Jr., Sudhir Penugonda, Susheel Reddy, Matthew Stephens, Linda Teplin; Los Angeles (U01-AI35040): University of California, UCLA Schools of Public Health and Medicine: Roger Detels (PI), Otoniel Martínez-Maza (Co-P I), Aaron Aronow, Peter Anton, Robert Bolan, Elizabeth Breen, Anthony Butch, Shehnaz Hussain, Beth Jamieson, Eric N. Miller, John Oishi, Harry Vinters, Dorothy Wiley, Mallory Witt, Otto Yang, Stephen Young, Zuo Feng Zhang; Pittsburgh (U01-AI35041): University of Pittsburgh, Graduate School of Public Health: Charles R. Rinaldo (PI), Lawrence A. Kingsley (Co-PI), James T. Becker, Phalguni Gupta, Kenneth Ho, Susan Koletar, Jeremy J. Martinson, John W. Mellors, Anthony J. Silvestre, Ronald D. Stall; Data Coordinating Center (UM1-AI35043): The Johns Hopkins University Bloomberg School of Public Health: Lisa P. Jacobson (PI), Gypsyamber D’Souza (Co-PI), Alison, Abraham, Keri Althoff, Jennifer Deal, Priya Duggal, Sabina Haberlen, Alvaro Muoz, Derek Ng, Janet Schollenberger, Eric C. Seaberg, Sol Su, Pamela Surkan.

Funding

This work was supported by NIH grants to D.G. (R01 DA28994, R01 DA30985, R01 DA40391, R01 MH110259). The work was also supported in part by NIH funding to the Northwestern University Clinical Research Unit of the MACS (U01-AI35039, with additional co-funding from National Institute on Drug Abuse (NIDA), and National Institute of Mental Health (NIMH)). Training and educational support for S.S.M and A.D. was provided by NIH T32-AG000222. Additional support for S.S.M included Harvard Catalyst Master’s Program in Clinical and Translational Investigation funded by the NIH Clinical and Translational Science Award Program (1UL1-TR001102), and Catalyst Biostatistical Consultation with contributions from Harvard Medical School and affiliated hospitals. The MACS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID) [U01-AI35039, U01-AI35040; U01-AI35041; U01-AI35042; and UM1-AI35043], with additional co-funding from the National Cancer Institute (NCI), National Institute on Drug Abuse (NIDA), and National Institute of Mental Health (NIMH) at the National Institutes of Health (NIH). MACS data collection is also supported by UL1-TR000424 (JHU CTSA). Website located at http://www.statepi.jhsph.edu/macs/macs.html.

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Mukerji, S., Haghighat, R., Misra, V. et al. Longitudinal Modeling of Depressive Trajectories Among HIV-Infected Men Using Cocaine. AIDS Behav 21, 1985–1995 (2017). https://doi.org/10.1007/s10461-017-1801-y

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Keywords

  • HIV
  • Cocaine
  • Crack cocaine
  • Depression
  • Cognitive function