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1.  Hospitalizations for Cardiovascular Disease in African Americans and Whites with HIV/AIDS 
Population Health Management  2013;16(3):201-207.
Therapeutic advances have resulted in an epidemiological shift in the predominant causes of hospitalization for patients with HIV/AIDS. An emerging cause for hospitalization in this patient population is cardiovascular disease (CVD); however, data are limited regarding how this shift affects different racial groups. The objective of this observational, retrospective study was to evaluate the association between race and hospitalization for CVD in African Americans and whites with HIV/AIDS and to compare the types of CVD-related hospitalizations between African Americans and whites with HIV/AIDS. Approximately 1.5 million hospital discharges from the US National Hospital Discharge Surveys for the years of 1996 to 2008 were identified. After controlling for potential confounders, the odds of CVD-related hospitalization in patients with HIV/AIDS were 45% higher for African Americans than whites (odds ratio [OR]=1.45, 95% CI, 1.39–1.51). Other covariates that were associated with increased odds of hospitalization for CVD included chronic kidney disease (OR=1.43, 95% CI, 1.36–1.51), age≥50 years (OR=3.22, 95% CI, 2.94–3.54), region in the Southern United States (OR=1.17, 95% CI, 1.11–1.23), and Medicare insurance coverage (OR=1.71, 95% CI, 1.60–1.83). Male sex was not significantly associated with the study outcome (OR=0.99, 95% CI, 0.96–1.02). Compared to whites with HIV/AIDS, African Americans with HIV/AIDS had more hospitalizations for heart failure and hypertension, but fewer hospitalizations for stroke and coronary heart disease. In conclusion, African Americans with HIV/AIDS have increased odds of CVD-related hospitalization as compared to whites with HIV/AIDS. Furthermore, the most common types of CVD-related hospitalizations differ significantly in African Americans and whites. (Population Health Management 2012;16:201–207)
PMCID: PMC3840471  PMID: 23194035
3.  The State of Disparities in Opportunistic Infection Prophylaxis for Blacks with HIV/AIDS 
Medical care  2012;50(11):920-927.
The purpose of this review is to identify and analyze published studies that have evaluated disparities for opportunistic infection (OI) prophylaxis between Blacks and Whites with HIV/AIDS in the United States.
The authors conducted a web-based search of MEDLINE (1950 to 2009) to identify original research articles evaluating the use of OI prophylaxis between Blacks and Whites with HIV/AIDS. The search was conducted utilizing the following MeSH headings and search terms alone and in combination: HIV, AIDS, Black, race, ethnicity, disparities, differences, access, opportunistic infection, and prophylaxis. The search was then expanded to include any relevant articles from the referenced citations of the articles that were retrieved from the initial search strategy. Of the 29 articles retrieved from the literature search, 19 articles were excluded.
Ten publications met inclusion criteria, collectively published between 1991 and 2005. The collective time periods of these studies spanned from 1987 to 2001. Four studies identified a race-based disparity in that Blacks were less likely than Whites to use OI prophylaxis, whereas five studies failed to identify such a relationship between race and OI prophylaxis. One study identified disparities for Mycobacterium avium complex (MAC) prophylaxis, but not for Pneumocystis jiroveci pneumonia (PCP) prophylaxis.
The evidence regarding race-based disparities in opportunistic infection prophylaxis is inconclusive. Additional research is warranted to explore potential race-based disparities in OI prophylaxis.
PMCID: PMC3470654  PMID: 23047780
Race; disparities; HIV/AIDS; opportunistic infection; prophylaxis
4.  Differences in National Antiretroviral Prescribing Patterns between Black and White Patients with HIV/AIDS, 1996–2006 
Southern medical journal  2011;104(12):794-800.
The benefit of improved health outcomes for blacks receiving highly active antiretroviral therapy (HAART) lags behind that of whites. This project therefore sought to determine whether the reason for this discrepancy in health outcomes could be attributed to disparities in use of antiretroviral therapy between black and white patients with HIV.
Materials and Methods
The 1996–2006 National Hospital Ambulatory Medical Care Surveys were used to identify hospital outpatient visits that documented antiretrovirals. Patients younger than 18 years, of nonblack or nonwhite race, and lacking documentation of antiretrovirals were excluded. A multivariable logistic regression model was constructed with race as the independent variable and use of HAART as the dependent variable.
Approximately 3 million HIV/AIDS patient visits were evaluated. Blacks were less likely than whites to use HAART and protease inhibitors (odds ratio, 95% CI 0.81 [0.81–0.82] and 0.67 [0.67–0.68], respectively). More blacks than whites used non-nucleoside reverse transcriptase inhibitors (odds ratio, 95% CI 1.18 [1.17–1.18]). In 1996, the crude rates of HAART were relatively low for both black and white cohorts (5% vs 6%). The rise in HAART for blacks appeared to lag behind that of whites for several years, until 2002, when the proportion of blacks receiving HAART slightly exceeded the proportion of whites receiving HAART. In later years, the rates of HAART were similar for blacks and whites (81% vs 82% in 2006). Blacks appeared less likely than whites to use protease inhibitors and more likely than whites to use non-nucleoside reverse transcriptase inhibitors from 2000 to 2004.
Blacks experienced a lag in the use of antiretrovirals at the beginning of the study; this discrepancy dissipated in more recent years.
PMCID: PMC3222681  PMID: 22089356
HIV/AIDS; highly active antiretroviral therapy; racial disparities
6.  Analysis of the ABCA4 Gene by Next-Generation Sequencing 
The authors conducted comprehensive analysis of an important and very variable eye disease gene, ABCA4, by next-generation sequencing in a large cohort of patients and follow-up analysis of identified mutations in both coding and noncoding regions of the ABCA4 locus.
To find all possible disease-associated variants in coding sequences of the ABCA4 gene in a large cohort of patients diagnosed with ABCA4-associated diseases.
One hundred sixty-eight patients who had been clinically diagnosed with Stargardt disease, cone-rod dystrophy, and other ABCA4-associated phenotypes were prescreened for mutations in ABCA4 with the ABCA4 microarray, resulting in finding 1 of 2 expected mutations in 111 patients and 0 of 2 mutations in 57 patients. The next-generation sequencing (NGS) strategy was applied to these patients to sequence the entire coding region and the splice sites of the ABCA4 gene. Identified new variants were confirmed or rejected by Sanger sequencing and analyzed for possible pathogenicity by in silico programs and, where possible, by segregation analyses.
Sequencing was successful in 159 of 168 patients and identified the second disease-associated allele in 49 of 103 (∼48%) of patients with one previously identified mutation. Among those with no mutations, both disease-associated alleles were detected in 4 of 56 patients, and one mutation was detected in 10 of 56 patients. The authors detected a total of 57 previously unknown, possibly pathogenic, variants: 29 missense, 4 nonsense, 9 small deletions and 15 splice-site-altering variants. Of these, 55 variants were deemed pathogenic by a combination of predictive methods and segregation analyses.
Many mutations in the coding sequences of the ABCA4 gene are still unknown, and many possibly reside in noncoding regions of the ABCA4 locus. Although the ABCA4 array remains a good first-pass screening option, the NGS platform is a time- and cost-efficient tool for screening large cohorts.
PMCID: PMC3208189  PMID: 21911583
7.  Cardiovascular Disease in Blacks with HIV/AIDS in the United States: A Systematic Review of the Literature 
The Open AIDS Journal  2012;6:29-35.
Blacks in the United States bear a disproportionate burden of Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and cardiovascular disease (CVD). It has been demonstrated that HIV/AIDS itself and HIV/AIDS-related therapies may predispose patients to early onset of CVD. It is also possible that Black patients may be at greater risk for this interaction. Thus, the objective of this literature review was to identify and critically evaluate disparities in CVD between Black and White patients with HIV/AIDS.
A MEDLINE search (January 1, 1950 to May 31, 2010) was performed to identify original research articles published in the English language. The search was limited to articles that evaluated race-based disparities for CVD among patients with HIV/AIDS.
Of the five publications included in this review, a CVD diagnosis was the primary focus for only three of the studies and was a secondary objective for the remaining two studies. Two studies concluded that Blacks were more likely than Whites to have a CVD diagnosis at time of hospital admission, whereas, the other three studies did not detect any race-based disparities.
Few studies have addressed the issue of Black race, HIV/AIDS, and CVD, highlighting the need for future research in this area.
PMCID: PMC3343316  PMID: 22563364
AIDS; cardiovascular disease; diagnosis; disparities; HIV; race.
8.  Use of Complementary and Alternative Medicine (CAM) for Treatment among African-Americans: A Multivariate Analysis 
Complementary and alternative medicine (CAM) use is substantial among African-Americans; however, research on characteristics of African-Americans who use of CAM to treat specific conditions is scarce.
To determine what predisposing, enabling, need, and disease state factors are related to CAM use for treatment among a nationally representative sample of African-Americans.
A cross-sectional study design was employed using the 2002 National Health Interview Survey (NHIS). A nationwide representative sample of adult (≥ 18 years) African-Americans who used CAM in the past 12 months (n= 16,113,651 weighted; n=2,952 unweighted) were included. The Andersen Healthcare Utilization Model served the framework with CAM use for treatment as the main outcome measure. Independent variables included: predisposing (e.g., age, gender, education), enabling (e.g., income, employment, access to care); need (e.g., health status, physician visits, prescription medication use); and disease state (i.e., most prevalent conditions among African-Americans) factors. Multivariate logistic regression was used to address the study objective.
Approximately one in five (20.2%) CAM past 12 month users used CAM to treat a specific condition. Ten of the 15 CAM modalities were used primarily for treatment by African-Americans. CAM for treatment was significantly (p<0.05) associated with the following factors: graduate education, smaller family size, higher income, region (northeast, midwest, west more likely than south), depression/anxiety, more physician visits, less likely to engage in preventive care, more frequent exercise behavior, more activities of daily living (ADL) limitations, and neck pain.
Twenty percent of African-Americans who used CAM in the past year were treating a specific condition. Alternative medical systems, manipulative and body-based therapies, as well as folk medicine, prayer, biofeedback, and energy/Reiki were used most often. Health care professionals should routinely ask patients about CAM use, but when encountering African-Americans, there may be a number of factors that may serve as cues for further inquiry.
PMCID: PMC2933406  PMID: 20813333
African-American; Andersen Healthcare Utilization Model; CAM; CAM for treatment complementary/alternative medicine
9.  Fluorescein-labeled glutathione to study protein S-glutathionylation 
Analytical biochemistry  2010;402(1):102-104.
Numerous studies of S-glutathionylation of cysteine thiols indicate that this protein modification plays a key role in redox regulation of proteins. To facilitate the study of protein S-glutathionylation, we developed a synthesis and purification to produce milligram quantities of fluorescein-labeled glutathione. The amino terminus of the glutathione tripeptide reacted with fluorescein isothiocyanate readily in ammonium bicarbonate. Purification by solid phase extraction on C8 and C18 columns separated excess reactants from desired products. Both oxidized and reduced fluorescein-labeled glutathione reacted with a variety of thiol containing proteins to yield fluorescent proteins.
PMCID: PMC2883778  PMID: 20156418
S-glutathionylation; glutathione; cysteine; fluorescein; biotinylation; thiol; disulfide
10.  Black race as a predictor of poor health outcomes among a national cohort of HIV/AIDS patients admitted to US hospitals: a cohort study 
In general, the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) population has begun to experience the benefits of highly active antiretroviral therapy (HAART); unfortunately, these benefits have not extended equally to Blacks in the United States, possibly due to differences in patient comorbidities and demographics. These differences include rates of hepatitis B and C infection, substance use, and socioeconomic status. To investigate the impact of these factors, we compared hospital mortality and length of stay (LOS) between Blacks and Whites with HIV/AIDS while adjusting for differences in these key characteristics.
The 1996–2006 National Hospital Discharge Surveys were used to identify HIV/AIDS patients admitted to US hospitals. Survey weights were incorporated to provide national estimates. Patients < 18 years of age, those who left against medical advice, those with an unknown discharge disposition and those with a LOS < 1 day were excluded. Patients were stratified into subgroups by race (Black or White). Two multivariable logistic regression models were constructed with race as the independent variable and outcomes (mortality and LOS > 10 days) as the dependent variables. Factors that were significantly different between Blacks and Whites at baseline via bivariable statistical tests were included as covariates.
In the general US population, there are approximately 5 times fewer Blacks than Whites. In the present study, 1.5 million HIV/AIDS hospital discharges were identified and Blacks were 6 times more likely to be hospitalized than Whites. Notably, Blacks had higher rates of substance use (30% vs. 24%; P < 0.001), opportunistic infections (27% vs. 26%; P < 0.001) and cocaine use (13% vs. 5%; P < 0.001). Conversely, fewer Blacks were co-infected with hepatitis C virus (8% vs. 12%; P < 0.001). Hepatitis B virus was relatively infrequent (3% for both groups). Crude mortality rates were similar for both cohorts (5%); however, a greater proportion of Blacks had a LOS > 10 days (21% vs. 19%; P < 0.001). Black race, in the presence of comorbidities, was correlated with a higher odds of LOS > 10 days (OR, 95% CI = 1.20 [1.10–1.30]), but was not significantly correlated with a higher odds of mortality (OR, 95% CI = 1.07 [0.93–1.25]).
Black race is a predictor of LOS > 10 days, but not mortality, among HIV/AIDS patients admitted to US hospitals. It is possible that racial disparities in hospital outcomes may be closing with time.
PMCID: PMC2736968  PMID: 19671170

Results 1-10 (10)