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1.  Illicit Drug Use, Depression and their Association with Highly Active Antiretroviral Therapy in HIV-Positive Women 
Drug and alcohol dependence  2007;89(1):74-81.
We examined the interaction of illicit drug use and depressive symptoms, and how they affect the subsequent likelihood of highly active antiretroviral therapy (HAART) use among women with HIV/AIDS.
Subjects included 1,710 HIV-positive women recruited from six sites in the U.S. including Brooklyn, Bronx, Chicago, Los Angeles, San Francisco/Bay Area, and Washington, DC. Cases of probable depression were identified using depressive symptom scores on the Centers for Epidemiologic Studies Depression Scale. Crack, cocaine, heroin, and amphetamine use were self-reported at 6-month time intervals. We conducted multivariate logistic random regression analysis of data collected during sixteen waves of semiannual interviews conducted from April 1996 through March 2004.
We found an interaction effect between illicit drug use and depression that acted to suppress subsequent HAART use, controlling for virologic and immunologic indicators, socio-demographic variables, time, and study site.
This is the first study to document the interactive effects of drug use and depressive symptoms on reduced likelihood of HAART use in a national cohort of women. Since evidence-based behavioral health and antiretroviral therapies for each of these three conditions are now available, comprehensive HIV treatment is an achievable public health goal.
PMCID: PMC4009351  PMID: 17291696
HIV; depression; HAART; drug use
2.  Biologic markers of ovarian reserve and reproductive aging: application in a cohort study of HIV infection in women 
Fertility and sterility  2007;88(6):1645-1652.
To compare Müllerian inhibiting substance (MIS) levels in serum obtained during the early follicular phase to those obtained randomly during the menstrual cycle. To determine if HIV infection influences early follicular MIS levels, an early marker of ovarian aging.
A cross-sectional study
Women’s Interagency HIV Study, a multicenter prospective study
Serum samples obtained from 263 (187 HIV infected and 76 uninfected) participants of the Women’s Interagency HIV Study who reported menstrual bleeding during the preceding 6 months and who were not taking exogenous hormones.
Early follicular (cycle day 2–5) MIS samples were compared with serum samples that had been obtained without regard to menstrual cycle phase. Comparison samples were obtained within 6 weeks prior to and/or within 3 to 6 months after the early follicular samples. Early follicular FSH, estradiol, inhibin B and MIS levels were also compared between the HIV infected and uninfected women.
Main Outcomes
Correlation between early follicular MIS and prior and subsequent samples. Comparison of serum markers of ovarian reserve between HIV positive and negative women.
MIS values from early follicular and other random cycle phases were highly correlated with each other (r>0.93, p<0.0001). In multivariate analysis, increased age and FSH level and lower inhibin B levels were associated with lower MIS level; MIS values did not vary by HIV serostatus.
MIS without regard to cycle phase was similar during early follicular phase and highly correlated with early follicular FSH and inhibin B in women with and without HIV. Measurement of serum MIS offers a simplified method of determining ovarian reserve using specimens obtained without menstrual phase timing. Furthermore, using biologic measures of reproductive aging, we found no evidence that HIV infection influences ovarian aging.
PMCID: PMC2682326  PMID: 17418155
3.  Awareness of Hepatitis C Infection Among Women With and At Risk for HIV 
Journal of General Internal Medicine  2007;22(12):1689-1694.
Treatment guidelines recommend all HIV/HCV-co-infected persons be considered for hepatitis C virus (HCV) treatment, yet obstacles to testing and accessing treatment for HCV continue for women.
To assess awareness of HCV, and describe diagnostic referrals and HCV treatment among women in the Women’s Interagency HIV Study (WIHS).
Prospective epidemiologic cohort.
Of 3,768 HIV-infected and uninfected women in WIHS, 1,166 (31%) were HCV antibody positive.
Awareness of HCV infection and probability of referrals for diagnostic evaluations and treatment using logistic regression. Follow-up HCV information was available for 681 (390 died, 15 withdrew, 80 missed visit) in 2004. Of these 681, 522 (76.7%) reported knowing their HCV diagnosis. Of these, 247 of 522 (47.3%) stated their providers recommended a liver biopsy, whereas 139 of 247 or 56.3% reported having a liver biopsy. A total of 170 of 522 (32.6%) reported being offered treatment and 74.1% (n = 126 of 170) reported receiving HCV treatment. In multivariate regression analyses, African-American race, Hispanic/Latina ethnicity, poverty, and current crack/cocaine/heroin use were negatively associated with treatment referrals, whereas elevated alanine aminotransferase (ALT) was associated with increased likelihood of referral and increased likelihood of treatment.
One quarter of women with HCV in this cohort were not aware of their diagnosis. Among those aware of their HCV, 1 in 4 received liver biopsy and treatment for HCV. Both provider and patient education interventions regarding HCV testing and HCV treatment options and guidelines are needed to enhance HCV awareness and participation in HCV evaluation and treatment.
PMCID: PMC2219830  PMID: 17924170
women; hepatitis C; HIV; race; drug use; therapy
4.  Obesity and Immune Cell Counts in Women 
Obesity is common in women and associated with a number of adverse health outcomes including cardiovascular disease, infectious diseases, and cancer. We explore the relationship between obesity and immune cell counts in women.
Longitudinal study of 322 women from 1999 through 2003 enrolled as HIV-negative comparators in the Women’s Interagency HIV Study.
Body mass index (BMI) was categorized as normal weight (BMI 18.5 - 24.9), overweight (BMI 25 - 29.9), obese (BMI 30 - 34.9), and morbid obesity (BMI ≥35). CD4 and CD8 counts and percents, total lymphocyte and white blood cell (WBC) counts were measured annually using standardized techniques. A mixed model repeated measures analysis was performed using an autoregressive correlation matrix.
At the index visit, 61% of women were African-American; mean age was 35 years, and median BMI was 29 kg/m2. Immunologic parameters were in the normal range (median CD4 count: 995 cells/mm3; CD8 count: 488 cells/mm3; total lymphocyte count: 206 cells/mm3; median WBC: 6 × 103 cells/mm3). In multivariate analyses, being overweight, obese or morbidly obese were independently associated with higher CD4, total lymphocyte, and WBC counts than being normal weight; morbid obesity was associated with a higher CD8 count. The strongest associations between body weight and immune cell counts were demonstrated in the morbidly obese.
Increasing body weight is associated with higher CD4, CD8, total lymphocyte, and WBC counts in women. Investigation into the impact of obesity on immune function and long term adverse outcomes is needed.
PMCID: PMC1939725  PMID: 17570264

Results 1-4 (4)