Catalina Ramirez

Oral diseases are prevalent and linked to systemic health outcomes. People with HIV may face elevated oral disease risk, yet data on dental disease in this

Objective: This study compares rates of menopausal hormone therapy (MHT) initiation between perimenopausal and postmenopausal women with moderate–severe vasomotor symptoms (VMS) with and without substance use in a longitudinal cohort of diverse US women with or without HIV. Methods: Using menopause symptoms, hormone use, and substance use data from Women's Interagency HIV Study biannual visits (10/2008–9/2019), we compared initiation of and breaks in MHT among participants with moderate–severe VMS (1) with or without current substance use and (2) with or without ever using substances. We calculated unadjusted rates and adjusted rate ratios (RR) for demographics and health variables using Poisson regression. Results: The median age of participants ( n = 1579) with moderate–severe VMS was 50 years old, with 73% living with HIV, and 68% identifying as Black. They reported ever using tobacco (76%), heavy alcohol (39%), cannabis (45%), and other drugs (43%). Few reported hormonal contraception (5%) or MHT (9%) during the study period. Hormone initiation (overall 3.53 per 100 person‐years; 95% confidence interval [CI]: 2.93, 4.26) was less likely with current tobacco use (RR: 0.67, 95% CI: 0.45, 0.99) or ever using other drugs (RR: 0.61; 95% CI: 0.40, 0.91). Hormone breaks (overall 52.58 per 100 person‐years [95% CI: 44.52, 61.90]) were not associated with substance use. Conclusion: The rate of MHT initiation was low and the rate of MHT breaks was high in this sample of perimenopausal and postmenopausal participants with moderate–severe VMS. Patients and providers might benefit from specific guidance regarding MHT use among individuals with current tobacco use and those who have ever used other drugs.

The MACS and WIHS cohort studies merged to form the MACS/WIHS Combined Cohort Study (MWCCS) in 2019. We calculated the proportion of active MACS and WIHS participants seen October 2017-September 2019 (pre-merger) who enrolled in the MWCCS between October 2020-September 2024. Pre-merger, there were 4286 active participants: MACS (N=2038) and WIHS (N=2248). Complementary log-log regression was used to estimate factors associated with enrollment. Active participants pre-merger were 54% female, 62% living with HIV, 78% aged 45-74 years, with a median study follow-up of 17 years. Most historic MACS (81%) and WIHS (89%) participants enrolled in MWCCS, with 75% enrolling during the first year. Enrollment did not significantly differ by HIV serostatus, behavioral or socio-demographic characteristics. Most health-related factors were not associated with enrollment, including comorbidities (e.g., diabetes, hypertension) and HIV-specific clinical factors (i.e., CD4+ T cell count, viral suppression, antiretroviral therapy use). Factors associated with lower enrollment included age ≥75 years (aHR=0.68, 95%CI=0.55-0.83) and being underweight (BMI<18.5 kg/m2), (aHR=0.64, 95%CI=0.45-0.88). Despite challenges inherent in merging two long-standing cohorts and with enrollment beginning during the COVID-19 pandemic, overall high retention across key participant characteristics demonstrate a strong foundation for the continued study of HIV-related morbidity and mortality in the MWCCS.

Background: Tenofovir-diphosphate (TFV-DP) in dried blood spots (DBS) is an objective drug concentration measure which is predictive of future viremia in virally-suppressed persons with HIV (PWH) on TFV-based antiretroviral therapy (ART). Viral load (VL):TFV-DP mismatch (suppressed VL despite low TFV-DP concentrations) may increase future viremia risk. Previously, Black race, male sex, and higher body mass index were associated with lower TFV-DP concentrations among PWH receiving tenofovir disoproxil fumarate (TDF). The aim of this study was to assess mismatch rates in PWH on tenofovir alafenamide (TAF). Methods: DBS samples were obtained from Multicenter AIDS Cohort Study/Women’s Interagency HIV Study Combined Cohort participants receiving TAF-based ART for ≥3 months. Associations between pre-specified covariates and pharmacologic virologic mismatch (plasma VL <200 copies/mL and intracellular TFV-DP concentrations <1800 fmol/punches), were evaluated using logistic regression. Results: DBS was measured in 627 PWH (63% female) and median [IQR] age 55 [47-61] years. TFV-DP for VL 200 copies/mL was 2,375 [1,493-3,340] and 264 [13-949] fmol/punches, respectively. Females experienced 39% mismatch. Higher estimated glomerular filtration rate (eGFR; +15 mL/minute/1.73 m2), weight (+15 kg), and lower self-reported adherence (<95%) were associated with higher mismatch odds: 1.77 (1.40-2.28), 1.32 (1.11-1.57), and 5.12 (2.16-12.90), respectively. Males experienced 27% mismatch. Higher eGFR, weight, Black race, and lower adherence were associated with higher mismatch odds: 1.75 (1.22-2.62), 1.66 (1.19-2.39), 7.53 (2.87-22.28), and 9.61 (2.17-51.95), respectively. Conclusions: Weight, eGFR, self-reported adherence and Black race in males were associated with mismatch. These characteristics should be considered when designing adherence interventions.

HIV infection is known to increase the risk for cardiovascular disease (CVD). Although almost 400 single-nucleotide polymorphisms (SNPs) are significantly associated with CAD alone, a subtype of CVD, the functions of most of these risk loci are unclear. Here, we investigated the impact of genetic variants/SNPs on the expression of nearby genes as potential cis expression quantitative trait loci (cis-eQTLs). We investigated peripheral blood mononuclear cells (PBMCs) from 31 participants in the Women’s Interagency HIV Study (WIHS) using genotyping, single-cell (sc)RNA-seq, and CITE-seq. We found 187 statistically significant sc-eQTLs (single-cell eQTLs). In total, 160 were specific for just one immune cell type. We found a set of 3 sc-eQTLs impacting expression of IFNGR1 in CD4+ T cells at the mRNA and protein level as detected by flow cytometry. Two other sc-eQTLs representing one locus impact IFNG expression in CD8+ T cells, one of the primary sources of this cytokine. The sc-eQTLs impacting IFNG were associated with Th1 (T-helper1) gene expression patterns in CD4+ T cells in this cohort. These data suggest that some individuals are genetically predisposed to greater levels of Th1 polarization, which is known to be associated with atherosclerosis.

As women living with HIV (WWH) age, screening for common comorbid conditions is increasingly important. However, gaps exist in how best to support mammography adherence among WWH. To examine relationships between health care empowerment (HCE) and mammography adherence, we analyzed data from the Women's Interagency HIV Study. HCE is defined as (a) being informed, committed, collaborative, and engaged in one's health care and (b) tolerant of uncertainties in treatment outcomes. Of 846 WWH, 68.7% reported mammogram receipt over a 2-year period following HCE scale completion. Multiple logistic regression analysis found that women reporting mammograms had higher informed, committed, collaborative, and engaged in one's health care scores than those who did not (adjusted odds ratio = 1.10, 95% confidence interval = 1.02–1.20, p = .02), adjusting for model covariates. Being tolerant of uncertainties in treatment outcomes was not associated with mammogram receipt. These findings expand research on modifiable determinants of mammography screening, the role of HCE, and can inform interventions to improve health outcomes among WWH.

Background: To reduce atherosclerotic cardiovascular disease (ASCVD) among US people with human immunodeficiency virus (HIV, PWH), it is critical to assess shortfalls in statin initiation. We aimed to describe patterns in clinically indicated statin initiation among demographically similar people with or at increased vulnerability to HIV. Methods: Using data from the Multicenter AIDS Cohort Study and Women's Interagency HIV Study, we followed 842 men and 852 women with an indication for statin use based on 2013 American College of Cardiology/American Heart Association guidelines for statin initiation between January 2014 and March 2020. We estimated 2-year incidence of statin initiation stratified by demographic, clinical, and behavioral characteristics and compared estimates using incidence differences. Results: Within 2 years of statin indication, 20% of participants reported statin use. Initiation of statin therapy did not differ significantly by HIV status. However, initiation was lower among Black versus non-Black persons, especially among men (14.0% versus 22.3%; difference, −8.3%; 95% confidence interval, −13.8% to −2.8%). Compared with initiation among persons indicated based only on ≥7.5% 10-year predicted ASCVD risk (incidence: men, 14.2%; women, 15.2%), initiation was higher among those with existing ASCVD (incidence: men, 32.9%; women, 22.0%) or diabetes (incidence: men, 26.4%; women, 24.5%). Initiation was lower among current versus noncurrent smokers and higher among those with comorbidities. Conclusions: Guideline-driven statin initiation was low, with large inequities by race. With indications for statin use expanding for PWH, redressing barriers to guideline implementation will be crucial to achieving improved outcomes through uptake of these evidence-based therapies.

Background: Depression affects 33% of women with type 2 diabetes (T2D) and leads to increased risks of premature mortality. Fluctuation and variation of depressive presentations can hinder clinical identification. Purpose: We aimed to identify and examine subgroups characterized by distinct depressive symptom trajectories among women with T2D. Methods: This retrospective analysis leveraged the Women’s Interagency HIV Study data to identify depressive symptom trajectories based on the Center for Epidemiological Studies Depression scores (2014-2019) among women with and without HIV. Descriptive statistics characterized sample demographics (eg, age, race, income), clinical indices (eg, hemoglobin A1C [HbA1c], BMI, HIV status), and psychosocial experiences (eg, discrimination, social support, anxiety, pain). We used growth mixture modeling to identify groups defined by distinct depressive symptom trajectories and parametric and non-parametric tests to examine demographic, clinical, and psychosocial differences across subgroups. Results: Among the 630 women included, the mean age was 50.4 (SD = 8.3) years, 72.4% identified as Black and non-Hispanic, and 68.2% were living with HIV. Five subgroups were identified and distinguished by severity and symptom type. Participants with lower incomes (P = .01), lower employment (P < .0001), lower social support (P = .0001), and experiences of discrimination (P < .0001) showed greater membership in threshold, moderate, and severe depressive subgroups. Subgroup membership was not associated with metabolic indices (BMI, HbA1c) or HIV status. Anxiety, pain, and loneliness (all P = .0001) were worse in subgroups with higher depressive symptoms. Conclusions: Among women with T2D, depressive symptom trajectories differ across clinical and social contexts. This study advances precision by delineating subgroups within a broad clinical category.

We studied cervicovaginal β-/γ-human papillomavirus (HPV) and their relationship to cervical precancer in women with HIV (WWH); having previously reported strong positive associations of β-/γ-HPV with incident head and neck cancer in the general population. Cases (N=124) had cervical intraepithelial neoplasia (CIN)-3 or CIN-2. Controls (N=247) were individually matched 2:1 to cases. Unexpectedly, multivariate analyses found strong inverse associations between β-/γ-HPV and CIN-2/CIN-3 (OR=0.19; 95% CI 0.04-0.86; P=0.03) with P_trend<0.01. This is, to our knowledge, the first study of β-/γ-HPV and cervical precancer. If confirmed, a strong inverse (protective) association would be of potential clinical and biologic relevance.