Publications by authors named "Margaret A Fischl"

Background: Studies suggest that the use of race-specific pulmonary function reference equations may obscure racial inequities in respiratory health. Whether removing race from the interpretation of pulmonary function would influence analyses of HIV and pulmonary function is unknown.

Setting: Pulmonary function measurements from 1,067 men (591 with HIV) in the Multicenter AIDS Cohort Study (MACS) and 1,661 women (1,175 with HIV) in the Women's Interagency HIV Study (WIHS) were analyzed.

View Article and Find Full Text PDF

Causal inference methods can be applied to estimate the effect of a point exposure or treatment on an outcome of interest using data from observational studies. For example, in the Women's Interagency HIV Study, it is of interest to understand the effects of incarceration on the number of sexual partners and the number of cigarettes smoked after incarceration. In settings like this where the outcome is a count, the estimand is often the causal mean ratio, i.

View Article and Find Full Text PDF

Objective: Diabetes mellitus (DM) is associated with lower antiretroviral (ART) drug exposure among persons with HIV (PWH) compared to PWH without DM. The association between DM and virologic control in PWH, however, remains unknown.

Methods: We included participants in the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) who had initiated ART between 1999 and 2020 and had a suppressed HIV viral load (≤200 copies/ml) within 1 year of ART initiation.

View Article and Find Full Text PDF

Hypermutated proviruses, which arise in a single HIV replication cycle when host antiviral APOBEC3 proteins introduce extensive G-to-A mutations throughout the viral genome, persist in all people living with HIV receiving antiretroviral therapy (ART). But, the within-host evolutionary origins of hypermutated sequences are incompletely understood because phylogenetic inference algorithms, which assume that mutations gradually accumulate over generations, incorrectly reconstruct their ancestor-descendant relationships. Using > 1400 longitudinal single-genome-amplified HIV sequences isolated from six women over a median 18 years of follow-up - including plasma HIV RNA sequences collected over a median 9 years between seroconversion and ART initiation, and > 500 proviruses isolated over a median 9 years on ART - we evaluated three approaches for removing hypermutation from nucleotide alignments.

View Article and Find Full Text PDF
Article Synopsis
  • The study investigates how race/ethnicity and HIV status affect hypertension outcomes, focusing on awareness, treatment, and control among women.
  • The research involved cisgender women living with HIV and matched women without HIV, evaluating data from the Women's Interagency HIV Study between 2013 and 2019.
  • Results indicate that while non-Hispanic black women quickly recognized their hypertension, they took longer to manage it, whereas women with HIV were quicker to receive treatment compared to those without HIV.
View Article and Find Full Text PDF

Hepatitis C virus (HCV) infection is associated with extrahepatic effects, including reduced diffusing capacity of the lungs. It is unknown whether clearance of HCV infection is associated with improved diffusing capacity. In this sample of women with and without human immunodeficiency virus, there was no association between HCV clearance and diffusing capacity.

View Article and Find Full Text PDF

Background: Steatohepatitis is common in persons living with HIV and may be associated with gut microbial translocation (MT). However, few studies have evaluated the gut-liver axis in persons living with HIV. In the Women's Interagency HIV Study, we examined the associations of HIV and circulating biomarkers linked to MT and gut damage using the FibroScan-aspartate aminotransferase (FAST) score, a noninvasive surrogate for steatohepatitis with advanced fibrosis.

View Article and Find Full Text PDF

Long COVID (LongC) is associated with a myriad of symptoms including cognitive impairment. We reported at the beginning of the COVID-19 pandemic that neuronal-enriched or L1CAM+ extracellular vesicles (nEVs) from people with LongC contained proteins associated with Alzheimer's disease (AD). Since that time, a subset of people with prior COVID infection continue to report neurological problems more than three months after infection.

View Article and Find Full Text PDF
Article Synopsis
  • * The study analyzed IgG N-glycans in over 1200 individuals, revealing that PLWH show more significant glycan changes associated with aging and inflammation compared to those without HIV.
  • * These glycan alterations are linked to higher inflammation markers and worse health outcomes, suggesting they could be used to develop new biomarkers to help monitor and prevent age-related diseases in PLWH.
View Article and Find Full Text PDF

Women living with HIV (WLWH) are often coinfected with (TV), and annual screening is recommended. Our goal was to assess differences in TV prevalence at study entry and over time in enrollment cohorts of the Women's Interagency HIV Study. In a multisite study, TV was diagnosed by wet mount microscopy.

View Article and Find Full Text PDF
Article Synopsis
  • HIV populations in untreated infections diversify continuously, and this diversity remains even during antiretroviral therapy (ART), which is crucial for understanding HIV persistence and potential cures.
  • In a study involving seven participants, researchers examined the evolutionary history of HIV in blood over 12 years on ART, revealing that proviral diversity generally increased while some clones persisted long-term.
  • The findings suggest that while the overall pool of proviruses is stable, the replication-competent HIV reservoir is a smaller, genetically restricted subset, emphasizing the need to differentiate these two for effective HIV cure strategies.
View Article and Find Full Text PDF
Article Synopsis
  • The study investigates the prevalence and management of hypertension among women living with HIV, focusing on differences across race/ethnicity.
  • About 56% of the 712 women studied had hypertension, with a notable 83% awareness of their condition, and 63% of those treated effectively controlled their blood pressure.
  • Results showed that non-Hispanic Black women had the highest hypertension prevalence, while Hispanic women had the lowest, and women with HIV were more likely to be on antihypertensive medication compared to those without HIV.
View Article and Find Full Text PDF
Article Synopsis
  • - The study examines how menopause affects cardiovascular risk in women with HIV, focusing on changes in carotid artery intima-media thickness (CIMT) over time.
  • - Among the 979 women studied from 2004 to 2019, those with HIV who went through menopause showed a significant increase in CIMT, particularly during the menopausal transition phase.
  • - The findings suggest that menopause may speed up the development of subclinical atherosclerosis in women with HIV, highlighting a need for increased awareness and monitoring during this period.
View Article and Find Full Text PDF

Background: We investigated whether there exists an association between dietary acid load and kidney function decline in women living with HIV (WLWH) receiving antiretroviral therapy (ART).

Setting: One thousand six hundred eight WLWH receiving ART in the WIHS cohort with available diet data and a baseline estimated glomerular filtration rate (eGFR) ≥15 mL/minute/1.73 m2.

View Article and Find Full Text PDF
Article Synopsis
  • The study investigates the link between antiretroviral therapy (ART) and depressive symptoms in women with HIV, focusing on both somatic and nonsomatic symptoms.
  • It analyzes data from the Women's Interagency HIV Study, categorizing participants into groups based on their depression screening results and utilizing advanced Bayesian machine learning methods to evaluate ART's impact.
  • Results show that certain ART combinations are linked to higher somatic depressive symptoms in women with chronic depression, while no associations were found in those with infrequent or no depression, highlighting the need for future research on specific symptoms and drug combinations.
View Article and Find Full Text PDF

Within-host HIV populations continually diversify during untreated infection, and members of these diverse forms persist within infected cell reservoirs, even during antiretroviral therapy (ART). Characterizing the diverse viral sequences that persist during ART is critical to HIV cure efforts, but our knowledge of on-ART proviral evolutionary dynamics remains incomplete, as does our understanding of the differences between the overall pool of persisting proviral DNA (which is largely genetically defective) and the subset of intact HIV sequences capable of reactivating. Here, we reconstructed within-host HIV evolutionary histories in blood from seven participants of the Women's Interagency HIV Study (WIHS) who experienced HIV seroconversion.

View Article and Find Full Text PDF

People with HIV (PWH) experience an increased vulnerability to premature aging and inflammation-associated comorbidities, even when HIV replication is suppressed by antiretroviral therapy (ART). However, the factors that contribute to or are associated with this vulnerability remain uncertain. In the general population, alterations in the glycomes of circulating IgGs trigger inflammation and precede the onset of aging-associated diseases.

View Article and Find Full Text PDF

Importance: Despite aging-related comorbidities representing a growing threat to quality-of-life and mortality among persons with HIV (PWH), clinical guidance for comorbidity screening and prevention is lacking. Understanding comorbidity distribution and severity by sex and gender is essential to informing guidelines for promoting healthy aging in adults with HIV.

Objective: To assess the association of human immunodeficiency virus on the burden of aging-related comorbidities among US adults in the modern treatment era.

View Article and Find Full Text PDF

Background And Objective: Observations of overweight and obesity in association with neuropsychological performance (NP) vary over the adult life course depending on baseline levels, biological sex, age, race, temporality of measurements, and other factors. Therefore, similar published analyses across cohorts are inconsistent. In our sample of women living with HIV (WLWH) and women without HIV (WWOH), we conducted comparable analyses as those published in men with and without HIV.

View Article and Find Full Text PDF

Background: To evaluate the effect of cumulative human immunodeficiency virus (HIV)-1 viremia on aging-related multimorbidity among women with HIV (WWH), we analyzed data collected prospectively among women who achieved viral suppression after antiretroviral therapy (ART) initiation (1997-2019).

Methods: We included WWH with ≥2 plasma HIV-1 viral loads (VL) <200 copies/mL within a 2-year period (baseline) following self-reported ART use. Primary outcome was multimorbidity (≥2 nonacquired immune deficiency syndrome comorbidities [NACM] of 5 total assessed).

View Article and Find Full Text PDF

Increased life expectancy of people with HIV has health implications including the intersection of the long-term use of antiretroviral treatment, inflammatory events, and age-related immunosenescence. In a cross-sectional study utilizing using the Socio-Eecological Model, we identified pathways of cognitive function (CF) among 448 women with HIV, 50 years and older. A structural equation model showed the direct effects of mood (β = -0.

View Article and Find Full Text PDF
Article Synopsis
  • This study examined the cardiovascular health of women with HIV compared to those without, focusing on various heart conditions using echocardiography in the Women's Interagency HIV Study.
  • Of the 1,654 participants, about 70% had HIV, with findings revealing a higher risk of left ventricular systolic dysfunction (LVSD) in women with HIV, particularly as their CD4+ count decreased.
  • The results suggest that while women with HIV do have an increased risk for certain heart issues, especially at lower immune cell counts, it emphasizes the need for both heart health monitoring and HIV management in this population.
View Article and Find Full Text PDF
Article Synopsis
  • The study aimed to determine if substance use is a factor that mediates the connection between gender-based violence (GBV) and poor adherence to antiretroviral therapy (ART) or missed HIV care appointments among women living with HIV (WLHIV) in the US.
  • Researchers analyzed data from 1,717 WLHIV over four years, focusing on their experiences with GBV, substance use, and their HIV treatment adherence.
  • Findings revealed that women who experienced GBV were more likely to have suboptimal ART adherence and miss care appointments, with substance use explaining a significant portion of this relationship; thus, addressing both substance abuse and GBV is crucial for improving HIV care for these women
View Article and Find Full Text PDF

There is an unmet need for a point-of-care test that is accurate, affordable, and simple to diagnose bacterial vaginosis, the most common cause of vaginal symptoms among women. Bacterial vaginosis leaves patients with undesirable vaginal discharge, malodor, and discomfort. Currently, the diagnosis of bacterial vaginosis is inaccurate and complex, leading to high rates of misdiagnosis.

View Article and Find Full Text PDF
Article Synopsis
  • HIV affects lung health, but the long-term effects on pulmonary function patterns are unclear, prompting a study of individuals with HIV over 8 years to track changes in lung function.* -
  • The study identified different trajectories for lung function measurements, revealing that some individuals experience a slow decline while others experience a rapid decline, with distinct patterns associated with other health issues like dyspnea and mortality.* -
  • Factors like current smoking and history of smoking were linked to worse outcomes in lung function, highlighting the influence of lifestyle choices on health in individuals living with HIV.*
View Article and Find Full Text PDF