Ellie E Schoenbaum

Albert Einstein College of Medicine, New York, New York, United States

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Publications (134)1065.11 Total impact

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    ABSTRACT: Research projects in translational science are increasingly complex and require interdisciplinary collaborations. In the context of training translational researchers, this suggests that multiple mentors may be needed in different content areas. This study explored mentoring structure as it relates to perceived mentoring effectiveness and other characteristics of master's-level trainees in clinical-translational research training programs. A cross-sectional online survey of recent graduates of clinical research master's program was conducted. Of 73 surveys distributed, 56.2% (n = 41) complete responses were analyzed. Trainees were overwhelmingly positive about participation in their master's programs and the impact it had on their professional development. Overall the majority (≥75%) of trainees perceived they had effective mentoring in terms of developing skills needed for conducting clinical-translational research. Fewer trainees perceived effective mentoring in career development and work-life balance. In all 15 areas of mentoring effectiveness assessed, higher rates of perceived mentor effectiveness was seen among trainees with ≥2 mentors compared to those with solo mentoring (SM). In addition, trainees with ≥2 mentors perceived having effective mentoring in more mentoring aspects (median: 14.0; IQR: 12.0-15.0) than trainees with SM (median: 10.5; IQR: 8.0-14.5). Results from this survey suggest having ≥2 mentors may be beneficial in fulfilling trainee expectations for mentoring in clinical-translational training. Clin Trans Sci 2015; Volume #: 1-8.
    Clinical and Translational Science 11/2015; DOI:10.1111/cts.12343 · 1.43 Impact Factor
  • Anjali Sharma · Peter L Flom · Clifford J Rosen · Ellie E Schoenbaum ·
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    ABSTRACT: To characterize changes in bone mineral density (BMD) according to race among HIV-infected and uninfected women, and to evaluate the relationship between race and menopause-related bone loss. Dual x-ray absorptiometry measured BMD on study entry and a minimum of 18 months later in 246 HIV-infected and 219 HIV-uninfected women in the Menopause Study. Linear regression analyses determined percent annual BMD change at total hip (TH), femoral neck (FN), and lumbar spine (LS) after adjusting for potential confounders. Race-stratified and HIV-infected subgroup analyses were performed. At baseline, mean age was 45 years, 19% of women were postmenopausal. HIV-infected women were more likely to be black (58% vs. 38%), and had lower BMI and less cigarette exposure when compared to HIV-uninfected women. Women who were perimenopausal at baseline and postmenopausal at follow-up had the greatest TH bone loss (-1.68%/yr, p<.0001) followed by those postmenopausal throughout (-1.02%/yr, p=.007). We found a significant interaction between HIV status and race in multivariate analyses of BMD change at the FN and TH. In race-stratified analyses, HIV infection was associated with TH BMD loss in non-black women. Black women experienced greater menopause-associated decline in TH BMD compared with non-black women. The association of HIV and BMD differs strikingly by race, as do the effects of the menopausal transition on bone. Determining the extent to which the effect of HIV on fracture risk varies by race will be crucial to identify HIV-infected women at greatest risk for osteoporotic fracture, particularly as they enter menopause. Copyright © 2015. Published by Elsevier Inc.
    Bone 04/2015; 77. DOI:10.1016/j.bone.2015.04.018 · 3.97 Impact Factor
  • Sh Factor · Y Lo · E Schoenbaum · Rs Klein ·
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    ABSTRACT: Objectives: Antiretroviral (ARV) therapy has prolonged the life expectancy of HIV-infected persons, increasing their risk of age-associated diseases, including atherosclerosis (AS). Decreased risk of AS has been associated with the prevention and control of hypertension (HTN). We conducted a cohort study of perimenopausal women and older men with or at risk of HIV infection to identify risk factors for incident HTN. Methods: Standardized interviews, physical examinations, and laboratory examinations were scheduled at 6-month intervals. Interview data included demographics, medical, family, sexual behaviour and drug use histories, and physical activity. Results: There were 330 women and 329 men eligible for inclusion in the study; 27% and 35% of participants developed HTN during a median follow-up period of 1080 and 1071 days, respectively. In gender-stratified analysis, adjusting for traditional HTN risk factors (age, race, body mass index, smoking, diabetes, family history of HTN, alcohol dependence, physical activity and high cholesterol), HIV infection was not associated with incident HTN in women [hazard ratio (HR) 1.31; 95% confidence interval (CI) 0.56, 3.06] or men (HR 1.67; 95% CI 0.75, 3.74). Among HIV-infected women, although exposure to ARVs was not significantly associated with incident HTN (HR 0.72; 95% CI 0.26, 1.99), CD4 T-cell count was positively associated with incident HTN (HR 1.15 per 100 cells/μL; 95% CI 1.03, 1.28). Among physically active HIV-infected men, exposure to ARVs was negatively associated with incident HTN (HR 0.15; 95% CI 0.03, 0.78). Conclusions: HIV infection was not associated with incident HTN in older men or women. This study provides additional evidence supporting a causal relationship between immune function and incident HTN, which warrants further study.
    HIV Medicine 01/2013; 14(6). DOI:10.1111/hiv.12010 · 3.99 Impact Factor
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    ABSTRACT: Bacterial pneumonia risk is disproportionately high among those infected with HIV. This risk is present across all CD4(+) T-cell levels (TCLs), suggesting that additional factors govern susceptibility. This study examines CD8(+) TCLs and risk for HIV-associated bacterial pneumonia and all-cause mortality. Demographic, clinical, and laboratory data were obtained for 885 HIV-infected women enrolled in the HIV Epidemiologic Research Study (HERS). Bacterial pneumonia cases were identified using clinical, microbiological, and radiographic criteria. CD8(+) TCLs were assessed at 6-month intervals. Statistical methods included Cox proportional hazards regression modeling and covariate-adjusted survival estimates. Relative to a referent CD8(+) TCL of 401-800 cells per cubic millimeter, risk for bacterial pneumonia was significantly higher when CD8(+) TCLs were <400 (hazard ratio 1.65, P = 0.017, 95% confidence interval 1.10 to 2.49), after adjusting for age, CD4(+) TCL, viral load, and antiretroviral use. There was also a significantly higher risk of death when CD8(+) TCLs were ≤400 cells per cubic millimeter (hazard ratio 1.45, P = 0.04, 95% confidence interval 1.02 to 2.06). Covariate-adjusted survival estimates revealed shorter time to pneumonia and death in this CD8(+) TCL category, and the overall associations of the categorized CD8(+) TCL with bacterial pneumonia and all-cause mortality were each statistically significant (P = 0.017 and P < 0.0001, respectively). CD8(+) TCL ≤400 cells per cubic millimeter was associated with increased risk for pneumonia and all-cause mortality in HIV-infected women in the HERS cohort, suggesting that CD8(+) TCL could serve as an adjunctive biomarker of pneumonia risk and mortality in HIV-infected individuals.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 02/2012; 60(2):191-8. DOI:10.1097/QAI.0b013e31824d90fe · 4.56 Impact Factor
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    ABSTRACT: An analysis of data from a prospective study of 1257 high-risk women revealed 7 predictors of discordance between self-reported lack of recent exposure to semen and detection of spermatozoa on Gram stain, suggesting that inaccuracies in the reporting of sexual behaviors cannot be assumed to be distributed randomly.
    Sexually transmitted diseases 10/2011; 38(10):909-12. DOI:10.1097/OLQ.0b013e318223be4b · 2.84 Impact Factor
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    Anjali Sharma · Hillel W Cohen · Ruth Freeman · Nanette Santoro · Ellie E Schoenbaum ·
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    ABSTRACT: We undertook a prospective study to assess the impact of HIV infection on BMD in a cohort of HIV-infected and uninfected women that included illicit drug users, and to measure the contribution of traditional risk factors as well as HIV-related factors to loss of BMD over time. We analyzed BMD at baseline and after ≥18 months in 245 middle-aged HIV-infected and 219 uninfected women, and conducted linear regression analysis to determine factors associated with annual BMD change at the femoral neck, total hip and lumbar spine. HIV-infected women had lower baseline BMD at the femoral neck and total hip compared with controls; unadjusted rates of BMD change did not differ by HIV status at any site. In multivariable analyses, we found that HIV seropositivity without protease inhibitor (PI) use was associated with BMD decline at the lumbar spine (-.009g/cm(2) per year, p=.03). Additional factors associated with BMD decline were: postmenopausal status, lower BMI, and methadone use at the lumbar spine; postmenopausal status and hepatitis C seropositivity at the femoral neck; and postmenopausal status, age, smoking, and lower BMI at the total hip (all p<.05). Among HIV-infected women, ≥3 years of PI use was associated with an increase in lumbar spine BMD (.013g/cm(2) per year, p=.008). Bone loss among HIV-infected middle-aged women was modest, and possibly mitigated by PI use. Methadone use was associated with BMD decline, and should be considered when evaluating women for osteoporosis risk.
    Maturitas 09/2011; 70(3):295-301. DOI:10.1016/j.maturitas.2011.08.003 · 2.94 Impact Factor
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    M. Gallo · L. Warner · C. King · J. Sobel · A. Rompalo · S. Cu-Uvin · R. Klein · E. Schoenbaum · D. Jamieson ·
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    ABSTRACT: Objectives (1) To identify correlates of incident Bacterial vaginosis (BV) among high-risk women and (2) to identify predictors of discordance between self-reported lack of semen exposure in the past 6 months and the detection of spermatozoa on Gram stain, which provides biological evidence of recent exposure. Methods Analyses were based on among 871 HIV-infected and 439 HIV-uninfected women participating in HIV Epidemiology Research Study (HERS) which was conducted in 4 sites in the US Participants completed study visits conducted at baseline and at 6-month intervals thereafter. We conducted both cohort and case-crossover analyses, stratified by HIV infection status, to evaluate potential correlates of incident BV. We also used logistic regression to identify predictors of discordance between self-reported lack of exposure to semen and the detection of spermatozoa on Gram stain. Results BV incidence was 21% among HIV-infected women and 19% among HIV-uninfected women. We found fewer correlates of incident BV when assessed with a case-crossover design than with a cohort design. Reporting frequent coitus (regardless of consistency of condom use) was correlated with incident BV in the cohort analyses but not in the case-crossover analyses. The sole correlate that emerged in both the cohort and case-crossover analyses among HIV-infected and -uninfected women was the detection of spermatozoa on Gram stain. Seven factors were associated with discordance between self-reported semen exposure and spermatozoa detection in the multivariable analysis. Discordance differed by study site and race/ethnicity and was more common among younger women. The following infections or conditions also were predictive of discordance: HIV (adjusted OR [aOR], 2.8; 95% CI, 1.7% to 4.6%), BV (aOR, 1.9; 95% CI, 1.5% to 2.5%), and human papillomavirus (aOR, 1.3; 95% CI, 1.0% to 1.8%). Finally, reporting current injection drug use (aOR, 0.6; 95% CI, 0.4% to 0.9%) was inversely related to discordance. Conclusions The inconsistent association between condom use and BV found in prior studies could be the result of participant reporting bias. The present study found evidence of a relationship between semen exposure and incident BV. Also, given the number and range of correlates of discordance between self-reported and biological evidence of semen exposure, inaccuracies in the reporting of sexual behaviours cannot be assumed to be distributed randomly across a study population.
    Sexually Transmitted Infections 07/2011; 87(Suppl 1):A32-A32. DOI:10.1136/sextrans-2011-050109.26 · 3.40 Impact Factor
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    ABSTRACT: HIV infection has been associated with development of prediabetes and diabetes. Optimum screening practices for these disorders in HIV-infected populations remain unclear. We screened 377 adults, with or at-risk for HIV infection, for incident hyperglycaemia (prediabetes or diabetes) using two oral glucose tolerance tests (OGTTs) a median of 18.6 months apart. We determined proportion of incident cases detected by fasting and 120-min plasma glucose levels. Independent predictors of incident hyperglycaemia were identified using logistic regression. The baseline OGTT was consistent with diabetes in 7% of participants and with prediabetes in 31%. Among 352 normoglycaemic and prediabetic participants at baseline, 19 (5%) developed diabetes on follow-up. Among participants normoglycaemic at baseline, an additional 38 (16%) developed prediabetes. Overall 52% of incident hyperglycaemia cases were detected by fasting plasma glucose alone, 33% by a 120-min glucose level alone and 15% by both. Factors independently associated with incident hyperglycaemia included age ≥50 years and body mass index ≥30 kg/m(2). Neither HIV infection nor highly active antiretroviral therapy (HAART) use were associated with increased risk of diabetes. Incident hyperglycaemia is common among older adults with or at-risk for HIV infection. HIV-infected individuals with classic diabetes risk factors should be screened for hyperglycaemia regardless of HAART use. OGTTs might be the preferred screening strategy in HIV-infected individuals at high risk for developing hyperglycaemia.
    Antiviral therapy 01/2011; 16(2):181-8. DOI:10.3851/IMP1711 · 3.02 Impact Factor
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    ABSTRACT: To define the characteristics of effective mentor-protégé relationships in a Clinical Research Training Program (CRTP) and to assess the agreement among mentors and protégés regarding those attributes. The authors administered an anonymous survey to protégés who completed the Albert Einstein College of Medicine's CRTP during its first seven years (2000-2006) and their mentors. Statements included aspects of mentoring thought to be important within the program, such as availability (Statement 1) and oversight of the thesis process (Statements 2-4). Additional statements were related both to career development (e.g., looking out for the best interests of the scholar and assisting in negotiations for a faculty position after program completion [Statements 5 and 6]) and to the expectation that the mentor would continue to be a resource for the protégé in years to come (Statement 7). The authors assessed overall agreement among mentors and protégés, using matched pair analysis. Overall response was 70.7% (133/188), with fewer matched pairs (n = 50, 50%). Seventy-five percent of respondents agreed strongly or somewhat with all statements. Analysis indicated significant agreement with Statements 2, 4, 6, and 7. Median scores from protégés did not differ whether their mentor responded (paired) or not (unpaired); however, mentor-protégé pairs had significantly greater agreement with Statements 3-7 than unpaired mentors and protégés (P < .01). Mentors and protégés seemed to agree that mentors within a CRTP demonstrated effective mentor attributes, including fostering a long-term relationship with the protégé.
    Academic medicine: journal of the Association of American Medical Colleges 06/2010; 85(6):1067-72. DOI:10.1097/ACM.0b013e3181dbc5c7 · 2.93 Impact Factor
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    ABSTRACT: Because translational research is not clearly defined, developers of translational research programs are struggling to articulate specific program objectives, delineate the knowledge and skills (competencies) that trainees are expected to develop, create an appropriate curriculum, and track outcomes to assess whether program objectives and competency requirements are being met. Members of the Evaluation Committee of the Association for Clinical Research Training (ACRT) reviewed current definitions of translational research and proposed an operational definition to use in the educational framework. In this article, the authors posit that translational research fosters the multidirectional and multidisciplinary integration of basic research, patient-oriented research, and population-based research, with the long-term aim of improving the health of the public. The authors argue that the approach to designing and evaluating the success of translational training programs must therefore be flexible enough to accommodate the needs of individual institutions and individual trainees within the institutions but that it must also be rigorous enough to document that the program is meeting its short-, intermediate-, and long-term objectives and that its trainees are meeting preestablished competency requirements. A logic model is proposed for the evaluation of translational research programs.
    Academic medicine: journal of the Association of American Medical Colleges 03/2010; 85(3):470-5. DOI:10.1097/ACM.0b013e3181ccd618 · 2.93 Impact Factor
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    Nanette Santoro · Maria Fan · BatSheva Maslow · Ellie Schoenbaum ·
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    ABSTRACT: With the advent of highly active antiretroviral agents, women with HIV infection can expect to live longer than ever before. This increased survival has led to concerns about the long-term implications of HIV disease and its treatment. Women with HIV infection appear to lose ovarian function earlier in life than women without HIV infection. They also have evidence of reduced bone mineral density and increased cardiovascular risk. Moreover, many of these increases in risk factors are present even prior to the menopausal transition. All of these risks, present at midlife, augur poorly for future health and describe a substantially increased burden of disease likely to accrue to HIV-infected women as they enter older age groups. Further compounding the adversity faced by the HIV infected, the demographics of women most vulnerable to this disease include adverse social and economic influences, both of which worsen their long-term prognosis. For example, drug use and poverty are related to more severe menopausal symptoms and chronic stress is related to worse psychological and cardiovascular risk. An understanding of how menopause interacts with HIV infection is therefore most important to alert the clinician to perform surveillance for common health problems in postmenopausal women, and to address directly and appropriately symptomatology during the menopausal transition.
    Maturitas 09/2009; 64(3):160-4. DOI:10.1016/j.maturitas.2009.09.001 · 2.94 Impact Factor
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    ABSTRACT: We evaluated the association of alcohol consumption and depression, and their effects on HIV disease progression among women with HIV. The study included 871 women with HIV who were recruited from 1993-1995 in four US cities. The participants had physical examination, medical record extraction, and venipuncture, CD4+T-cell counts determination, measurement of depression symptoms (using the self-report Center for Epidemiological Studies-Depression Scale), and alcohol use assessment at enrollment, and semiannually until March 2000. Multilevel random coefficient ordinal models as well as multilevel models with joint responses were used in the analysis. There was no significant association between level of alcohol use and CD4+ T-cell counts. When participants were stratified by antiretroviral therapy (ART) use, the association between alcohol and CD4+ T-cell did not reach statistical significance. The association between alcohol consumption and depression was significant (p<0.001). Depression had a significant negative effect on CD4+ T-cell counts over time regardless of ART use. Our findings suggest that alcohol consumption has a direct association with depression. Moreover, depression is associated with HIV disease progression. Our findings have implications for the provision of alcohol use interventions and psychological resources to improve the health of women with HIV.
    AIDS Care 07/2009; 21(7):834-41. DOI:10.1080/09540120802537864 · 1.60 Impact Factor
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    ABSTRACT: HIV-infected individuals may be at increased risk for atherosclerosis. Although this is partially attributable to metabolic factors, HIV-associated inflammation may play a role. To investigate associations of HIV disease with serum monocyte chemoattractant protein-1/chemokine (C-C motif) ligand 2 (MCP-1/CCL2) levels and atherosclerosis burden. A cross-sectional analysis. : Serum MCP-1/CCL2, fasting lipids, and glucose tolerance were measured in 98 HIV-infected and 79 demographically similar uninfected adults. Eighty-four participants had MRI of the carotid arteries and thoracic aorta to measure atherosclerosis burden. Multivariate analyses were performed using linear regression. Mean MCP-1/CCL2 levels did not differ between HIV-infected and uninfected participants (P = 0.65). Among HIV-infected participants, after adjusting for age, BMI, and cigarette smoking, HIV-1 viral load was positively associated with MCP-1/CCL2 (P = 0.02). Multivariate analyses adjusting for sex, low-density lipoprotein cholesterol, total cholesterol:high-density lipoprotein cholesterol ratio, cigarette smoking, MCP-1/CCL2, and protease inhibitor use found that HIV infection was associated with greater mean thoracic aorta vessel wall area (VWA, P < 0.01) and vessel wall thickness (VWT, P = 0.03), but not with carotid artery parameters. Compared with being uninfected, having detectable HIV-1 viremia was associated with greater mean thoracic aorta VWA (P < 0.01) and VWT (P = 0.03), whereas being HIV-infected with undetectable viral load was associated with greater thoracic aorta VWA (P = 0.02) but not VWT (P = 0.15). There was an independent positive association of MCP-1/CCL2 with thoracic aorta VWA (P = 0.01) and VWT (P = 0.01). HIV-1 viral burden is associated with higher serum levels of MCP-1/CCL2 and with atherosclerosis burden, as assessed by thoracic aorta VWA and VWT.
    AIDS (London, England) 04/2009; 23(8):941-9. DOI:10.1097/QAD.0b013e328329c76b · 5.55 Impact Factor
  • Maria D Fan · Bat-Sheva Maslow · Nanette Santoro · Ellie Schoenbaum ·
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    ABSTRACT: Dramatic improvement in the survival of the HIV population has occurred with the ascendance of highly active antiretroviral therapy (HAART). In the foreseeable future, HIV-infected women who acquired disease during the peak years of the epidemic are expected to survive to experience menopause and even years beyond. The HIV epidemic may be viewed as 'mature', as its earlier victims become part of the geriatric population. Research about the process of menopause in HIV-infected women and, conversely, about HIV infection in women undergoing menopause is currently limited. Existing research suggests that the process of menopause is affected by HIV infection, inasmuch as infected women appear to experience menopause at an earlier age, with greater symptomatology, and with different reproductive hormone profiles compared with HIV-uninfected women. HIV infection also appears to affect bone mineral density, cardiovascular disease and cognition, with some age-related interactions. Lifestyle and demographic factors have pervasive importance for both HIV infection and the menopause in women. This article reviews the current state of knowledge about the menopausal process in HIV-infected women, and the common conditions in postmenopausal women that are likely to be affected by HIV infection. Clinicians should appreciate the potential role of HIV infection in caring for menopause-aged women.
    Menopause International 01/2009; 14(4):163-8. DOI:10.1258/mi.2008.008027
  • Kinga Cieloszyk · Diana Hartel · Galina Moskaleva · Ellie E Schoenbaum ·
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    ABSTRACT: To examine the relationship between hepatitis C virus (HCV) infection with menopause status and vasomotor symptoms among middle-aged, impoverished women. The baseline interview and laboratory data from a study on menopause were used for a cross-sectional analysis of HCV antibody and HCV-RNA levels and their relationship to menopause status and symptoms, using logistic regression. For HCV-infected and HCV-uninfected women, menopause status was defined according to the World Health Organization criteria. Of 559 participants, 48% were black, 38.6% were Hispanic, and 267 (47.8%) were HCV seropositive; of these, 189 (72.1%) had detectable HCV-RNA levels. The median age was 43 years [interquartile range (IQR), 40-46 years]; 50.2% of the women were premenopausal, 31.8% were perimenopausal, and 18% were postmenopausal. Median age at natural menopause was 46 years (IQR, 42.25-49 years) in HCV-infected women compared with 47 years (IQR, 40.25-48 years) in uninfected controls. Women infected with HCV were more likely to be postmenopausal than were uninfected women (adjusted odds ratio [ORadj], 1.68; 95% CI, 1.02-2.77). Human immunodeficiency virus status (ORadj, 1.69; 95% CI, 1.04-2.75), drug use (ORadj, 2.34; 95% CI, 1.42-3.86), and nulliparity (ORadj, 2.74; 95% CI, 1.42-5.29) were independently associated with natural menopause, whereas being more physically active (ORadj, 0.90; 95% CI, 0.85-0.95) was inversely associated with menopause. Women infected with HCV were more likely than uninfected women to report vasomotor symptoms (ORadj, 1.52; 95% CI, 1.06-2.18). Hepatitis C virus infection is independently associated with natural menopause, controlling for age. In addition, HCV was associated with vasomotor symptoms. Further studies are warranted to better understand the menopausal transition in HCV-infected women.
    Menopause (New York, N.Y.) 12/2008; 16(2):401-6. DOI:10.1097/gme.0b013e318186d7cf · 3.36 Impact Factor
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    ABSTRACT: Previous studies have shown that use of complementary and alternative medicine (CAM) is prevalent among HIV-infected persons, but have focused primarily on men who have sex with men. To determine factors associated with CAM use in an inner city population, individuals (n = 93) recruited from two established cohort studies were interviewed between October and November 2004. The interview assessed the use of dietary supplements and other CAM therapies, reasons for CAM use, and use of prescription medications. Study participants were 52% male and 47% HIV infected. Median age was 50 years, and 60% reported illicit drug use ever. CAM use during the prior 6 months was reported by 94%, with 48% reporting daily use of a dietary supplement. Vitamin C, vitamin E, and soy were used more often by HIV-infected than uninfected persons (p < 0.05). Prevention of illness was the most common reason for dietary supplement use (27%). HIV-infected persons were more likely than uninfected persons (95% versus 67%) to report use of both dietary supplements and prescription medications within the past 6 months (p < 0.001). In multivariate analysis, HIV infection (odds ratio [OR] 3.1, CI 1.3, 7.7) was the only factor associated with daily dietary supplement use whereas gender, race/ethnicity, working in the last year, homelessness, and financial comfort were not associated. CAM use among persons with or at risk for HIV infection due to drug use or high-risk heterosexual behaviors is common, and is used almost exclusively as an adjunct and not an alternative to conventional health care.
    AIDS patient care and STDs 10/2008; 22(10):811-6. DOI:10.1089/apc.2007.0159 · 3.50 Impact Factor
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    ABSTRACT: To study attitudes toward menopause in women with or at risk of human immunodeficiency virus (HIV) aged 35 to 60 in New York City, NY, USA. Data were obtained at the baseline interview in a cohort study of menopause. Of 502 participating women, 92 were postmenopausal and 162 were perimenopausal. Overall, 37.5% of women had a relatively favorable attitude toward menopause. African Americans had a 72% greater odds of a positive attitude (OR = 1.72, 95% CI 1.16-2.57) than all other groups after adjusting for covariates. Hispanic women had the least favorable view of menopause. Experience of > 3 menopausal symptoms and negative life events-being a witness to a murder, and the death ofa child-were significantly associated with negative attitudes towards menopause (OR = 0.62, 95% CI 0.42-0.93 and OR = 0.64, 95% CI 0.43-0.93, respectively). Depressive symptoms, street drug use, and having a domestic partner, which is significant in single variable analyses, did not remain independent predictors in multivariate results. HIV status, menopause status, and age at interview were not associated with menopause attitudes. HIV-infected, drug-using, low-income women showed generally unfavorable attitudes towards menopause. High stress life events coupled with a high prevalence of depressive symptoms indicate this population has special needs marked by the menopause transition into older age.
    Clinical Interventions in Aging 08/2008; 3(3):561-6. · 2.08 Impact Factor
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    ABSTRACT: To examine the relationship of human immunodeficiency virus (HIV) and attribution of menopausal symptoms. Peri- and postmenopausal women participating in a prospective study of HIV-infected and at-risk midlife women (the Ms. Study) were interviewed to determine whether they experienced hot flashes and/or vaginal dryness and to what they attributed these symptoms. Of 278 women, 70% were perimenopausal; 54% were HIV-infected; and 52% had used crack, cocaine, heroin, and/or methadone within the past 5 years. Hot flashes were reported by 189 women and vaginal dryness was reported by 101 women. Overall, 69.8% attributed hot flashes to menopause and 28.7% attributed vaginal dryness to menopause. In bivariate analyses, age 45 years and older was associated with attributing hot flashes and vaginal dryness to menopause, and postmenopausal status and at least 12 years of education were associated with attributing vaginal dryness to menopause, but HIV status was not associated with attribution to menopause. In multivariate analysis, significant interactions between age and menopause status were found for both attribution of hot flashes (P=0.019) and vaginal dryness (P=0.029). Among perimenopausal women, older age was independently associated with attribution to menopause for hot flashes (adjusted odds ratio=1.2, 95% CI: 1.1-1.4, P=0.001) and vaginal dryness (adjusted odds ratio=1.3, 95% CI: 1.1-1.6, P=0.011). None of the tested factors were independently associated with attribution to menopause among postmenopausal women. Tailored health education programs may be beneficial in increasing the knowledge about menopause among HIV-infected and drug-using women, particularly those who are perimenopausal.
    Menopause 05/2008; 15(3):551-7. DOI:10.1097/gme.0b013e31815879df · 3.36 Impact Factor
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    ABSTRACT: The insulin-like growth factor (IGF) axis has been hypothesized to influence the rate of human immunodeficiency virus (HIV) disease progression. This premise is based largely on laboratory models showing that IGF-I stimulates thymic growth and increases lymphocyte numbers and that IGF-binding protein (IGFBP)-3 has an opposing effect, inhibiting hematopoietic stem cell development. We studied 1422 HIV-infected women enrolled in a large cohort that entailed semiannual follow-up (initiated in 1994). Baseline serum samples were tested for IGF-I and IGFBP-3 to determine their associations with incident clinical acquired immunodeficiency syndrome (AIDS) and CD4+ T cell count decline prior to April 1996 (before the era of highly active antiretroviral therapy [HAART]). Low IGF-I levels (Ptrend= .02) and high IGFBP-3 levels (Ptrend= .02) were associated with rapid CD4+ T cell count decline. Only IGFBP-3, however, was significantly associated with AIDS incidence (hazard ratio for highest vs. lowest quartile, 2.65 [95% confidence interval, 1.30-5.42]; Ptrend= .02) in multivariable models. These findings suggest that serum levels of IGFBP-3 (and possibly IGF-I) are associated with the rate of HIV disease progression in women and, more broadly, that interindividual heterogeneity in the IGF axis may influence HIV pathogenesis. If correct, the IGF axis could be a target for interventions to slow HIV disease progression and extend the time before use of HAART becomes necessary.
    The Journal of Infectious Diseases 02/2008; 197(2):319-27. DOI:10.1086/524848 · 6.00 Impact Factor
  • Dawn Fishbein · Diane Tider · Ellie Schoenbaum · Nancy Budner · Robert Klein ·
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    ABSTRACT: Background: Despite a growing body of knowledge regarding hepatitis C (HCV) care, barriers to care and treatment persist. Although HIV+ persons interface frequently with medical personnel, providers may not prioritize HCV compared to acute, symptomatic co-morbidities. Individuals assume their HCV is monitored, when it may be overlooked until late-stage symptoms appear. This suggests the need for research into factors associated with the actual engagement in HCV clinical care. Methods: Medical charts of participants in a study of HCV+ persons with or at risk for HIV infection in NYC were abstracted using a standardized form, focusing on HCV discussion, harm reduction, alcohol and psychiatric management, HCV screening and treatment. Results: Of 343 HCV+ participants, 278 (81%) reported receiving HCV care, of whom only 212 (62%) were able to identify specific HCV providers. Of these 212, 106 (50%) medical records were abstracted; 67% were HIV+, 43% women, 48% black, 39% Hispanic; mean age was 54 years. Approximately 1/3 received comprehensive HCV care. Thirty-eight charts (36%) noted HCV education, 36 (34%) discussed treatment options. Thirty (28%) participants discussed illicit drug use reduction, 20 (19%) alcohol reduction, and 49 (46%) received psychiatric care and/or medication. Thirty-two (35%) charts noted liver radiology; 38 (36%) had a liver biopsy. Twenty (19%) were treated for HCV in the past; 2 (10%) of those treated had a sustained virologic response. Five (5%) were being treated during the course of the study. Conclusion: Forty percent of all participants could not name their HCV provider. Even among better-informed participants, more than 50% erroneously believed their HCV was adequately monitored. Providers may not prioritize HCV care. Greater attention is warranted to HCV education, harm reduction and liver disease progression screening, particularly within a vulnerable, HIV+ population.
    Infectious Diseases Society of America 2007 Annual Meeting; 10/2007

Publication Stats

7k Citations
1,065.11 Total Impact Points


  • 1987-2015
    • Albert Einstein College of Medicine
      • • Department of Epidemiology & Population Health
      • • Institute for Clinical and Translational Research
      • • Department of Obstetrics & Gynecology & Women's Health
      • • Department of Medicine
      • • General Internal Medicine
      New York, New York, United States
  • 1988-2009
    • Montefiore Medical Center
      • Albert Einstein College of Medicine
      New York, New York, United States
  • 2007
    • Yeshiva University
      New York, New York, United States
  • 2001
    • Yale University
      • Center for Interdisciplinary Research on AIDS (CIRA)
      New Haven, Connecticut, United States
  • 2000
    • Wayne State University
      • Division of Infectious Diseases
      Detroit, Michigan, United States
  • 1990-2000
    • The Children’s Hospital at Montefiore (CHAM)
      New York, New York, United States
  • 1999
    • Columbia University
      New York, New York, United States
    • Brown University
      Providence, Rhode Island, United States
  • 1998
    • Harlem Hospital Center
      New York, New York, United States
  • 1993
    • CUNY Graduate Center
      New York, New York, United States
  • 1992
    • Bronx-Lebanon Hospital
      Bronxville, New York, United States
  • 1991
    • Centers for Disease Control and Prevention
      • National Center for Emerging and Zoonotic Infectious Diseases
      Атланта, Michigan, United States