Psychosocial and Behavioral Modulators of Vascular Dysfunction and Blood Pressure in People Living with HIV Restricted; Files Only
Romero, Cesar (Summer 2025)
Abstract
Background:
Antiretroviral therapy (ART) has shifted the disease burden toward non-communicable conditions in people living with HIV (PWH). Cardiovascular diseases (CVD) are leading cause of morbidity and mortality in aging PWH. In addition to traditional CVD risk factors, chronic immune activation, direct viral effects, and a high prevalence of co-morbid conditions—including mental health disorders, substance use, and sleep disturbances—make CVD in PWH a unique and incompletely understood entity. We aimed to evaluate how mental health disorders, substance use, and sleep disturbances affect vascular function and blood pressure in PWH.
Methods:
We enrolled PWH aged >40 years, receiving stable ART with undetectable viral load and no history of CVD. Clinical, demographic, and laboratory data, including CD4+ count and inflammatory markers, were collected. Blood pressure was measured in triplicate. Flow-mediated dilation (FMD) and pulse wave velocity (PWV) were assessed using ultrasound and arterial tonometry, respectively. Mental health, substance use, and sleep disturbances were evaluated with validated questionnaires. Multivariable linear and logistic regression models were used.
Results:
Among 118 PWH, 54.6% were female at birth, 83.9% identified as Black, and 55.5% had a high school education or less. Substance use was reported by 37.5%, sleep disturbances by 7.1%, and mental health disorders by 47.3%. Endothelial dysfunction was present in 42%, arterial stiffness in 15%, and hypertension in 60%. In adjusted models, cocaine use was associated with lower FMD (β −1.48; 95% CI: −2.46, −0.54) and higher odds of endothelial dysfunction (OR 19.3; 95% CI: 1.72, 217.74). Sleep disturbances were associated with higher PWV (β 1.6; 95% CI: 0.23, 2.97). Hallucinogen use was inversely associated with hypertension (OR 0.32; 95% CI: 0.12, 0.86).
Conclusions:
Endothelial dysfunction, arterial stiffness, and hypertension are highly prevalent in PWH. Cocaine use is strongly associated with vascular dysfunction, while hallucinogen use was inversely associated with hypertension.
Table of Contents
Chapter 1. Background and Literature Review……………………..Pag 1.
Chapter 1. References…………………………………………………Pag 32.
Chapter 2. Manuscript Format ………………………………………..Pag 39.
Table and Figures…………………………………………………...….Pag 59.
Chapter 3. Future Directions and Public Health Implications……...Pag 64.
About this Honors Thesis
| School | |
|---|---|
| Department | |
| Subfield / Discipline | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| Keyword | |
| Committee Chair / Thesis Advisor |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
File download under embargo until 20 August 2026 | 2025-07-29 10:29:42 -0400 | File download under embargo until 20 August 2026 |
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|