2020
DNA methylation mediates the effect of cocaine use on HIV severity
Shu C, Justice AC, Zhang X, Wang Z, Hancock DB, Johnson EO, Xu K. DNA methylation mediates the effect of cocaine use on HIV severity. Clinical Epigenetics 2020, 12: 140. PMID: 32928285, PMCID: PMC7491141, DOI: 10.1186/s13148-020-00934-1.Peer-Reviewed Original ResearchConceptsHIV-positive participantsHIV severityVACS IndexCocaine useCocaine effectsVeterans Aging Cohort Study Biomarker CohortVeterans Aging Cohort Study (VACS) IndexEpigenome-wide associationHuman immunodeficiency virus (HIV) progressionHigher VACS indexFrequent cocaine useCandidate CpG sitesPersistent cocaine useMendelian randomization analysisHIV outcomesBiomarker cohortHIV progressionVirus progressionVAC indexVeteran populationAntiviral responseCandidate mediatorsStudy indicesMR analysisSeverityPolypharmacy in HIV: recent insights and future directions.
Edelman EJ, Rentsch CT, Justice AC. Polypharmacy in HIV: recent insights and future directions. Current Opinion In HIV And AIDS 2020, 15: 126-133. PMID: 31833963, PMCID: PMC7543953, DOI: 10.1097/coh.0000000000000608.Commentaries, Editorials and LettersConceptsSeverity of illnessInappropriate medicationsDrug interactionsActual adverse eventsSubstance useTotal drug burdenMechanism of injuryElectronic health recordsNonantiretroviral medicationsUpdate findingsMore medicationsAdverse eventsDrug burdenClinical managementPolypharmacyDirect biomarkerMedicationsModifiable mechanismsPWHSicker individualsHealth recordsStrong associationHIVInjuryIllnessFIB-4 stage of liver fibrosis is associated with incident heart failure with preserved, but not reduced, ejection fraction among people with and without HIV or hepatitis C
So-Armah KA, Lim JK, Re V, Tate JP, Chang CH, Butt AA, Gibert CL, Rimland D, Marconi VC, Goetz MB, Ramachandran V, Brittain E, Long M, Nguyen KL, Rodriguez-Barradas MC, Budoff MJ, Tindle HA, Samet JH, Justice AC, Freiberg MS, Team V. FIB-4 stage of liver fibrosis is associated with incident heart failure with preserved, but not reduced, ejection fraction among people with and without HIV or hepatitis C. Progress In Cardiovascular Diseases 2020, 63: 184-191. PMID: 32068085, PMCID: PMC7278895, DOI: 10.1016/j.pcad.2020.02.010.Peer-Reviewed Original ResearchMeSH KeywordsAdultAnti-HIV AgentsFemaleHealth StatusHeart FailureHepatitis CHIV InfectionsHIV Long-Term SurvivorsHumansIncidenceLiver CirrhosisMaleMiddle AgedPrognosisRisk AssessmentRisk FactorsSeverity of Illness IndexStroke VolumeTime FactorsUnited StatesVentricular Function, LeftVeterans HealthViral LoadConceptsType of HFIncident heart failureHeart failureHepatitis C statusAdvanced fibrosisLiver fibrosisEjection fractionHazard ratioC statusVeterans Aging Cohort StudyRisk of HFpEFLast clinic visitReduced ejection fractionAging Cohort StudyLiver fibrosis scoresPrevalent cardiovascular diseaseFirst HF eventProportional hazards modelIncident HFpEFHepatitis CClinic visitsCohort studyPrimary outcomeFibrosis scoreHF eventsExtracting lung function measurements to enhance phenotyping of chronic obstructive pulmonary disease (COPD) in an electronic health record using automated tools
Akgün KM, Sigel K, Cheung KH, Kidwai-Khan F, Bryant AK, Brandt C, Justice A, Crothers K. Extracting lung function measurements to enhance phenotyping of chronic obstructive pulmonary disease (COPD) in an electronic health record using automated tools. PLOS ONE 2020, 15: e0227730. PMID: 31945115, PMCID: PMC6964890, DOI: 10.1371/journal.pone.0227730.Peer-Reviewed Original ResearchMeSH KeywordsCohort StudiesData MiningElectronic Health RecordsForced Expiratory VolumeHealth Information SystemsHospitalizationHumansLungNatural Language ProcessingPulmonary Disease, Chronic ObstructiveSeverity of Illness IndexSoftwareUnited StatesUnited States Department of Veterans AffairsVeteransVital CapacityConceptsChronic obstructive pulmonary diseaseVeterans Aging Cohort StudyObstructive pulmonary diseaseFEV1 valuesPulmonary diseasePhenotyping of patientsPulmonary function testsAging Cohort StudyLung function measurementsElectronic health record dataHealth record dataStructured electronic health record dataPositive predictive valueElectronic health recordsAirflow obstructionChart reviewCohort studyExpiratory volumeCOPD phenotypesFunction testsVital capacityFEV1 measurementsDATA SOURCESPredictive valueClinical notes
2019
HIV Disease Severity Is Sensitive to Temporal Changes in Alcohol Use: A National Study of VA Patients With HIV.
Williams EC, McGinnis KA, Tate JP, Matson TE, Rubinsky AD, Bobb JF, Lapham GT, Edelman EJ, Catz SL, Satre DD, Bryant KJ, Marshall BDL, Kraemer KL, Bensley KM, Richards JE, Skanderson M, Justice AC, Fiellin DA, Bradley KA. HIV Disease Severity Is Sensitive to Temporal Changes in Alcohol Use: A National Study of VA Patients With HIV. JAIDS Journal Of Acquired Immune Deficiency Syndromes 2019, 81: 448-455. PMID: 30973541, PMCID: PMC6594884, DOI: 10.1097/qai.0000000000002049.Peer-Reviewed Original ResearchMeSH KeywordsAgedAlcohol DrinkingAlcoholismCohort StudiesEthnicityFemaleFollow-Up StudiesHIV InfectionsHumansMaleMiddle AgedRacial GroupsSeverity of Illness IndexVeteransConceptsVACS Index 2.0HIV disease severityVeterans Aging Cohort StudyAlcohol useDisease severityLow-level alcohol useNational Veterans Health AdministrationChange scoresAging Cohort StudyVeterans Health AdministrationAUDIT-C screensAUDIT-CsCohort studyHIV severityVA patientsHealth AdministrationSeverity measuresSeverityHIVPWHMultiple mechanismsNational studyScoresNational sampleDaysComparison of the prevalence, severity, and risk factors for hepatic steatosis in HIV-infected and uninfected people
Torgersen J, So-Armah K, Freiberg MS, Goetz MB, Budoff MJ, Lim JK, Taddei T, Butt AA, Rodriguez-Barradas MC, Justice AC, Kostman JR, Lo Re V. Comparison of the prevalence, severity, and risk factors for hepatic steatosis in HIV-infected and uninfected people. BMC Gastroenterology 2019, 19: 52. PMID: 30987601, PMCID: PMC6466708, DOI: 10.1186/s12876-019-0969-1.Peer-Reviewed Original ResearchConceptsAdvanced hepatic fibrosisSeverity of steatosisHepatic steatosisHIV infectionHIV statusHepatic fibrosisLiver attenuationCardiovascular diseaseSteatosis severityUninfected individualsGreater severityVeterans Aging Cohort StudyNoncontrast abdominal CTAging Cohort StudySpleen attenuation ratioHepatic steatosis severityCross-sectional studyMultivariable linear regressionUninfected participantsAntiretroviral therapyCohort studyAbdominal CTUninfected personsOverall prevalenceRisk factors
2018
Changes in alcohol use associated with changes in HIV disease severity over time: A national longitudinal study in the Veterans Aging Cohort
Williams EC, McGinnis KA, Bobb JF, Rubinsky AD, Lapham GT, Skanderson M, Catz SL, Bensley KM, Richards JE, Bryant KJ, Edelman EJ, Satre DD, Marshall BDL, Kraemer KL, Blosnich JR, Crystal S, Gordon AJ, Fiellin DA, Justice AC, Bradley KA. Changes in alcohol use associated with changes in HIV disease severity over time: A national longitudinal study in the Veterans Aging Cohort. Drug And Alcohol Dependence 2018, 189: 21-29. PMID: 29859388, PMCID: PMC6344121, DOI: 10.1016/j.drugalcdep.2018.04.022.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAgingAlcohol DrinkingFemaleHIV InfectionsHumansLongitudinal StudiesMaleMiddle AgedSeverity of Illness IndexVeteransConceptsHIV severityAUDIT-C screensViral loadAlcohol useVeterans Aging Cohort Study (VACS) dataPoor HIV controlVeterans Aging CohortHIV disease severityAUDIT-C scoresCohort study dataLow-level drinkingStable drinkingVL analysisHIV controlMean changeAging CohortDisease severityPLWHGreater riskCD4Individual alcohol useSeverityDrinking trajectoriesNational Longitudinal StudyLongitudinal studyRacial/ethnic differences in the association between alcohol use and mortality among men living with HIV
Bensley KM, McGinnis KA, Fiellin DA, Gordon AJ, Kraemer KL, Bryant KJ, Edelman EJ, Crystal S, Gaither JR, Korthuis PT, Marshall BDL, Ornelas IJ, Chan KCG, Dombrowski JC, Fortney JC, Justice AC, Williams EC. Racial/ethnic differences in the association between alcohol use and mortality among men living with HIV. Addiction Science & Clinical Practice 2018, 13: 2. PMID: 29353555, PMCID: PMC6389249, DOI: 10.1186/s13722-017-0103-z.Peer-Reviewed Original ResearchConceptsLow-risk alcohol useMortality riskAlcohol useRace/ethnicityWhite PLWHMortality rateAlcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaireVeterans Aging Cohort StudyCox proportional hazards modelHigh-risk alcohol useAUDIT-C screeningAging Cohort StudyElectronic health record dataRisk of mortalityHigh-risk relativesUnhealthy alcohol useHigher mortality riskProportional hazards modelHealth record dataHigh mortality rateEthnic groupsMale PLWHCohort studyWhite patientsGeneral outpatients
2017
FIB‐4 stage of liver fibrosis predicts incident heart failure among HIV‐infected and uninfected patients
So‐Armah K, Lim JK, Re V, Tate JP, Chang C, Butt AA, Gibert CL, Rimland D, Marconi VC, Goetz MB, Rodriguez‐Barradas M, Budoff MJ, Tindle HA, Samet JH, Justice AC, Freiberg MS, Team F. FIB‐4 stage of liver fibrosis predicts incident heart failure among HIV‐infected and uninfected patients. Hepatology 2017, 66: 1286-1295. PMID: 28543215, PMCID: PMC5609079, DOI: 10.1002/hep.29285.Peer-Reviewed Original ResearchMeSH KeywordsAdultCase-Control StudiesCohort StudiesFemaleHeart FailureHIV InfectionsHumansLiver CirrhosisMaleMiddle AgedSeverity of Illness IndexConceptsHuman immunodeficiency virusFibrosis/cirrhosisHIV/HCV statusAdvanced fibrosis/cirrhosisLiver fibrosisCHF eventsHCV statusFIB-4Hepatitis CAdvanced liver fibrosis/cirrhosisIncident CHFCongestive heart failure riskCardiovascular disease risk factorsVeterans Aging Cohort StudyProportional hazards regression modelsLiver fibrosis/cirrhosisIncident CHF eventsRisk of CHFFibrosis-4 indexIncident heart failureDisease risk factorsHeart failure riskAging Cohort StudyCardiovascular disease riskPrevalent cardiovascular diseaseAssociation of Cannabis, Stimulant, and Alcohol use with Mortality Prognosis Among HIV-Infected Men
Adams JW, Bryant KJ, Edelman J, Fiellin DA, Gaither JR, Gordon AJ, Gordon KS, Kraemer KL, Mimiaga MJ, Operario D, Tate JP, van den Berg JJ, Justice AC, Marshall BDL. Association of Cannabis, Stimulant, and Alcohol use with Mortality Prognosis Among HIV-Infected Men. AIDS And Behavior 2017, 22: 1341-1351. PMID: 28887669, PMCID: PMC5881942, DOI: 10.1007/s10461-017-1905-4.Peer-Reviewed Original ResearchConceptsVeterans Aging Cohort StudyLow-risk alcohol useRisk alcohol useMortality riskAlcohol useStimulant useAdjusted longitudinal analysesAging Cohort StudyUnhealthy alcohol useAssociation of cannabisVACS IndexCause mortalityCohort studyPatient populationPrognostic indicatorMortality prognosisHIVStudy periodSubstance useCannabisRiskLongitudinal analysisMenMortalityStimulantsLong-term alcohol use patterns and HIV disease severity
Marshall BDL, Tate JP, McGinnis KA, Bryant KJ, Cook RL, Edelman EJ, Gaither JR, Kahler CW, Operario D, Fiellin DA, Justice AC. Long-term alcohol use patterns and HIV disease severity. AIDS 2017, 31: 1313-1321. PMID: 28492393, PMCID: PMC5596310, DOI: 10.1097/qad.0000000000001473.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAlcohol DrinkingFemaleHIV InfectionsHumansMaleMiddle AgedProspective StudiesSeverity of Illness IndexUnited StatesConceptsHIV disease severityVeterans Aging Cohort StudyHigh-risk drinkersDisease severityAlcohol useRisk drinkersLower riskAlcohol use trajectoriesIndex groupModerate riskIndex trajectoriesVeterans Health Administration sitesAging Cohort StudyHigh-risk groupMeasures of morbidityAlcohol Use Disorders IdentificationLow index groupAlcohol consumption trajectoriesUse trajectoriesSubset of participantsAlcohol use patternsVACS IndexCause mortalityCohort studyProspective cohortTrajectories of Sleep Disturbance Severity in HIV-Infected and Uninfected Veterans
Womack JA, Murphy TE, Bathulapalli H, Akgün KM, Gibert C, Kunisaki KM, Rodriguez-Barradas M, Yaggi HK, Justice AC, Redeker NS. Trajectories of Sleep Disturbance Severity in HIV-Infected and Uninfected Veterans. Journal Of The Association Of Nurses In AIDS Care 2017, 28: 431-437. PMID: 28389058, PMCID: PMC5442598, DOI: 10.1016/j.jana.2017.02.006.Peer-Reviewed Original Research
2016
The musculoskeletal diagnosis cohort
Goulet JL, Kerns RD, Bair M, Becker W, Brennan P, Burgess DJ, Carroll CM, Dobscha S, Driscoll M, Fenton BT, Fraenkel L, Haskell S, Heapy A, Higgins D, Hoff RA, Hwang U, Justice AC, Piette JD, Sinnott P, Wandner L, Womack J, Brandt CA. The musculoskeletal diagnosis cohort. Pain 2016, 157: 1696-1703. PMID: 27023420, PMCID: PMC4949131, DOI: 10.1097/j.pain.0000000000000567.Peer-Reviewed Original ResearchConceptsMSD diagnosisMusculoskeletal disordersMSD cohortIndex dateVeterans Health Administration (VHA) careNumeric rating scale scoreICD-9-CM codesCohort inclusion criteriaNontraumatic joint disordersPain-related treatmentsMore outpatient visitsVeterans Health AdministrationMental health diagnosesRating Scale scoresHigher NRS scoresHealth services researchElectronic health recordsDiagnosis cohortSevere painInpatient visitsNRS scoresOutpatient visitsNeck disordersFirst diagnosisMean age
2014
Increased Risk of Radiographic Emphysema in HIV Is Associated With Elevated Soluble CD14 and Nadir CD4
Attia EF, Akgün KM, Wongtrakool C, Goetz MB, Rodriguez-Barradas MC, Rimland D, Brown ST, Hoo G, Kim J, Lee PJ, Schnapp LM, Sharafkhaneh A, Justice AC, Crothers K. Increased Risk of Radiographic Emphysema in HIV Is Associated With Elevated Soluble CD14 and Nadir CD4. CHEST Journal 2014, 146: 1543-1553. PMID: 25080158, PMCID: PMC4251616, DOI: 10.1378/chest.14-0543.Peer-Reviewed Original ResearchMeSH KeywordsAdultAge FactorsBiomarkersCD4 AntigensComorbidityConfidence IntervalsCross-Sectional StudiesFemaleHIV InfectionsHumansLipopolysaccharide ReceptorsLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPrognosisPulmonary EmphysemaRadiographyReference ValuesRisk AssessmentSensitivity and SpecificitySeverity of Illness IndexSex FactorsStatistics, NonparametricConceptsIndependent risk factorSoluble CD14 levelsHIV infectionRadiographic emphysemaEmphysema severityCD14 levelsRisk factorsHIV-Associated Lung Emphysema (EXHALE) studyHigher soluble CD14 levelsNadir CD4 cell countMultivariable logistic regression modelElevated soluble CD14CD4 cell countCells/μLLower lung zonesRisk of HIVCross-sectional analysisLogistic regression modelsNadir CD4HIV RNALung involvementHIV severityD-dimerDiffuse involvementMultivariable analysisHIV Infection and Cardiovascular Disease in Women
Womack JA, Chang C, So‐Armah K, Alcorn C, Baker JV, Brown ST, Budoff M, Butt AA, Gibert C, Goetz MB, Gottdiener J, Gottlieb S, Justice AC, Leaf D, McGinnis K, Rimland D, Rodriguez‐Barradas M, Sico J, Skanderson M, Tindle H, Tracy RP, Warner A, Freiberg MS. HIV Infection and Cardiovascular Disease in Women. Journal Of The American Heart Association 2014, 3: e001035. PMID: 25324353, PMCID: PMC4323817, DOI: 10.1161/jaha.114.001035.Peer-Reviewed Original ResearchMeSH KeywordsAdultAge DistributionAgedCardiovascular DiseasesCase-Control StudiesComorbidityConfidence IntervalsFemaleHIV InfectionsHumansLongitudinal StudiesMiddle AgedPrevalenceProportional Hazards ModelsProspective StudiesRisk AssessmentSeverity of Illness IndexSurvival AnalysisUnited StatesUser-Computer InterfaceVeteransConceptsRisk of CVDCVD eventsCardiovascular diseaseHIV infectionVeterans Aging Cohort StudyCox proportional hazards modelHIV uninfected womenIncident CVD eventsIncident cardiovascular diseaseIndependent risk factorAging Cohort StudyClinical Modification codesFirst clinical encounterDeath certificate dataProportional hazards modelSubstance use/abuseUse/abuseRace/ethnicityUninfected womenHepatitis CHIV- womenLast followCohort studyIschemic strokeUnstable angina
2013
Acetaminophen receipt among HIV‐infected patients with advanced hepatic fibrosis
Edelman EJ, Gordon KS, Re V, Skanderson M, Fiellin DA, Justice AC, Team F. Acetaminophen receipt among HIV‐infected patients with advanced hepatic fibrosis. Pharmacoepidemiology And Drug Safety 2013, 22: 1352-1356. PMID: 24285468, PMCID: PMC4164158, DOI: 10.1002/pds.3517.Peer-Reviewed Original ResearchConceptsAdvanced hepatic fibrosisAcetaminophen exposureHCV statusHepatic fibrosisHIV/HCV-coinfected patientsVeterans Aging Cohort StudyAdvanced liver fibrosisAging Cohort StudyAcetaminophen-induced hepatotoxicitySample of HIVCross-sectional associationsPolytomous logistic regressionAlcohol use disorderCross-sectional analysisAcetaminophen prescriptionsAcetaminophen useHIV-monoinfectedFIB-4Cohort studyLiver injuryPlatelet countLiver fibrosisAlanine aminotransferaseHIVPatients
2010
Rural Residence Is Associated With Delayed Care Entry and Increased Mortality Among Veterans With Human Immunodeficiency Virus Infection
Ohl M, Tate J, Duggal M, Skanderson M, Scotch M, Kaboli P, Vaughan-Sarrazin M, Justice A. Rural Residence Is Associated With Delayed Care Entry and Increased Mortality Among Veterans With Human Immunodeficiency Virus Infection. Medical Care 2010, 48: 1064-1070. PMID: 20966783, PMCID: PMC3138500, DOI: 10.1097/mlr.0b013e3181ef60c2.Peer-Reviewed Original ResearchMeSH KeywordsCohort StudiesConfidence IntervalsFemaleHealth Services AccessibilityHIV InfectionsHumansMaleOdds RatioPatient Acceptance of Health CareRetrospective StudiesRisk AssessmentRural Health ServicesRural PopulationSeverity of Illness IndexSurveys and QuestionnairesSurvival AnalysisUnited StatesUrban PopulationVeteransConceptsHuman immunodeficiency virusRural residenceCare entryHazard ratioHIV outcomesHIV severityRural personsVeterans AdministrationCombination antiretroviral therapy useHuman immunodeficiency virus (HIV) infectionRural-Urban Commuting Area codesAdvanced HIV infectionAntiretroviral therapy useRetrospective cohort studyImmunodeficiency virus infectionMortality hazard ratioCommunity-level determinantsRural-urban variationDrug use problemsCART initiationCause mortalityHepatitis CCohort studyHepatitis BHIV infectionTowards a combined prognostic index for survival in HIV infection: the role of ‘non‐HIV’ biomarkers
Justice A, McGinnis K, Skanderson M, Chang C, Gibert C, Goetz M, Rimland D, Rodriguez‐Barradas M, Oursler K, Brown, Braithwaite R, May M, Covinsky K, Roberts, Fultz S, Bryant K, Team F. Towards a combined prognostic index for survival in HIV infection: the role of ‘non‐HIV’ biomarkers. HIV Medicine 2010, 11: 143-151. PMID: 19751364, PMCID: PMC3077949, DOI: 10.1111/j.1468-1293.2009.00757.x.Peer-Reviewed Original ResearchMeSH KeywordsAgedAIDS-Related Opportunistic InfectionsAnemiaAnti-HIV AgentsBiomarkersCause of DeathCD4 Lymphocyte CountCohort StudiesConfidence IntervalsDisease ProgressionDrug Therapy, CombinationFemaleHepatitis, Viral, HumanHIV InfectionsHIV Long-Term SurvivorsHumansLiver CirrhosisMaleMiddle AgedRNA, ViralSeverity of Illness IndexSubstance-Related DisordersSurvival AnalysisConceptsCombination antiretroviral therapyVeterans Aging Cohort StudyHIV biomarkersVACS IndexHIV infectionSurvival intervalAging Cohort StudyShorter survival intervalAntiretroviral therapyCause mortalityCohort studyHIV markersPrognostic indexAIDS conditionsChronic inflammationMortality riskHIVSubstance abuseBiomarkersMortalityBiomarker groupsComplete dataSimilar intervalsInfectionFurther validation
2009
Development of an Electronic Medical Record-Based Clinical Decision Support Tool to Improve HIV Symptom Management
Nader CM, Tsevat J, Justice AC, Mrus JM, Levin F, Kozal MJ, Mattocks K, Farber S, Rogers M, Erdos J, Brandt C, Kudel I, Braithwaite R. Development of an Electronic Medical Record-Based Clinical Decision Support Tool to Improve HIV Symptom Management. AIDS Patient Care And STDs 2009, 23: 521-529. PMID: 19538046, PMCID: PMC3048777, DOI: 10.1089/apc.2008.0209.Peer-Reviewed Original ResearchMeSH KeywordsAdultDecision Making, Computer-AssistedDecision Support Systems, ClinicalFemaleHIV InfectionsHumansMaleMedical Records Systems, ComputerizedMiddle AgedPatient SatisfactionPilot ProjectsPractice Guidelines as TopicPractice Patterns, Physicians'Severity of Illness IndexSurveys and QuestionnairesUnited StatesUnited States Department of Veterans AffairsConceptsClinical decision support toolVeterans Health Administration electronic medical recordsElectronic medical recordsSymptom managementMedical recordsProvider awarenessProgress notesClinical HIV careHIV symptom managementEMR notesHIV careHIV clinicClinical responseControl patientsHIV diseaseCommon symptomsPoint of careHIV symptomsProvider notesPatients' perceptionsIntervention groupIntervention periodCare plansPatientsSymptoms
2002
Clinical Importance of HIV and Depressive Symptoms Among Veterans with HIV Infection
Kilbourne AM, Justice AC, Rollman BL, McGinnis KA, Rabeneck L, Weissman S, Smola S, Schultz R, Whittle J, Rodriguez‐Barradas M. Clinical Importance of HIV and Depressive Symptoms Among Veterans with HIV Infection. Journal Of General Internal Medicine 2002, 17: 512-520. PMID: 12133141, PMCID: PMC1495073, DOI: 10.1046/j.1525-1497.2002.10803.x.Peer-Reviewed Original ResearchConceptsSevere depressive symptomsIllness severityHIV symptomsDepressive symptomsHIV infectionClinical importanceHIV Symptom IndexEpidemiologic Studies Depression ScaleInfectious disease clinicPatient illness severitySeverity of illnessSignificant depressive symptomsCross-sectional studyVA Medical CenterHealth care providersDepression symptom severityAntiretroviral useDisease clinicViral loadCommon symptomsSymptom IndexDepression statusSymptom frequencyDepression ScaleMedical Center