Characteristics of the MACS/WIHS Combined Cohort Study: Opportunities for Research on Aging With HIV in the Longest US Observational Study of HIV

Abstract

In 2019, NIH combined the Multicenter AIDS Cohort Study and the Women’s Interagency HIV Study into the MACS/WIHS Combined Cohort Study (MWCCS). Participants completing a visit October 2018-September 2019 (targeted for MWCCS enrollment) are described by HIV serostatus and compared to people living with HIV (PLWH) in the U.S. Participants include 2115 women, 1901 men, median age 56 years (IQR 48-63), 62% PLWH. Study sites encompass the South (18%), Mid-Atlantic/Northeast (45%), West Coast (22%), and Midwest (15%). Participant race/ethnicity approximates that of U.S. PLWH. Longitudinal data and specimens collected for 35 years (men) and 25 years (women) were combined. Differences in data collection and coding were reviewed and key risk factor and comorbidity data harmonized. For example, recent use of alcohol (62%) and tobacco (28%) are common, as are dyslipidemia (64%), hypertension (56%), obesity (42%), impaired daily activities (31%), depressive symptoms (28%), and diabetes (22%). The repository includes serum, plasma, cells, cell pellets, urine, cervical vaginal lavage, oral, B-cell lines, stool, and semen specimens. Demographic differences between the MACS and WIHS can confound analyses by sex. The merged MWCCS is both an ongoing observational cohort and a valuable resource of harmonized longitudinal data and specimens for HIV-related research.

Short-term binge drinking, marijuana, and recreational drug use trajectories in a prospective cohort of people living with HIV at the start of COVID-19 mitigation efforts in the United States

“…The MWCCS merged two prospective observational cohort studies, the Multicenter AIDS Cohort Study (MACS) and the Women’s Interagency HIV Study (WIHS) ( D’Souza et al, 2021 ). Before they were combined, the MACS and the WIHS were the two longest-running epidemiologic HIV studies in the US designed to characterize the natural and treatment trajectories of the epidemic.…”

Prevalence of COVID-19–Related Social Disruptions and Effects on Psychosocial Health in a Mixed-Serostatus Cohort of Men and Women

“…The response rate of active cohort participants to baseline COVID-19 survey questions was high (84.9%) and likely reflects the uniquely long-standing nature of this observational cohort study, in which many participants have been attending semiannual visits for 30 years or more and are deeply committed to their participation and to the scientific advancements that have ensued as a result. 37 We initially hypothesized that HIV-positive status would be associated with higher rates of social and health care disruptions among both men and women. Among men, this hypothesis was generally confirmed: MLHIV were more likely than HIV-negative men to report employment and financial disruptions.…”

“…Certain measures based on existing scales (PROMIS Anxiety Short Form 4a; Brief Resilient Coping Scale) were truncated to reduce participant burden and facilitate rapid deployment; psychometric properties of these reduced scales have not been assessed, restricting our ability to confirm the reliability, validity, and clinical utility of cutoffs used. The MACS sample is comprised almost entirely of sexual minority men, and the WIHS sample is composed of almost entirely sexual majority women, 37 limiting our ability to conduct either cohort-stratified (because of limited variance) or combined cohort (because of multicollinearity with the gender/HIV status interaction covariate) analyses that might otherwise assess pandemic-associated differences in psychosocial health by sexual and gender minority status. Because this study was cross-sectional, we cannot verify causal pathways between social disruption and psychosocial health outcomes.…”

“…The MACS and WIHS cohorts were combined in 2019, 36 comprising 2115 women (3:1 ratio of women living with HIV, or WLHIV, to HIV-seronegative women) and 1901 men (1:1 ratio of men living with HIV, or MLHIV, to HIV-seronegative men). 37 MACS study sites are located in Baltimore, MD/Washington, DC; Chicago, IL; Los Angeles, CA; and Pittsburgh, PA, with satellite sites in San Francisco, CA, and Columbus, OH. WIHS study sites are located in Atlanta, GA, Bronx and Brooklyn, NY; Birmingham, AL/Jackson, MS; Chapel Hill, NC; Chicago, IL, Miami, FL; San Francisco, CA; and Washington, D.C. 38 Participants attended semiannual study visits through October 2019, including biopsychosocial data collection.…”

Central Nervous System Effects of COVID-19 in People with HIV Infection

“…An ideal study design would include clinical and biologic data from prior to and following the SARS-CoV-2 pandemic. Large observational cohorts of HIV infection [ 112 , 113 ] that include a subset of individuals who developed COVID-19 could be leveraged to conduct such studies. Studies that are unable to evaluate pre-COVID-19 timepoints in PWH will require thoughtfully selected comparator groups.…”