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Drug Alcohol Depend. 2016 Apr 1;161:95-103. doi: 10.1016/j.drugalcdep.2016.01.017. Epub 2016 Jan 29.

Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men.

Author information

1
Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, CT 06510, USA. Electronic address: amy.Justice2@va.gov.
2
VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA.
3
Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, CT 06510, USA.
4
Department of Population Health New York University School of Medicine, 227 East 30th Street, New York, NY 10016, USA.
5
National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, MSC 9304, Bethesda, MD 20892-9304, USA.
6
Department of Epidemiology, University of Florida, PO Box 100231, Gainesville, FL, USA.
7
Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, CT 06510, USA.
8
Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA; Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, 2525 West End Avenue, Nashville, TN, USA.
9
VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Suite 600, 230 McKee Place, Pittsburgh, PA 15213, USA.
10
Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA.
11
University of Washington School of Public Health, 325 Ninth Avenue, Box 359762, Seattle, WA, USA.

Abstract

BACKGROUND:

HIV infected (HIV+) individuals may be more susceptible to alcohol-related harm than uninfected individuals.

METHODS:

We analyzed data on HIV+ and uninfected individuals in the Veterans Aging Cohort Study (VACS) with an Alcohol Use Disorders Identification Test-Consumption AUDIT-C score from 2008 to 2012. We used Cox proportional hazards models to examine the association between alcohol exposure and mortality through July, 2014; and linear regression models to assess the association between alcohol exposure and physiologic injury based on VACS Index Scores. Models were adjusted for age, race/ethnicity, smoking, and hepatitis C infection.

RESULTS:

The sample included 18,145 HIV+ and 42,228 uninfected individuals. Among HIV+ individuals, 76% had undetectable HIV-1 RNA (<500 copies/ml). The threshold for an association of alcohol use with mortality and physiologic injury differed by HIV status. Among HIV+ individuals, AUDIT-C score ≥4 (hazard ratio [HR] 1.25, 95% CI 1.09-1.44) and ≥30 drinks per month (HR, 1.30, 95% CI 1.14-1.50) were associated with increased risk of mortality. Among uninfected individuals, AUDIT-C score ≥5 (HR, 1.19, 95% CI 1.07-1.32) and ≥70 drinks per month (HR 1.13, 95% CI 1.00-1.28) were associated with increased risk. Similarly, AUDIT-C threshold scores of 5-7 were associated with physiologic injury among HIV+ individuals (beta 0.47, 95% CI 0.22, 0.73) and a score of 8 or more was associated with injury in uninfected (beta 0.29, 95% CI 0.16, 0.42) individuals.

CONCLUSIONS:

Despite antiretroviral therapy, HIV+ individuals experienced increased mortality and physiologic injury at lower levels of alcohol use compared with uninfected individuals. Alcohol consumption limits should be lower among HIV+ individuals.

KEYWORDS:

AUDIT-C; Alcohol; HIV; Morbidity; Mortality; VACS Index; Veteran

PMID:
26861883
PMCID:
PMC4792710
DOI:
10.1016/j.drugalcdep.2016.01.017
[Indexed for MEDLINE]
Free PMC Article

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