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Drug Alcohol Depend. 2018 Aug 1;189:21-29. doi: 10.1016/j.drugalcdep.2018.04.022. Epub 2018 May 24.

Changes in alcohol use associated with changes in HIV disease severity over time: A national longitudinal study in the Veterans Aging Cohort.

Author information

1
Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, USA; Department of Health Services, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660 Seattle, WA, USA. Electronic address: emily.williams3@va.gov.
2
Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, 950 Campbell Avenue, Building 35A, 11-ACSLG, West Haven, CT, USA.
3
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, USA.
4
Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, USA; Kidney Health Research Collaborative, University of California, San Francisco and San Francisco VA Medical Center, 4150 Clement St., Building 18, San Francisco, CA, USA.
5
Betty Irene Moore School of Nursing, University of California at Davis, 2570 48th St., Sacramento, CA, USA.
6
Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, USA; Department of Health Services, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660 Seattle, WA, USA.
7
Department of Health Services, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660 Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, USA.
8
National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA.
9
Yale University Schools of Medicine and Public Health, 333 Cedar Street, New Haven, CT, USA.
10
Department of Psychiatry, Weill Institute for Neurosciences, University of California, 401 Parnassus Ave., San Francisco, CA, USA; Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA, USA.
11
Department of Epidemiology, Brown University School of Public Health, 121 South Main St., Second floor, Providence, RI, USA.
12
Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Suite 933W, Pittsburgh, PA, USA.
13
Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Suite 933W, Pittsburgh, PA, USA; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 3900 Woodland Avenue, Annex Suite 202, Pittsburgh, PA, USA.
14
Health Services Research, Rutgers University, 61 Dudley Rd, New Brunswick, NJ, USA.
15
Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, USA; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), Salt Lake City VA Health Care System, 500 Foothill Drive, Salt Lake City, UT, USA.
16
Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, 950 Campbell Avenue, Building 35A, 11-ACSLG, West Haven, CT, USA; Yale University Schools of Medicine and Public Health, 333 Cedar Street, New Haven, CT, USA.
17
Health Services Research and Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, USA; Department of Health Services, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660 Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA, USA; Center of Excellence in Substance Abuse Treatment and Education (CESATE) VA Puget Sound Healthcare System - Seattle Division, 1660 S Columbian Way, Seattle, WA, USA; Department of Medicine, University of Washington, 1959 NE Pacific Street, Box 356420, Seattle, WA, USA.

Abstract

BACKGROUND:

Among groups of persons living with HIV (PLWH), high-risk drinking trajectories are associated with HIV severity. Whether changes in individuals' alcohol use are associated with changes in HIV severity over the same period is unknown.

METHODS:

Veterans Aging Cohort Study (VACS) data from VA's EHR (2/1/2008-9/30/2016) identified AUDIT-C screens for all PLWH. Pairs of AUDIT-C screens within 9-15 months were included if CD4 and/or viral load (VL) was measured within 9 months after baseline and follow-up AUDIT-Cs. Linear regression assessed change in HIV severity (CD4 and logVL) associated with AUDIT-C change adjusted for confounders. Mean changes in HIV severity were estimated for each AUDIT-C change value. For all measures of change, positive values indicate improvements (lower drinking and improved HIV severity).

RESULTS:

Among PLWH, 21,999 and 22,143 were eligible for CD4 and VL analyses, respectively. Most had non- or low-level drinking and stable consumption over time (mean AUDIT-C change = .08, SD = 1.91). HIV severity improved over time [mean CD4 change = 20.5 (SD 180.8); mean logVL change = 0.12 (SD 0.71)]. AUDIT-C changes were associated non-linearly with changes in CD4 (p = 0.03) and logVL (p < 0.001). Improvement in HIV severity was greatest among those with stable AUDIT-C scores over time; those with greater AUDIT-C increases fared worse than those with smaller increases in or stable AUDIT-Cs.

CONCLUSIONS:

Improvement in HIV severity was greatest among PLWH with relatively stable drinking, most of whom initially did not drink or drank at low levels. Those with large changes (especially increases) in drinking appear at greatest risk for poor HIV control.

KEYWORDS:

Alcohol use; Alcohol use disorders; CD4; HIV; Veterans; Viral load

PMID:
29859388
PMCID:
PMC6344121
DOI:
10.1016/j.drugalcdep.2018.04.022
[Indexed for MEDLINE]
Free PMC Article

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