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J Acquir Immune Defic Syndr. 2019 Aug 1;81(4):448-455. doi: 10.1097/QAI.0000000000002049.

HIV Disease Severity Is Sensitive to Temporal Changes in Alcohol Use: A National Study of VA Patients With HIV.

Author information

1
Health Services Research & Development (HSR&D), Veteran Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle, WA.
2
Department of Health Services, University of Washington, Seattle, WA.
3
Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT.
4
Yale School of Medicine, New Haven, CT.
5
Kaiser Permanente Washington Health Research Institute, Seattle, WA.
6
Kidney Health Research Collaborative, San Francisco VA Medical Center, University of California, San Francisco, San Francisco, CA.
7
Yale School of Public Health, New Haven, CT.
8
Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA.
9
Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA.
10
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
11
National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD.
12
Department of Epidemiology, Brown University School of Public Health, Providence, RI.
13
Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
14
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.
15
School of Public Health, University of California, Berkeley, CA.
16
Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Healthcare System-Seattle Division, Seattle, WA.
17
Department of Medicine, University of Washington, Seattle, WA.

Abstract

BACKGROUND:

Alcohol use influences HIV disease severity through multiple mechanisms. Whether HIV disease severity is sensitive to changes in alcohol use among people with HIV (PWH) is understudied.

SETTING:

National Veterans Health Administration.

METHODS:

Pairs of AUDIT-C screens within 9-15 months (February 1, 2008-September 30, 2014) were identified among PWH from the Veterans Aging Cohort Study (VACS). Initial and follow-up VACS Index 2.0 pairs obtained 0-270 days after initial and follow-up AUDIT-Cs, respectively, determined change in VACS Index 2.0, a composite HIV severity measure. Change in VACS Index 2.0 was regressed on AUDIT-C change scores (-12 to +12) adjusted for demographics, initial VACS Index 2.0, and days between VACS Index measures.

RESULTS:

Among 23,297 PWH (76,202 observations), most had no (51%) or low-level (38%) alcohol use initially. Most (54%) had no subsequent change; 21% increased and 24% decreased drinking. Initial VACS Index 2.0 scores ranged from 0 to 134, change scores ranged from -65 to +73, with average improvement of 0.76 points (SD 9.48). AUDIT-C change was associated with VACS Index 2.0 change (P < 0.001). Among those with stable alcohol use (AUDIT-C change ≤ │1│ point), VACS Index 2.0 improvements ranged 0.36-0.60 points. For those with maximum AUDIT-C increase (change from 0 to 12), VACS Index 2.0 worsened 3.74 points (95% CI: -4.71 to -2.78); for those with maximum AUDIT-C decrease (change from 12 to 0), VACS Index 2.0 changed minimally [-0.60 (95% CI: -1.43 to 0.23)].

CONCLUSIONS:

In this national sample, improvement in HIV severity was generally greatest among those with stable alcohol use (primarily those with no use).

PMID:
30973541
PMCID:
PMC6594884
[Available on 2020-08-01]
DOI:
10.1097/QAI.0000000000002049

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