Increases in Unhealthy Drinking Are Associated With Poorer Outcomes for People Living With HIV

Unhealthy drinking among people living with HIV (PLWH) is associated with HIV disease progression and poorer disease management. There are limited data on the effect of changes in patterns of alcohol use over time and HIV outcomes. Researchers used data from the Veterans Aging Cohort Study to investigate the association between changes in Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) scores and HIV outcomes among PLWH. The sample included 33,224 PLWH who had at least 2 AUDIT-C measurements within 9–15 months and a CD4 cell count or HIV viral load (VL) measurement following each AUDIT-C measurement.

  • At baseline, approximately one half of observations had an AUDIT-C score of 0 and ~10% had a score of ≥4. Participants with higher AUDIT-C scores had lower CD4 cell counts and higher VL.
  • AUDIT-C scores remained relatively stable, with a mean change of 0.08 points, and overall CD4 counts and VL improved over time. On analyses adjusted for other factors including demographics, psychiatric disorders, other substance use, and baseline medication adherence, improvements in CD4 count and VL were highest among those with stable AUDIT-C scores and lowest among those with the largest increases.

Comments: This study adds to previous observations documenting the harms of unhealthy alcohol use for PLWH. It remains to be seen whether interventions targeting alcohol use disorders can improve outcomes in this population.

Darius A. Rastegar, MD

Reference: Williams EC, McGinnis KA, Bobb JF, et al. Changes in alcohol use associated with changes in HIV disease severity over time: a national longitudinal study in the Veterans Aging Cohort. Drug Alcohol Depend. 2018;189:21–29.

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