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Long-term alcohol use patterns and HIV disease severity

Marshall, Brandon D.L.a; Tate, Janet P.b,c,d; McGinnis, Kathleen A.b; Bryant, Kendall J.e; Cook, Robert L.f; Edelman, E. Jenniferc,d; Gaither, Julie R.d,g; Kahler, Christopher W.h,i; Operario, Donh; Fiellin, David A.c,d; Justice, Amy C.b,c,d

doi: 10.1097/QAD.0000000000001473
Epidemiology and Social

Objective: We examined the relationship between alcohol use trajectories and HIV disease severity among men and women participating in the Veterans Aging Cohort Study (VACS).

Design: Prospective cohort of HIV-infected persons in care at eight US Veterans Health Administration sites.

Methods: Between 2002 and 2010, we assessed alcohol consumption annually using the alcohol use disorders identification test-consumption (AUDIT-C). HIV disease severity was ascertained using the VACS index, a validated measure of morbidity and all-cause mortality. We examined the relationship between alcohol use and HIV disease severity patterns using joint trajectory modeling. Alcohol use trajectories were validated using phosphatidylethanol – a biomarker of alcohol consumption – measured between 2005 and 2006 among a subset of participants. We examined associations between membership in alcohol use and VACS index trajectories using multinomial regression.

Results: Among eligible participants, we identified four alcohol consumption trajectories: abstainers (24% of the sample), lower risk (44%), moderate risk (24%), and higher risk drinkers (8%). Alcohol use trajectories were highly correlated with phosphatidylethanol (Cramér's V = 0.465, P < 0.001): mean concentrations were 4.4, 17.8, 57.7, and 167.6 ng/ml in the abstainer, lower risk, moderate risk, and higher risk groups, respectively. Four VACS index trajectories were identified: low (2%), moderate (46%), high (36%), and extreme (16%). Higher risk drinkers were most common in the extreme VACS index group, and were absent in the low index group. In multivariable analysis, the association between alcohol use and VACS index trajectory membership remained significant (P = 0.002).

Conclusion: Alcohol use trajectories characterized by persistent unhealthy drinking are associated with more advanced HIV disease severity among HIV-infected veterans in the United States.

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aDepartment of Epidemiology, Brown University School of Public Health, Providence, Rhode Island

bVA Connecticut Healthcare System, West Haven

cDepartment of Internal Medicine, Yale University School of Medicine

dCenter for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut

eNational Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland

fDepartment of Epidemiology, University of Florida, Gainesville, Florida

gDepartment of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut

hDepartment of Behavioral and Social Sciences

iCenter for Alcohol and Addiction Studies and the Alcohol Research Center on HIV (ARCH), Brown University School of Public Health, Providence, Rhode Island, USA.

Correspondence to Brandon D.L. Marshall, PhD, Brown University School of Public Health, 121 South Main Street (Box G-S-121-2), Providence, RI 02912, USA. Tel: +1 401 863 6427; fax: +1 401 863 3713; e-mail:

Received 25 November, 2016

Revised 24 February, 2017

Accepted 6 March, 2017

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