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HIV Disease Severity is Sensitive to Temporal Changes in Alcohol Use

A National Study of VA Patients with HIV

Williams, Emily C. PhD, MPH1,2; McGinnis, Kathleen A. DrPH, MS3; Tate, Janet P. ScD, MPH3,4; Matson, Theresa E. MPH1,5; Rubinsky, Anna D. PhD, MS1,6; Bobb, Jennifer F. PhD5; Lapham, Gwen T. PhD, MPH, MSW2,5; Edelman, E. Jennifer MD, MHS4,10; Catz, Sheryl L. PhD7; Satre, Derek D. PhD11,12; Bryant, Kendall J. PhD9; Marshall, Brandon D.L. PhD13; Kraemer, Kevin L. MD, MSc14,15; Bensley, Kara M. PhD, MSc1,8; Richards, Julie E. MPH2,5; Skanderson, Melissa MSW3; Justice, Amy C. MD, PhD3,4,10; Fiellin, David A. MD3,10; Bradley, Katharine A. MD, MPH1,2,5,16,17

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 15, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002049
Original Article: PDF Only

Background: Alcohol use influences HIV disease severity via 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 (2/1/08-9/30/14) 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 0-134, 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 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, -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, 0.23)].

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

1Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA ) Puget Sound Health Care System, Seattle, WA

2Department of Health Services, University of Washington, Seattle, WA

3Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT

4Yale School of Medicine, New Haven, CT

5Kaiser Permanente Washington Health Research Institute, Seattle, WA

6Kidney Health Research Collaborative, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA

7Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA

8School of Public Health, University of California, Berkeley, CA.

9National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD

10Yale School of Public Health, New Haven, CT

11Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA

12Kaiser Permanente Northern California, Division of Research, Oakland, CA

13Department of Epidemiology, Brown University School of Public Health, Providence, RI

14Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA

15Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA

16Center of Excellence in Substance Abuse Treatment and Education (CESATE) VA Puget Sound Healthcare System – Seattle Division, Seattle, WA

17Department of Medicine, University of Washington, Seattle, WA

Correspondence: Emily C. Williams, PhD, MPH; VA Puget Sound Health Care System; 1660 S. Columbian Way, S-152; Seattle, WA 98108; Email:; Phone (206) 277-6133

conflicts of interest: All authors declare no potential conflicts of interest.

Preliminary findings of this study were presented at the Research Society on Alcoholism (RSA) Conference in San Diego, CA in June 2018.

Sources of funding: This research was funded by a grant from the National Institute on Alcohol Abuse and Alcoholism (R21AA022866-01; Williams/Bradley PIs) and COMpAAAS/Veterans Aging Cohort Study (U24-AA020794, U01-AA020790, U01-AA020795,U01-AA020799; U10 AA013566). Dr. Williams is supported by a Career Development Award from VA Health Services Research & Development (CDA 12-276), and Dr. Bradley is supported by a mid-career mentorship award from NIAAA (K24-AA022128). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. An employee of the funder (K. Bryant) served as a scientific collaborator and helped guide analysis, interpretation and presentation of data and participated in the decision to submit the manuscript for publication. Views presented in the manuscript are those of the authors and do not represent the official position of the U.S. Government, the Department of Veterans Affairs, or other affiliated institutions.

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