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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, MPHa,b; McGinnis, Kathleen A. DrPH, MSc; Tate, Janet P. ScD, MPHc,d; Matson, Theresa E. MPHa,e; Rubinsky, Anna D. PhD, MSa,f; Bobb, Jennifer F. PhDe; Lapham, Gwen T. PhD, MPH, MSWb,e; Edelman, E. Jennifer MD, MHSd,g; Catz, Sheryl L. PhDh; Satre, Derek D. PhDi,j; Bryant, Kendall J. PhDk; Marshall, Brandon D. L. PhDl; Kraemer, Kevin L. MD, MScm,n; Bensley, Kara M. PhD, MSca,o; Richards, Julie E. MPHb,e; Skanderson, Melissa MSWc; Justice, Amy C. MD, PhDc,d,g; Fiellin, David A. MDc,g; Bradley, Katharine A. MD, MPHa,b,e,p,q

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1, 2019 - Volume 81 - Issue 4 - p 448–455
doi: 10.1097/QAI.0000000000002049
Clinical Science

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).

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

bDepartment of Health Services, University of Washington, Seattle, WA;

cVeterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT;

dYale School of Medicine, New Haven, CT;

eKaiser Permanente Washington Health Research Institute, Seattle, WA;

fKidney Health Research Collaborative, San Francisco VA Medical Center, University of California, San Francisco, San Francisco, CA;

gYale School of Public Health, New Haven, CT;

hBetty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA;

iDepartment of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA;

jDivision of Research, Kaiser Permanente Northern California, Oakland, CA;

kNational Institute on Alcohol Abuse and Alcoholism, Bethesda, MD;

lDepartment of Epidemiology, Brown University School of Public Health, Providence, RI;

mDivision of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA;

nCenter for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA;

oSchool of Public Health, University of California, Berkeley, CA;

pCenter of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Healthcare System—Seattle Division, Seattle, WA; and

qDepartment of Medicine, University of Washington, Seattle, WA.

Correspondence to: Emily C. Williams, PhD, MPH, VA Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA 98108 (e-mail:

Supported by the National Institute on Alcohol Abuse and Alcoholism (R21AA022866-01; E.C.W./K.A.B. PIs) and COMpAAAS/Veterans Aging Cohort Study (U24-AA020794, U01-AA020790, U01-AA020795, U01-AA020799, U10 AA013566). E.C.W. is supported by a Career Development Award from VA Health Services Research & Development (CDA 12-276), and K.A.B. 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.J.B.) 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.

Presented at the Research Society on Alcoholism (RSA) Conference; June 17, 2018; San Diego, CA.

The authors have no conflicts of interest to disclose.

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Received September 21, 2018

Accepted February 24, 2019

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