Journal
AIDS
Volume 31, Issue 9, Pages 1313-1321Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0000000000001473
Keywords
alcohol; HIV infection; morbidity; trajectories; trends; veterans
Categories
Funding
- NCATS NIH HHS [UL1 TR001863] Funding Source: Medline
- NIAAA NIH HHS [U24 AA020794, U24 AA022002, U01 AA020795, P01 AA019072, U24 AA022000, U10 AA013566, U01 AA020790] Funding Source: Medline
- NIAID NIH HHS [P30 AI042853] Funding Source: Medline
- NIDA NIH HHS [K12 DA033312, DP2 DA040236, F31 DA035567, R01 DA035616] Funding Source: Medline
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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 (Cramer'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. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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