Direct and Indirect Effects of Heavy Alcohol Use on Clinical Outcomes in a Longitudinal Study of HIV Patients on ART

  • Christopher W. Kahler
  • Tao Liu
  • Patricia A. Cioe
  • Vaughn Bryant
  • Megan M. Pinkston
  • Erna M. Kojic
  • Nur Onen
  • Jason V. Baker
  • John Hammer
  • John T. Brooks
  • Pragna Patel
Original Paper

DOI: 10.1007/s10461-016-1474-y

Cite this article as:
Kahler, C.W., Liu, T., Cioe, P.A. et al. AIDS Behav (2016). doi:10.1007/s10461-016-1474-y

Abstract

In a cohort of patients receiving care for HIV, we examined longitudinally the impact of past 30-day frequency of heavy drinking (consuming 5+ drinks on one occasion) on HIV-related (detectable viral load and CD4+ T cell count) and non-HIV-related (hemoglobin and biomarkers of kidney function and liver fibrosis) clinical outcomes and the extent to which these effects were due to reduced antiretroviral therapy (ART) adherence. Data came from the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy. Between March 2004 and June 2006, 533 individuals receiving ART were recruited and followed every 6 months for six years. Using longitudinal mediation analysis, we estimated natural direct effects (NDE) of heavy drinking frequency (never, 1–3 times, or 4+ times in the past 30 days) on clinical outcomes and natural indirect effects (NIE) mediated via ART adherence. A one-level increase in heavy drinking frequency had a significant negative NDE on CD4+ T-cell counts (-10.61 cells/mm3; 95 % CI [-17.10, -4.12]) and a significant NIE through reduced ART adherence of -0.72 cells/mm3 (95 % CI [-1.28, -0.15]), as well as a significant NIE on risk of detectable viral load (risk ratio = 1.03; 95 % CI [1.00, 1.05]). Heavy drinking had a significant detrimental NIE on a combined index of 5-year mortality risk and detrimental NDE and total effect on a biomarker of liver fibrosis. Heavy drinking has deleterious effects on multiple clinical outcomes in people living with HIV, some of which are mediated through reduced ART adherence.

Keywords

Alcohol HIV Adherence Viral load Liver function VACS Index 

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Christopher W. Kahler
    • 1
  • Tao Liu
    • 2
  • Patricia A. Cioe
    • 1
  • Vaughn Bryant
    • 3
  • Megan M. Pinkston
    • 4
  • Erna M. Kojic
    • 5
  • Nur Onen
    • 6
  • Jason V. Baker
    • 7
  • John Hammer
    • 8
  • John T. Brooks
    • 9
  • Pragna Patel
    • 10
  1. 1.Center for Alcohol and Addiction StudiesBrown University School of Public HealthProvidenceUSA
  2. 2.Center for Statistical SciencesBrown University School of Public HealthProvidenceUSA
  3. 3.Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleUSA
  4. 4.Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceUSA
  5. 5.Department of Infectious DiseaseBrown UniversityProvidenceUSA
  6. 6.Washington University School of MedicineSt. LouisUSA
  7. 7.Division of Infectious Diseases, Hennepin County Medical CenterUniversity of MinnesotaMinneapolisUSA
  8. 8.Denver Infectious Disease ConsultantsDenverUSA
  9. 9.Division of HIV/AIDS PreventionCenters for Disease Control and PreventionAtlantaUSA
  10. 10.Division of Global Health ProtectionCenters for Disease Control and PreventionAtlantaUSA

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