Level of Alcohol Use Associated with HIV Care Continuum Targets in a National U.S. Sample of Persons Living with HIV Receiving Healthcare

  • Emily C. Williams
  • Kathleen A. McGinnis
  • E. Jennifer Edelman
  • Theresa E. Matson
  • Adam J. Gordon
  • Brandon D. L. Marshall
  • Kendall J. Bryant
  • Anna D. Rubinsky
  • Gwen T. Lapham
  • Derek D. Satre
  • Julie E. Richards
  • Sheryl L. Catz
  • David A. Fiellin
  • Amy C. Justice
  • Katharine A. Bradley
Original Paper


We evaluated associations between levels of alcohol use and HIV care continuum components using national Veterans Aging Cohort Study data for all patients with HIV and AUDIT-C screening (2/1/2008–9/30/2014). Poisson regression models evaluated associations between alcohol use levels (non-drinking, low-, medium-, high-, and very high-level drinking) and: (1) engagement with care (documented CD4 cells/µl or viral load copies/ml labs), (2) ART treatment (≥ 1 prescription), and (3) viral suppression (HIV RNA < 500 copies/ml) within one year. Among 33,224 patients, alcohol use level was inversely associated with all care continuum outcomes (all p < 0.001). Adjusted prevalence of care engagement ranged from 77.8% (95% CI 77.1–78.4%) for non-drinking to 69.1% (66.6–71.6%) for high-level drinking. The corresponding range for ART treatment was 74.0% (73.3–74.7%) to 60.1% (57.3–62.9%) and for viral suppression was 57.3% (56.5–58.1%) to 38.3% (35.6–41.1%). Greater alcohol use is associated with suboptimal HIV treatment across the HIV care continuum.


HIV Care continuum Treatment cascade Antiretroviral therapy Viral suppression Alcohol 


Authors Contribution

Data for this study were obtained from the Veterans Aging Cohort Study (PI: Amy Justice, MD, PhD). All authors contributed to study design, protocol development, and data interpretation.


This study was funded by a grant from the National Institute on Alcohol Abuse and Alcoholism (R21AA022866-01; Williams/Bradley PIs) and by 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); Dr. Bradley is supported by a mid-career mentoring award from the National Institute on Alcohol Abuse and Alcoholism (K24-AA022128). The funders of this study had no role in study design, data collection, analysis, interpretation and presentation, or in the decision to submit the manuscript for publication. Views presented in the manuscript are those of the authors and do not reflect those of the University of Washington, the Department of Veterans Affairs, or the United States Government.

Compliance with Ethical Standards

Conflict of Interest

Dr. Bradley owns stock in Pfizer Pharmaceuticals. All other authors declare no potential conflicts of interest. Preliminary findings of this research study were presented at the Addictions Health Services Research (AHSR) Conference in Madison, WI in September 2017.

Ethical Approval

For this type of study, formal consent is not required. The study, including waivers of written consent and HIPAA authorization, was approved by Internal Review Boards at VA Connecticut Healthcare System and VA Puget Sound.


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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  • Emily C. Williams
    • 1
    • 2
  • Kathleen A. McGinnis
    • 3
  • E. Jennifer Edelman
    • 4
  • Theresa E. Matson
    • 1
    • 5
  • Adam J. Gordon
    • 6
    • 7
  • Brandon D. L. Marshall
    • 8
  • Kendall J. Bryant
    • 9
  • Anna D. Rubinsky
    • 10
  • Gwen T. Lapham
    • 1
    • 5
  • Derek D. Satre
    • 11
    • 12
  • Julie E. Richards
    • 2
    • 5
  • Sheryl L. Catz
    • 13
  • David A. Fiellin
    • 3
    • 4
  • Amy C. Justice
    • 3
    • 4
  • Katharine A. Bradley
    • 1
    • 2
    • 5
    • 14
    • 15
  1. 1.Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven CareVeteran Affairs (VA) Puget Sound Health Care SystemSeattleUSA
  2. 2.Department of Health ServicesUniversity of WashingtonSeattleUSA
  3. 3.Veterans Aging Cohort Study Coordinating CenterVA Connecticut Healthcare SystemWest HavenUSA
  4. 4.Yale University School of Medicine and Public HealthNew HavenUSA
  5. 5.Kaiser Permanente Washington Health Research InstituteSeattleUSA
  6. 6.Division of General Internal MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  7. 7.Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghUSA
  8. 8.Department of EpidemiologyBrown University School of Public HealthProvidenceUSA
  9. 9.National Institute on Alcohol Abuse and AlcoholismBethesdaUSA
  10. 10.Kidney Health Research Collaborative, University of California, San Francisco, and VA San Francisco Healthcare SystemSan FranciscoUSA
  11. 11.Division of ResearchKaiser Permanente Northern CaliforniaOaklandUSA
  12. 12.Department of Psychiatry, Weill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoUSA
  13. 13.Betty Irene Moore School of NursingUniversity of California at DavisSacramentoUSA
  14. 14.Center of Excellence in Substance Abuse Treatment and Education (CESATE)VA Puget Sound Healthcare System – Seattle DivisionSeattleUSA
  15. 15.Department of MedicineUniversity of WashingtonSeattleUSA

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