Level of Alcohol Use Associated with HIV Care Continuum Targets in a National U.S. Sample of Persons Living with HIV Receiving Healthcare
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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.
KeywordsHIV Care continuum Treatment cascade Antiretroviral therapy Viral suppression Alcohol
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.
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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