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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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Abstract

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.

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Funding

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.

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Authors and Affiliations

  1. Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA

    Emily C. Williams, Theresa E. Matson, Gwen T. Lapham & Katharine A. Bradley

  2. Department of Health Services, University of Washington, Seattle, WA, USA

    Emily C. Williams, Julie E. Richards & Katharine A. Bradley

  3. Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA

    Kathleen A. McGinnis, David A. Fiellin & Amy C. Justice

  4. Yale University School of Medicine and Public Health, New Haven, CT, USA

    E. Jennifer Edelman, David A. Fiellin & Amy C. Justice

  5. Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA

    Theresa E. Matson, Gwen T. Lapham, Julie E. Richards & Katharine A. Bradley

  6. Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Adam J. Gordon

  7. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Adam J. Gordon

  8. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA

    Brandon D. L. Marshall

  9. National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA

    Kendall J. Bryant

  10. Kidney Health Research Collaborative, University of California, San Francisco, and VA San Francisco Healthcare System, San Francisco, CA, USA

    Anna D. Rubinsky

  11. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Derek D. Satre

  12. Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA

    Derek D. Satre

  13. Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA, USA

    Sheryl L. Catz

  14. Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Healthcare System – Seattle Division, Seattle, WA, USA

    Katharine A. Bradley

  15. Department of Medicine, University of Washington, Seattle, WA, USA

    Katharine A. Bradley

Authors
  1. Emily C. Williams
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  2. Kathleen A. McGinnis
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  3. E. Jennifer Edelman
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  4. Theresa E. Matson
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  5. Adam J. Gordon
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  6. Brandon D. L. Marshall
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  7. Kendall J. Bryant
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  8. Anna D. Rubinsky
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  9. Gwen T. Lapham
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  10. Derek D. Satre
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  11. Julie E. Richards
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  12. Sheryl L. Catz
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  13. David A. Fiellin
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  14. Amy C. Justice
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  15. Katharine A. Bradley
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Contributions

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.

Corresponding author

Correspondence to Emily C. Williams.

Ethics declarations

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.

Appendices

Appendix 1: List of Antiretroviral Medications

Zidovudine

Didanosine

Zalcitabine

Stavudine

Lamivudine

Lamivudine/zidovudine

Abacavir

Indinavir

Ritonavir

Saquinavir

Nelfinavir

Amprenavir

Nevirapine

Delavirdine

Efavirenz

Lopinavir/ritonavir

Tenofovir

Abacavir/lamivudine/zidovudine

Emtricitabine

Atazanavir

Fosamprenavir

Lopinavir

Emtricibine/tenofovir

Abacavir/lamividine

Enfuvirtide

Adefovir

Tipranavir

Darunavir

Efavirenz/emtricitabine/tenofovir

Etravirine

Maraviroc

Raltegravir

Elvitegravir/cobicistat/emtricitabine/tenofovir

Rilpivirine

Emtricitabine/rilpivirine/tenofovir

Dolutegravir

Elvitegravir

Abacavir/dolutegravir/lamivudine

Cobicistat

Cobicistat/darunavir

Atazanavir/cobicistat

Cobicistat/elvitegravir/emtricitabine/tenofovir

Appendix 2

See Fig. 3.

Fig. 3
figure 3

Among subpopulations of VA patients living with HIV targeted by each stage of the HIV care continuum, percent meeting care targets across level of alcohol use

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Williams, E.C., McGinnis, K.A., Edelman, E.J. et al. Level of Alcohol Use Associated with HIV Care Continuum Targets in a National U.S. Sample of Persons Living with HIV Receiving Healthcare. AIDS Behav 23, 140–151 (2019). https://doi.org/10.1007/s10461-018-2210-6

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  • DOI: https://doi.org/10.1007/s10461-018-2210-6

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