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Heavy Alcohol Use is Associated with Lower CD4 Counts among Russian Women Living with HIV: A Multilevel Analysis

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Abstract

Alcohol use remains prevalent among Russian women with HIV infection. Multilevel mixed effects models were used to estimate the association of heavy drinking and HIV outcomes among women (N = 250 at baseline; N = 207 at follow-up), aged 18–35, engaged in HIV care in Saint Petersburg. Alcohol use was assessed at baseline and 3 months by self-report and by the biomarker phosphatidylethanol (PEth). Overall, 35% of women were heavy drinkers, defined as women reporting ≥ 1 past-30-day heavy drinking episode (≥ 4 standard drinks on one occasion) or with PEth blood levels ≥ 80 ng/mL. Women who engaged in heavy drinking had an average 41 CD4 cells/mm3 (95% CI = − 81, − 2; z = − 2.04; P = 0.042) fewer than those who did not. Heavy drinking was associated with higher HIV symptom burden (IRR = 1.20; 95% CI = 1.05, 1.36; z = 2.73; P = 0.006) and suboptimal antiretroviral adherence (OR = 3.04; 95% CI = 1.27, 7.28; χ2 = 2.50; P = 0.013), but not with viral load. Findings support the integration of alcohol treatment interventions as part of routine HIV care in Russia.

Resumen

El consumo de alcohol es común en las mujeres rusas con VIH. Utilizamos modelos multinivel de efectos mixtos para estimar la asociación entre el consumo de alcohol excesivo y los resultados adversos de VIH en un grupo de mujeres (N = 250 al inicio del estudio; N = 207 en el seguimiento), de 18 a 35 años de edad, que recibían atención médica para el VIH en San Petersburgo. El consumo de alcohol excesivo, definido como el consumo de ≥ 4 bebidas alcohólicas en una ocasión en base a autoinforme o a niveles de fosfatidiletanol ≥ 80 ng/mL, se evaluó al inicio del estudio y a los 3 meses. Las mujeres que bebían en exceso, el 35% de la muestra, tenían un promedio de 41 células CD4/mm3 (IC del 95% = − 81, − 2; z = − 2,04; P = 0,042) menos que las que no lo hacían. El consumo excesivo de alcohol se asoció con una mayor carga de síntomas de VIH (TIR = 1,20; IC del 95% = 1,05, 1,36; z = 2,73; P = 0,006) y una adherencia al tratamiento antirretroviral subóptima (OR = 3,04; IC del 95% = 1,27, 7,28; χ2 = 2,50; P = 0,013), pero no con carga viral. Los hallazgos respaldan la integración de la atención para el tratamiento del alcoholismo en los servicios de atención rutinaria del VIH en Rusia.

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Data Availability

The data used for this analysis is available upon request from the corresponding author.

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Funding

This work was supported by grants from the National Institute on Drug Abuse (JLB: R03DA0377860; RJD: 1U01DA0362233) and the National Institute on Alcohol Abuse and Alcoholism (RJD: 1R01AA018096). The funding source had no role in the study design; data collection, analysis, or interpretation; writing or decision to submit the paper for publication. No financial disclosures that pose a conflict of interest are reported by the authors of this paper.

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Authors and Affiliations

  1. Social and Behavioral Sciences Department, NYU School of Global Public Heath, New York University, 715 Broadway, 12th Floor, New York, NY, 10003, USA

    Ariadna Capasso & Ralph J. DiClemente

  2. Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Jennifer L. Brown

  3. Saint Petersburg AIDS Center, Saint Petersburg, Russia

    Polina Safonova

  4. First Pavlov State Medical University, Saint Petersburg, Russia

    Nikolay Belyakov & Vadim Rassokhin

  5. Pasteur Institute of Epidemiology and Microbiology, Saint Petersburg, Russia

    Nikolay Belyakov & Vadim Rassokhin

  6. North-West Regional Center for Control and Prevention of AIDS, Saint Petersburg, Russia

    Nikolay Belyakov & Vadim Rassokhin

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  1. Ariadna Capasso
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  2. Jennifer L. Brown
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  3. Polina Safonova
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  4. Nikolay Belyakov
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  6. Ralph J. DiClemente
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Contributions

AC: Conception and design of the analysis; statistical analysis, interpretation and writing; JLB: Critical revision of the work; PS: Data collection, coordination, critical revision of the work; NB and VR: Project conception, data collection quality control, critical revision of the work; RJD: Conception of the project, data collection quality control, revision of the data, findings and writing, final approval of the manuscript.

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Correspondence to Ralph J. DiClemente.

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The Institutional Review Boards of Emory University (USA) and St. Petersburg AIDS Center (Russia) approved all study procedures.

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Capasso, A., Brown, J.L., Safonova, P. et al. Heavy Alcohol Use is Associated with Lower CD4 Counts among Russian Women Living with HIV: A Multilevel Analysis. AIDS Behav 25, 3734–3742 (2021). https://doi.org/10.1007/s10461-021-03270-4

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