HIV Disease Severity Is Sensitive to Temporal Changes in Alcohol Use: A National Study of VA Patients With HIV.
Emily C Williams, Kathleen A McGinnis, Janet P Tate, Theresa E Matson, Anna D Rubinsky, Jennifer F Bobb, Gwen T Lapham, E Jennifer Edelman, Sheryl L Catz, Derek D Satre, Kendall J Bryant, Brandon D L Marshall, Kevin L Kraemer, Kara M Bensley, Julie E Richards, Melissa Skanderson, Amy C Justice, David A Fiellin, Katharine A Bradley
Author Information
Emily C Williams: Health Services Research & Development (HSR&D), Veteran Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle, WA.
Kathleen A McGinnis: Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT.
Janet P Tate: Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT.
Theresa E Matson: Health Services Research & Development (HSR&D), Veteran Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle, WA.
Anna D Rubinsky: Health Services Research & Development (HSR&D), Veteran Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle, WA.
Jennifer F Bobb: Kaiser Permanente Washington Health Research Institute, Seattle, WA.
Gwen T Lapham: Department of Health Services, University of Washington, Seattle, WA.
E Jennifer Edelman: Yale School of Medicine, New Haven, CT.
Sheryl L Catz: Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA.
Derek D Satre: Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA.
Kendall J Bryant: National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD.
Brandon D L Marshall: Department of Epidemiology, Brown University School of Public Health, Providence, RI.
Kevin L Kraemer: Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Kara M Bensley: Health Services Research & Development (HSR&D), Veteran Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle, WA.
Julie E Richards: Department of Health Services, University of Washington, Seattle, WA.
Melissa Skanderson: Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT.
Amy C Justice: Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT.
David A Fiellin: Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT.
Katharine A Bradley: Health Services Research & Development (HSR&D), Veteran Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle, WA.
BACKGROUND: Alcohol use influences HIV disease severity through multiple mechanisms. Whether HIV disease severity is sensitive to changes in alcohol use among people with HIV (PWH) is understudied. SETTING: National Veterans Health Administration. METHODS: Pairs of AUDIT-C screens within 9-15 months (February 1, 2008-September 30, 2014) were identified among PWH from the Veterans Aging Cohort Study (VACS). Initial and follow-up VACS Index 2.0 pairs obtained 0-270 days after initial and follow-up AUDIT-Cs, respectively, determined change in VACS Index 2.0, a composite HIV severity measure. Change in VACS Index 2.0 was regressed on AUDIT-C change scores (-12 to +12) adjusted for demographics, initial VACS Index 2.0, and days between VACS Index measures. RESULTS: Among 23,297 PWH (76,202 observations), most had no (51%) or low-level (38%) alcohol use initially. Most (54%) had no subsequent change; 21% increased and 24% decreased drinking. Initial VACS Index 2.0 scores ranged from 0 to 134, change scores ranged from -65 to +73, with average improvement of 0.76 points (SD 9.48). AUDIT-C change was associated with VACS Index 2.0 change (P < 0.001). Among those with stable alcohol use (AUDIT-C change ≤ │1│ point), VACS Index 2.0 improvements ranged 0.36-0.60 points. For those with maximum AUDIT-C increase (change from 0 to 12), VACS Index 2.0 worsened 3.74 points (95% CI: -4.71 to -2.78); for those with maximum AUDIT-C decrease (change from 12 to 0), VACS Index 2.0 changed minimally [-0.60 (95% CI: -1.43 to 0.23)]. CONCLUSIONS: In this national sample, improvement in HIV severity was generally greatest among those with stable alcohol use (primarily those with no use).
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