Usama Bilal1,2, Mary E McCaul3, Heidi M Crane4, W Christopher Mathews5, Kenneth H Mayer6,7,8, Elvin Geng9, Sonia Napravnik10, Karen L Cropsey11, Michael J Mugavero11, Michael S Saag11, Heidi Hutton3, Bryan Lau1,12, Geetanjali Chander1,12. 1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 2. Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania. 3. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland. 4. Department of Medicine, UW School of Medicine, University of Washington, Seattle, Washington. 5. Department of Medicine, University of California San Diego, San Diego, California. 6. School of Medicine, Harvard University, Boston, Massachusetts. 7. School of Public Health, Harvard University, Boston, Massachusetts. 8. Fenway Health, Boston, Massachusetts. 9. School of Medicine, University of California San Francisco, San Francisco, California. 10. Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina. 11. Department of Medicine, University of Alabama, Birmingham, Alabama. 12. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract
BACKGROUND: Our aim was to describe alcohol consumption trajectories in a cohort of people living with HIV and determine clinical and sociodemographic predictors of each trajectory. METHODS: This is a prospective cohort study of 7,906 patients in the 7 Centers for AIDS Research Network of Integrated Clinical Systems sites. Alcohol consumption was categorized as none, moderate, and alcohol misuse. Predictors included age, race/ethnicity, depressive or anxiety symptoms, illicit drug use (opioids, methamphetamines, cocaine/crack), marijuana use, hepatitis C virus (HCV) infection, HIV transmission risk factor, and HIV disease progression. We estimated sex-stratified alcohol consumption trajectories and their predictors. RESULTS: We found 7 trajectories of alcohol consumption in men: stable nondrinking and increased drinking (71% and 29% of initial nondrinking); stable moderate, reduced drinking, and increased alcohol misuse (59%, 21%, and 21% of initial moderate alcohol use); and stable alcohol misuse and reduced alcohol misuse (75% and 25% of initial alcohol misuse). Categories were similar in women, except lack of an increase to alcohol misuse trajectory among women that begin with moderate use. Older men and women were more likely to have stable nondrinking, while younger men were more likely to increase to or remain in alcohol misuse. Minorities, people with depressive or anxiety symptoms, HCV-infected individuals, and people who injected drugs were more likely to reduce use. Illicit drug use was associated with a reduction in overall drinking, while marijuana use was associated with stable moderate drinking or misuse. CONCLUSIONS: Longitudinal trajectories of increasing alcohol use and stable misuse highlight the need to integrate routine screening and alcohol misuse interventions into HIV primary care.
BACKGROUND: Our aim was to describe alcohol consumption trajectories in a cohort of people living with HIV and determine clinical and sociodemographic predictors of each trajectory. METHODS: This is a prospective cohort study of 7,906 patients in the 7 Centers for AIDS Research Network of Integrated Clinical Systems sites. Alcohol consumption was categorized as none, moderate, and alcohol misuse. Predictors included age, race/ethnicity, depressive or anxiety symptoms, illicit drug use (opioids, methamphetamines, cocaine/crack), marijuana use, hepatitis C virus (HCV) infection, HIV transmission risk factor, and HIV disease progression. We estimated sex-stratified alcohol consumption trajectories and their predictors. RESULTS: We found 7 trajectories of alcohol consumption in men: stable nondrinking and increased drinking (71% and 29% of initial nondrinking); stable moderate, reduced drinking, and increased alcohol misuse (59%, 21%, and 21% of initial moderate alcohol use); and stable alcohol misuse and reduced alcohol misuse (75% and 25% of initial alcohol misuse). Categories were similar in women, except lack of an increase to alcohol misuse trajectory among women that begin with moderate use. Older men and women were more likely to have stable nondrinking, while younger men were more likely to increase to or remain in alcohol misuse. Minorities, people with depressive or anxiety symptoms, HCV-infected individuals, and people who injected drugs were more likely to reduce use. Illicit drug use was associated with a reduction in overall drinking, while marijuana use was associated with stable moderate drinking or misuse. CONCLUSIONS: Longitudinal trajectories of increasing alcohol use and stable misuse highlight the need to integrate routine screening and alcohol misuse interventions into HIV primary care.
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Authors: Heidi E Hutton; Catherine R Lesko; Ximin Li; Carol B Thompson; Bryan Lau; Sonia Napravnik; Kenneth H Mayer; W Christopher Mathews; Mary E McCaul; Heidi M Crane; Rob J Fredericksen; Karen L Cropsey; Michael Saag; Katerina Christopoulos; Geetanjali Chander Journal: AIDS Behav Date: 2019-06
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