Kathleen A McGinnis1, Melissa Skanderson1, E Jennifer Edelman2, Adam J Gordon3, P Todd Korthuis4, Benjamin Oldfield5, Emily C Williams6, Jessica Wyse7, Kendall Bryant8, David A Fiellin9, Amy C Justice10, Kevin L Kraemer11. 1. Veterans Affairs Connecticut Healthcare System, West Haven, CT, 06516 USA. 2. Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 16510 USA; National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892 USA. 3. Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT 84132, USA; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA. 4. Oregon Health Sciences University, Portland, OR, 97239 USA. 5. Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 16510 USA. 6. Department of Health Services, University of Washington School of Public Health, Seattle, WA, 98195 USA; Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, 98108 USA. 7. Oregon Health Sciences University, Portland, OR, 97239 USA; Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR 97239, USA. 8. National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892 USA. 9. Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 16510 USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06516 USA. 10. Veterans Affairs Connecticut Healthcare System, West Haven, CT, 06516 USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 16510 USA. 11. Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213 USA; VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA.
Abstract
BACKGROUND: For people with HIV (PWH) and alcohol use disorder (AUD) who initiated behavioral treatment (BAUD) we: 1) describe BAUD intensity and medication (MAUD); and 2) examine whether BAUD and MAUD were associated with changes in HIV-related outcomes (CD4 cell count, HIV-1 viral load [VL], VACS Index score 2.0, and antiretroviral [ARV] adherence) from before to one year after treatment initiation. METHODS: We used Veterans Aging Cohort Study (VACS) data to describe BAUD intensity and MAUD (acamprosate, disulfiram, and naltrexone, gabapentin or topiramate). Linear regression models estimated changes in outcomes and included BAUD, MAUD, age and race/ethnicity. RESULTS: We identified 7830 PWH who initiated BAUD from 01/2008-09/2017. Median age was 53, 60% were African-American and 28% white. BAUD intensity groups were: 1) Single Visit - 35%; 2) Minimal - 44% recieved ∼2 visits during first month; 3) Sustained Moderate - 17% recieved ∼8 visits/month initially; and 4) Intensive - 4% started out receiving ∼14-16 visits/month. Only 9% recieved MAUD, the majority of which was gabapentin. Among those with detectable VL: all HIV-related outcomes improved more among those with more intensive BAUD. Among those with undetectable VL: adherence improved more among those with greater BAUD intensity. MAUD was associated with increased CD4 among those with detectable VL and with improved adherence among both groups. CONCLUSION: Of those with >1 BAUD visit, only 21% received at least moderate BAUD and 9% received at least 6 months of MAUD. Increasing AUD treatment intensity may improve HIV-related outcomes, especially among those with detectable VL. Published by Elsevier B.V.
BACKGROUND: For people with HIV (PWH) and alcohol use disorder (AUD) who initiated behavioral treatment (BAUD) we: 1) describe BAUD intensity and medication (MAUD); and 2) examine whether BAUD and MAUD were associated with changes in HIV-related outcomes (CD4 cell count, HIV-1 viral load [VL], VACS Index score 2.0, and antiretroviral [ARV] adherence) from before to one year after treatment initiation. METHODS: We used Veterans Aging Cohort Study (VACS) data to describe BAUD intensity and MAUD (acamprosate, disulfiram, and naltrexone, gabapentin or topiramate). Linear regression models estimated changes in outcomes and included BAUD, MAUD, age and race/ethnicity. RESULTS: We identified 7830 PWH who initiated BAUD from 01/2008-09/2017. Median age was 53, 60% were African-American and 28% white. BAUD intensity groups were: 1) Single Visit - 35%; 2) Minimal - 44% recieved ∼2 visits during first month; 3) Sustained Moderate - 17% recieved ∼8 visits/month initially; and 4) Intensive - 4% started out receiving ∼14-16 visits/month. Only 9% recieved MAUD, the majority of which was gabapentin. Among those with detectable VL: all HIV-related outcomes improved more among those with more intensive BAUD. Among those with undetectable VL: adherence improved more among those with greater BAUD intensity. MAUD was associated with increased CD4 among those with detectable VL and with improved adherence among both groups. CONCLUSION: Of those with >1 BAUD visit, only 21% received at least moderate BAUD and 9% received at least 6 months of MAUD. Increasing AUD treatment intensity may improve HIV-related outcomes, especially among those with detectable VL. Published by Elsevier B.V.
Entities:
Keywords:
Alcohol use disorder; Behavioral treatment; HIV; HIV outcomes; Medication treatment
Authors: Jessica J Wyse; Kathleen A McGinnis; E Jennifer Edelman; Adam J Gordon; Ajay Manhapra; David A Fiellin; Brent A Moore; P Todd Korthuis; Amy J Kennedy; Benjamin J Oldfield; Julie R Gaither; Kirsha S Gordon; Melissa Skanderson; Declan T Barry; Kendall Bryant; Stephen Crystal; Amy C Justice; Kevin L Kraemer Journal: AIDS Behav Date: 2021-09-08
Authors: Thibaut Davy-Mendez; Varada Sarovar; Tory Levine-Hall; Alexandra N Lea; Stacy A Sterling; Felicia W Chi; Vanessa A Palzes; Kendall J Bryant; Constance M Weisner; Michael J Silverberg; Derek D Satre Journal: Drug Alcohol Depend Date: 2021-09-28 Impact factor: 4.492
Authors: Kathleen A McGinnis; Melissa Skanderson; Amy C Justice; Kathleen M Akgün; Janet P Tate; Joseph T King; Christopher T Rentsch; Vincent C Marconi; Evelyn Hsieh; Christopher Ruser; Farah Kidwai-Khan; Roozbeh Yousefzadeh; Joseph Erdos; Lesley S Park Journal: J Int AIDS Soc Date: 2021-10 Impact factor: 5.396