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Addressing unhealthy alcohol use among people living with HIV: recent advances and research directions. Curr Opin Infect Dis 2019; 31:1-7. [PMID: 29176446 DOI: 10.1097/qco.0000000000000422] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Unhealthy alcohol use is prevalent among people living with HIV (PLWH). We sought to identify the most current literature examining the impact of unhealthy alcohol on health outcomes and latest developments on how to best intervene. RECENT FINDINGS New research shows that PLWH have heightened morbidity and mortality at lower levels of alcohol consumption compared with HIV-uninfected persons. Studies published since 2016 have further elucidated the effects of persistent unhealthy alcohol use on HIV treatment outcomes over time. Screening and brief interventions, as well as pharmacologic treatment, can reduce unhealthy alcohol use among PLWH. SUMMARY Unhealthy alcohol use is an important and modifiable risk factor for poor health and HIV treatment outcomes among PLWH. More research is needed to encourage and maintain engagement in alcohol-related interventions and improve implementation.
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Scott-Sheldon LAJ, Carey KB, Johnson BT, Carey MP. Behavioral Interventions Targeting Alcohol Use Among People Living with HIV/AIDS: A Systematic Review and Meta-Analysis. AIDS Behav 2017; 21:126-143. [PMID: 28831609 PMCID: PMC5660648 DOI: 10.1007/s10461-017-1886-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Alcohol use is often reported among people living with HIV/AIDS (PLWHA) and is associated with increased sexual risk and poor medication adherence. This meta-analysis evaluated the efficacy of behavioral interventions addressing alcohol use among PLWHA. Twenty-one studies (N = 8461 PLWHA) that evaluated an individual-level intervention addressing alcohol use alone or as part of a more comprehensive alcohol/HIV intervention, included a control condition, and were available through December 2016 were included. Independent raters coded study, sample, and intervention content. Weighted mean effect sizes, using random-effects models, were calculated. Results indicate that interventions reduced alcohol consumption, increased condom use, and improved medication adherence relative to controls (d +s = 0.10-0.24). Plasma viral load was also reduced in intervention versus control participants (d + = 0.14, 95% CI = 0.02, 0.26; k = 7). These findings show that behavioral interventions addressing alcohol use can successfully reduce alcohol consumption and also improve HIV-related outcomes among PLWHA.
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Affiliation(s)
- Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Ave., Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA.
| | - Kate B Carey
- Brown School of Public Health, Center for Alcohol and Addiction Studies, Providence, RI, USA
| | - Blair T Johnson
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Ave., Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
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Edelman EJ, Lunze K, Cheng DM, Lioznov DA, Quinn E, Gnatienko N, Bridden C, Chaisson CE, Walley AY, Krupitsky EM, Raj A, Samet JH. HIV Stigma and Substance Use Among HIV-Positive Russians with Risky Drinking. AIDS Behav 2017. [PMID: 28634662 DOI: 10.1007/s10461-017-1832-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The link between HIV stigma with substance use is understudied. We characterized individuals with high HIV stigma and examined whether HIV stigma contributes to substance use among HIV-positive Russians reporting risky alcohol use. We analyzed data from HERMITAGE, a randomized controlled trial of 700 people living with HIV/AIDS (PLWHA) with past 6-month risky sex and risky alcohol use in St. Petersburg, Russia (2007-2011). Participants who were female and reported depressive symptoms and lower social support were more likely to endorse high HIV stigma (all p's < 0.001). In adjusted models, high HIV stigma was not significantly associated with the primary outcome unhealthy substance use and was not consistently associated with secondary substance use outcomes. Interventions to enhance social and mental health support for PLWHA, particularly women, may reduce stigma, though such reductions may not correspond to substantial decreases in substance use among this population.
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Affiliation(s)
- E Jennifer Edelman
- Yale University School of Medicine, PO Box 208025, New Haven, CT, 06520-8088, USA.
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
| | - Karsten Lunze
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Debbie M Cheng
- Boston University School of Public Health, Boston, MA, USA
| | - Dmitry A Lioznov
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
| | - Emily Quinn
- Boston University School of Public Health, Boston, MA, USA
| | - Natalia Gnatienko
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Carly Bridden
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | | | - Alexander Y Walley
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Evgeny M Krupitsky
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
- St.-Petersburg Bekhterev Research Psychoneurological Institute, St. Petersburg, Russian Federation
| | - Anita Raj
- University of California - San Diego, San Diego, CA, USA
| | - Jeffrey H Samet
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
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Elliott JC, Delker E, Wall MM, Feng T, Aharonovich E, Tracy M, Galea S, Ahern J, Sarvet AL, Hasin DS. Neighborhood-Level Drinking Norms and Alcohol Intervention Outcomes in HIV Patients Who Are Heavy Drinkers. Alcohol Clin Exp Res 2016; 40:2240-2246. [PMID: 27543208 DOI: 10.1111/acer.13198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/27/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Heavy alcohol consumption can be harmful, particularly for individuals with HIV. There is substantial variability in response to interventions that aim to reduce drinking. Neighborhood drinking norms may explain some of this variability among HIV-infected patients. Therefore, we investigated whether neighborhood-level drinking norms modified response to alcohol intervention among HIV-infected heavy drinkers. METHODS Heavily-drinking HIV comprehensive care patients (n = 230) completed 1 of 3 brief alcohol interventions (an educational intervention, a motivational interviewing [MI] intervention, or an MI intervention with a technological enhancement called HealthCall). Drinking was reported at baseline and end of treatment (60 days). Neighborhood-level drinking norms were obtained from a separate general population study. RESULTS Patients' reductions in drinks per drinking day in response to MI (as compared with the educational control) were more pronounced in neighborhoods with more permissive drinking norms. In contrast, patients' reductions in drinks per drinking day in response to MI plus HealthCall did not significantly vary between neighborhoods with different drinking norms. Norms did not evidence significant interactions with intervention condition for 3 other exploratory drinking outcomes (drinking frequency, binge frequency, and maximum quantity). CONCLUSIONS Neighborhood-level drinking norms help explain differential response to an alcohol MI intervention among HIV-infected patients. This study suggests the utility of considering neighborhood context as an effect modifier of alcohol interventions.
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Affiliation(s)
- Jennifer C Elliott
- New York State Psychiatric Institute , New York City, New York.,Department of Psychiatry , Columbia University Medical Center, New York City, New York
| | - Erin Delker
- New York State Psychiatric Institute , New York City, New York.,San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Epidemiology) , San Diego, California
| | - Melanie M Wall
- New York State Psychiatric Institute , New York City, New York.,Department of Psychiatry , Columbia University Medical Center, New York City, New York.,Department of Biostatistics , Mailman School of Public Health, Columbia University, New York City, New York
| | - Tianshu Feng
- New York State Psychiatric Institute , New York City, New York
| | - Efrat Aharonovich
- New York State Psychiatric Institute , New York City, New York.,Department of Psychiatry , Columbia University Medical Center, New York City, New York
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics , School of Public Health, University at Albany, State University of New York, Rensselaer, New York
| | - Sandro Galea
- School of Public Health , Boston University, Boston, Massachusetts
| | - Jennifer Ahern
- Division of Epidemiology , School of Public Health, University of California, Berkeley, California
| | - Aaron L Sarvet
- New York State Psychiatric Institute , New York City, New York
| | - Deborah S Hasin
- New York State Psychiatric Institute , New York City, New York. , .,Department of Psychiatry , Columbia University Medical Center, New York City, New York. , .,Department of Epidemiology , Mailman School of Public Health, Columbia University, New York City, New York. ,
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