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Xia C, Chander G, Hutton HE, McCaul ME, Delaney JA, Mayer KH, Jacobson JM, Puryear S, Crane HM, Shapiro AE, Cachay ER, Lau B, Napravnik S, Saag M, Lesko CR. Association of Alcohol Use with COVID-19 Infection and Hospitalization Among People Living with HIV in the United States, 2020. AIDS Behav 2024; 28:1795-1807. [PMID: 38421512 DOI: 10.1007/s10461-024-04301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
Alcohol use was associated with elevated COVID-19 risk in the general population. People with HIV (PWH) have high prevalences of alcohol use. To evaluate the effect of alcohol use on COVID-19 risks among PWH, we estimated the risk of COVID-19 diagnosis and COVID-19-related hospitalization among PWH in routine care at 8 HIV primary care centers that contributed data to the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort according to their alcohol use just prior to the COVID-19 pandemic. The CNICS data repository includes demographic characteristics, clinical diagnoses, and laboratory test results from electronic medical records and other sources. Alcohol use, substance use, and mental health symptoms were self-reported on tablet-based standardized surveys. Alcohol use was categorized according to standard, sex-specific Alcohol Use Disorder Identification Test-Consumption instrument cut-offs. We followed 5,496 PWH (79% male, 48% Black race, median age = 53 years) from March 1, 2020 to December 31, 2020. Relative to PWH with no baseline alcohol use, the adjusted hazard ratio (aHR) of COVID-19 diagnosis was 1.09 (95% confidence interval [CI]: 0.78, 1.51) for lower-risk drinking and 1.19 (95%CI: 0.81, 1.73) for unhealthy drinking. The aHR of COVID-19-related hospitalization was 0.82 (95%CI: 0.33, 1.99) for lower-risk drinking and 1.25 (95%CI: 0.50, 3.09) for unhealthy drinking. Results were not modified by recent cocaine or non-prescribed opioid use, depressive symptoms, or diagnoses of alcohol use disorder. The study suggested a slightly increased, but not statistically significant risk of COVID-19 diagnosis and hospitalization associated with unhealthy alcohol use.
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Affiliation(s)
- Chunyi Xia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Joseph A Delaney
- Division of General Internal Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, 02215, USA
- Department of Global Health and Population, Harvard University T.C. Chan School of Public Health, Boston, MA, 02115, USA
| | - Jeffrey M Jacobson
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
| | - Sarah Puryear
- Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, 94110, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Adrienne E Shapiro
- Division of Allergy and Infectious Disease, Department of Medicine, University of Washington School of Medicine, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, Seattle, WA, 98195, USA
| | - Edward R Cachay
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego School of Medicine, San Diego, CA, 92093, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, 27599, USA
| | - Michael Saag
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, 35233, USA
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
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Ruderman SA, Drumright LN, Delaney JAC, Webel AR, Fitzpatrick AL, Whitney BM, Nance RM, Hahn AW, Ma J, Mixson LS, Eltonsy S, Willig AL, Mayer KH, Napravnik S, Greene M, McCaul M, Cachay E, Kritchevsky SB, Austad SN, Landay A, Saag MS, Kitahata MM, Lau B, Lesko C, Chander G, Crane HM, Odden MC. Evaluating the Sick Quitting Hypothesis for Frailty Status and Reducing Alcohol Use Among People With HIV in a Longitudinal Clinical Cohort Study. J Assoc Nurses AIDS Care 2024; 35:5-16. [PMID: 38150572 DOI: 10.1097/jnc.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
ABSTRACT "Sick quitting," a phenomenon describing reductions in alcohol consumption following poor health, may explain observations that alcohol appears protective for frailty risk. We examined associations between frailty and reductions in drinking frequency among people with HIV (PWH). At six Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites between January 2012 and August 2021, we assessed whether frailty, measured through validated modified frailty phenotype, precedes reductions in drinking frequency. We associated time-updated frailty with quitting and reducing frequency of any drinking and heavy episodic drinking (HED), adjusted for demographic and clinical characteristics in Cox models. Among 5,654 PWH reporting drinking, 60% reported >monthly drinking and 18% reported ≥monthly HED. Over an average of 5.4 years, frail PWH had greater probabilities of quitting (HR: 1.56, 95% confidence interval [95% CI] [1.13-2.15]) and reducing (HR: 1.35, 95% CI [1.13-1.62]) drinking frequency, as well as reducing HED frequency (HR: 1.58, 95% CI [1.20-2.09]) versus robust PWH. Sick quitting likely confounds the association between alcohol use and frailty risk, requiring investigation for control.
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Affiliation(s)
- Stephanie A Ruderman
- Stephanie A. Ruderman, PhD, MPH, is a Research Scientist, School of Medicine, University of Washington, Seattle, Washington, USA. Lydia N. Drumright, PhD, MPH, is a Clinical Assistant Professor, School of Nursing, University of Washington, Seattle, Washington, USA. Joseph A. C. Delaney, PhD, is a Research Associate Professor, College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada, and School of Medicine, University of Washington, Seattle, Washington, USA. Allison R. Webel, RN, PhD, is an Associate Dean for Research, School of Nursing, University of Washington, Seattle, Washington, USA. Annette L. Fitzpatrick, PhD, is a Research Professor, Department of Epidemiology, University of Washington, Seattle, Washington, USA. Bridget M. Whitney, PhD, MPH, is a Senior Research Scientist, School of Medicine, University of Washington, Seattle, Washington, USA. Robin M. Nance, PhD, is a Research Scientist, School of Medicine, University of Washington, Seattle, Washington, USA. Andrew W. Hahn, MD, is a Clinical Assistant Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Jimmy Ma, MD, is an Infectious Disease Specialist, School of Medicine, University of Washington, Seattle, Washington, USA. L. Sarah Mixson, MPH, is a Research Scientist, School of Medicine, University of Washington, Seattle, Washington, USA. Sherif Eltonsy, PhD, is an Assistant Professor, College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada. Amanda L Willig, PhD, RD, is an Associate Professor, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Kenneth H. Mayer, MD, is a Professor, Harvard Medical School, Fenway Institute, Boston, Massachusetts, USA. Sonia Napravnik, PhD, MPH, is an Associate Professor, Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA. Meredith Greene, MD, is an Associate Professor, Department of Medicine, University of California San Francisco, San Francisco, California, USA. Mary McCaul, PhD, is a Professor, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. Edward Cachay, MD, is a Professor, Department of Medicine, University of California San Diego, San Diego, California, USA. Stephen B. Kritchevsky, PhD, is a Professor, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. Steven N. Austad, PhD, is a Distinguished Professor, Department of Biology, University of Alabama at Birmingham, Birmingham, Alabama, USA. Alan Landay, PhD, is a Professor, Department of Internal Medicine, Rush University, Chicago, Illinois, USA. Michael S. Saag, MD, is a Professor and Associate Dean, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. Mari M. Kitahata, MD, MPH, is a Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Bryan Lau, PhD, is a Professor, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA. Catherine Lesko, PhD, MPH, is an Assistant Professor, Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA. Geetanjali Chander, MD, MPH, is a Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Heidi M. Crane, MD, MPH, is a Professor, School of Medicine, University of Washington, Seattle, Washington, USA. Michelle C. Odden, PhD, is an Associate Professor, Department of Epidemiology, Stanford University, Stanford, California, USA
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Evaluating the Sick Quitting Hypothesis for Frailty Status and Reducing Alcohol Use Among People With HIV in a Longitudinal Clinical Cohort Study. J Assoc Nurses AIDS Care 2024; 35:e1-e2. [PMID: 38150573 PMCID: PMC10753926 DOI: 10.1097/jnc.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
“Sick quitting”, a phenomenon describing reductions in alcohol consumption following poor health, may explain observations that alcohol appears protective for frailty risk. We examined associations between frailty and reductions in drinking frequency among people with HIV (PWH). At six Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) sites between January 2012 and August 2021, we assessed whether frailty, measured via validated modified frailty phenotype, precedes reductions in drinking frequency. We associated time-updated frailty with quitting and reducing frequency of any drinking and heavy episodic drinking (HED), adjusted for demographic and clinical characteristics in Cox models. Among 5,654 PWH reporting drinking, 60% reported >monthly drinking and 18% reported ≥monthly HED. Over an average of 5.4 years, frail PWH had greater probabilities of quitting (HR:1.56, 95%CI:1.13–2.15) and reducing (HR:1.35, 95%CI:1.13–1.62) drinking frequency, as well as reducing HED frequency (HR:1.58, 95%CI:1.20–2.09) vs. robust PWH. Sick quitting likely confounds the association between alcohol use and frailty risk, requiring investigation for control.
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Davy-Mendez T, Sarovar V, Levine-Hall T, Lea AN, Leibowitz AS, Luu MN, Flamm JA, Hare CB, Dumoit Smith J, Iturralde E, Dilley J, Silverberg MJ, Satre DD. Racial, ethnic, and age disparities in the association of mental health symptoms and polysubstance use among persons in HIV care. PLoS One 2023; 18:e0294483. [PMID: 38015975 PMCID: PMC10684077 DOI: 10.1371/journal.pone.0294483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023] Open
Abstract
We characterized polysubstance use burden and associations with mental health problems across demographic subgroups of PWH. In 2018-2020, as part of a primary care-based intervention study, PWH in care at three medical centers in Kaiser Permanente Northern California were screened for depression (PHQ-9≥10), anxiety (GAD-2≥3), and substance use (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]≥1 per substance). We used Poisson regression to estimate prevalence ratios (PRs) comparing polysubstance use prevalence (TAPS≥1 for ≥2 substances) between PWH with positive screens for depression or anxiety vs. neither, among all PWH, and stratified by race/ethnicity and age (restricted to men), adjusting for sociodemographics, CD4, and HIV load. Screened PWH (N = 2865) included 92% men, 56% White, 19% Black, and 15% Hispanic PWH, with a median age of 55 years. Overall, polysubstance use prevalence was 26.4% (95% CI 24.9%-28.1%). PWH with depression or anxiety (n = 515) had an adjusted polysubstance use PR of 1.26 (1.09-1.46) vs. PWH with neither (n = 2350). Adjusted PRs were 1.47 (1.11-1.96), 1.07 (0.74-1.54), and 1.10 (0.85-1.41) among Black, Hispanic, and White men, respectively. Adjusted PRs did not differ by age group. Interventions should consider jointly addressing mental health and substance use problems and potential drivers, e.g. stigma or socioeconomic factors.
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Affiliation(s)
- Thibaut Davy-Mendez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Alexandra N. Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Amy S. Leibowitz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Mitchell N. Luu
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Jason A. Flamm
- Sacramento Medical Center, Kaiser Permanente Northern California, Sacramento, CA, United States of America
| | - C. Bradley Hare
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, United States of America
| | - Jaime Dumoit Smith
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - James Dilley
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, United States of America
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
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Nguyen MX, Reyes HL, Pence BW, Muessig KE, Hutton H, Latkin CA, Dowdy D, Chander G, Lancaster KE, Frangakis C, Sripaipan T, Tran HV, Go VF. Alcohol use as a mediator of the effect of two alcohol reduction interventions on mental health symptoms of ART clients in Vietnam. AIDS Care 2023; 35:1691-1699. [PMID: 36912652 PMCID: PMC10497730 DOI: 10.1080/09540121.2023.2183378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/14/2023] [Indexed: 03/14/2023]
Abstract
We aimed to examine the mediating role of alcohol use in the pathway from the interventions to depression and anxiety symptoms using data from a randomized controlled trial among people living with HIV (PWH) with hazardous alcohol use (n = 440) in Thai Nguyen, Vietnam. Participants were randomized into either a combined intervention (CoI), a brief intervention (BI) and a standard of care arm. Both interventions were based on cognitive behavioral therapy and motivational enhancement therapy. Alcohol use was measured as the percentage of days abstinent from alcohol in the last 30 days. Symptoms of depression and anxiety were measured with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales. Alcohol use was a significant mediator of the effects of two alcohol interventions on depression symptoms, but not anxiety symptoms. There were significant indirect effects via alcohol use of both interventions on depression symptoms at 12 months (CoI: mean difference (MD) = -0.134; 95%CI: -0.251, -0.035); (BI: MD = -0.141; 95%CI: -0.261, -0.038). There were no significant direct or total effects of the interventions on either symptoms at 12 months. Interventions with a dual focus on mental health and alcohol disorders are needed to determine optimal ways to tackle these common comorbidities among PWH.
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Affiliation(s)
- M X Nguyen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H L Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - B W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - D Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G Chander
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - K E Lancaster
- Department of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | - C Frangakis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T Sripaipan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H V Tran
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - V F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Lesko CR, Gnang JS, Fojo AT, Hutton HE, McCaul ME, Delaney JA, Cachay ER, Mayer KH, Crane HM, Batey DS, Napravnik S, Christopoulos KA, Lau B, Chander G. Alcohol use and the longitudinal HIV care continuum for people with HIV who enrolled in care between 2011 and 2019. Ann Epidemiol 2023; 85:6-12. [PMID: 37442307 PMCID: PMC10538410 DOI: 10.1016/j.annepidem.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE We described the impact of alcohol use on longitudinal engagement in HIV care including loss to follow-up, durability of viral suppression, and death. METHODS We followed a cohort of 1781 people with HIV from enrolled in care at one of seven US clinics, 2011-2019 through 102 months. We used a multistate, time-varying Markov process and restricted mean time to summarize engagement in HIV care over follow-up according to baseline self-reported alcohol use (none, moderate, or unhealthy). RESULTS Our sample (86% male, 54% White) had median age of 35 years. Over 102 months, people with no, moderate, and unhealthy alcohol use averaged 62.3, 61.1, and 59.5 months virally suppressed, respectively. People who reported unhealthy or moderate alcohol use spent 5.1 (95% confidence intervals (CI): 0.8, 9.3) and 7.6 (95%CI: 3.1, 11.7) more months lost to care than nondrinkers. Compared to no use, unhealthy alcohol use was associated with 3.4 (95%CI: -5.6, -1.6) fewer months in care, not virally suppressed. There were no statistically significant differences after adjustment for demographic and clinical characteristics. CONCLUSIONS Moderate or unhealthy drinking at enrollment in HIV care was associated with poor retention in care. Alcohol use was not associated with time spent virally suppressed.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Jeanine S Gnang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anthony T Fojo
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Heidi E Hutton
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Mary E McCaul
- School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Joseph A Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Canada; Department of Epidemiology, University of Washington, Seattle, WA
| | - Edward R Cachay
- Department of Medicine, Division of Infectious Diseases, University of California San Diego, San Diego, CA
| | | | - Heidi M Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA
| | - D Scott Batey
- School of Social Work, Tulane University, New Orleans, LA
| | - Sonia Napravnik
- School of Medicine, University of North Carolina, Chapel Hill, NC
| | | | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Geetanjali Chander
- School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Medicine, School of Medicine, University of Washington, Seattle, WA
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Davy-Mendez T, Sarovar V, Levine-Hall T, Lea AN, Sterling SA, Chi FW, Palzes VA, Luu MN, Flamm JA, Hare CB, Williams EC, Bryant KJ, Weisner CM, Silverberg MJ, Satre DD. Characterizing Unhealthy Alcohol Use Patterns and Their Association with Alcohol Use Reduction and Alcohol Use Disorder During Follow-Up in HIV Care. AIDS Behav 2023; 27:1380-1391. [PMID: 36169779 PMCID: PMC10043049 DOI: 10.1007/s10461-022-03873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/25/2022]
Abstract
Outcomes of PWH with unhealthy alcohol use, such as alcohol use reduction or progression to AUD, are not well-known and may differ by baseline patterns of unhealthy alcohol use. Among 1299 PWH screening positive for NIAAA-defined unhealthy alcohol use in Kaiser Permanente Northern California, 2013-2017, we compared 2-year probabilities of reduction to low-risk/no alcohol use and rates of new AUD diagnoses by baseline use patterns, categorized as exceeding: only daily limits (72% of included PWH), only weekly limits (17%), or both (11%), based on NIAAA recommendations. Overall, 73.2% (95% CI 70.5-75.9%) of re-screened PWH reduced to low-risk/no alcohol use over 2 years, and there were 3.1 (95% CI 2.5-3.8%) new AUD diagnoses per 100 person-years. Compared with PWH only exceeding daily limits at baseline, those only exceeding weekly limits and those exceeding both limits were less likely to reduce and likelier to be diagnosed with AUD during follow-up. PWH exceeding weekly drinking limits, with or without exceeding daily limits, may have a potential need for targeted interventions to address unhealthy alcohol use.
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Affiliation(s)
- Thibaut Davy-Mendez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Rd., CB #7030, Chapel Hill, NC, 27599, USA.
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Alexandra N Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Felicia W Chi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Vanessa A Palzes
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Mitchell N Luu
- Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jason A Flamm
- Sacramento Medical Center, Kaiser Permanente Northern California, Sacramento, CA, USA
| | - C Bradley Hare
- San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, USA
| | - Emily C Williams
- Center of Innovation for Veteran Centered and Value-Driven Care, Veterans Affairs Puget Sound, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD, USA
| | - Constance M Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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8
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Madkour AS, Felker-Kantor E, Welsh DA, Molina PE, Theall KP, Ferguson T. Lifetime Alcohol Use Trajectories and Health Status Among Persons Living with HIV (PLWH). J Stud Alcohol Drugs 2022; 83:695-703. [PMID: 36136440 PMCID: PMC9523753 DOI: 10.15288/jsad.21-00303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/20/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE We characterized lifetime drinking trajectories among persons living with HIV (PLWH) and examined how trajectories are related to health. METHOD Adults (ages 20-71) were recruited between 2015 and 2017 for a cohort study examining the impact of alcohol use on geriatric comorbidities in PLWH in New Orleans. The New Orleans Alcohol Use in HIV (NOAH) Study (n = 356; 68.8% male) included in-person interviews, anthropometric measurements, and biospecimen collection. Average monthly drinks per decade of life was derived from participants' reported average quantity and frequency of alcoholic beverages for each decade. Health indicators included CD4 count, viral load, health-related quality of life, frailty, comorbidities, body mass index, heavy drinking, anxiety, depression, and posttraumatic stress disorder. Participants also reported lifetime experiences with homelessness and incarceration. Latent curve modeling was applied in MPlus to derive lifetime drinking trajectories. Latent trajectory parameters were modeled as predictors of physical, mental, and social health, controlling for demographics. RESULTS Alcohol consumption increased significantly between the teen years and midlife (31-40), declining thereafter through ages 50-60. Significant interindividual differences were observed in all trajectory parameters. Persons with higher starting points of alcohol consumption showed worse mental health (depression and anxiety) and social experiences (homelessness and incarceration history) at study baseline. A steeper increase in volume of alcohol consumption after ages 10-20 was associated with worse health-related quality of life, greater frailty and comorbidities, and greater odds of current heavy drinking. CONCLUSIONS Understanding lifetime alcohol consumption patterns is important in addressing physical and mental health among adult PLWH.
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Affiliation(s)
- Aubrey Spriggs Madkour
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Erica Felker-Kantor
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - David A. Welsh
- Section of Pulmonary/Critical Care, School of Medicine, Louisiana State University, New Orleans, Louisiana
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, New Orleans, Louisiana
| | - Patricia E. Molina
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, New Orleans, Louisiana
- Department of Physiology, School of Medicine, Louisiana State University, New Orleans, Louisiana
| | - Katherine P. Theall
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Tekeda Ferguson
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, New Orleans, Louisiana
- Department of Epidemiology, School of Public Health, Louisiana State University, New Orleans, Louisiana
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Lesko CR, Hutton HE, Edwards JK, McCaul ME, Fojo AT, Keruly JC, Moore RD, Chander G. Alcohol Use Disorder and Recent Alcohol Use and HIV Viral Non-Suppression Among People Engaged in HIV Care in an Urban Clinic, 2014-2018. AIDS Behav 2022; 26:1299-1307. [PMID: 34626264 PMCID: PMC8940688 DOI: 10.1007/s10461-021-03487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 01/28/2023]
Abstract
We estimated joint associations between having history of alcohol use disorder (AUD) (based on prior ICD-9/ICD-10 codes) and recent self-reported alcohol use and viral non-suppression (≥ 1 viral load measurement > 20 copies/mL in the same calendar year as alcohol consumption was reported) among patients on ART enrolled in routine care, 2014-2018, in an urban specialty clinic. Among 1690 patients, 26% had an AUD, 21% reported high-risk alcohol use, and 39% had viral non-suppression. Relative to person-years in which people without AUD reported not drinking, prevalence of viral non-suppression was higher in person-years when people with AUD reported drinking at any level; prevalence of viral non-suppression was not significantly higher in person-years when people with AUD reported not drinking or person-years when people without AUD reported drinking at any level. No level of alcohol use may be "safe" for people with a prior AUD with regard to maintaining viral suppression.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Mary E McCaul
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jeanne C Keruly
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Richard D Moore
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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10
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Wu Q, Ren Q, Zhong N, Bao J, Zhao Y, Du J, Chen T, Zhao M. Internet behavior patterns of adolescents before, during, and after COVID-19 pandemic. Front Psychiatry 2022; 13:947360. [PMID: 36440398 PMCID: PMC9685307 DOI: 10.3389/fpsyt.2022.947360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The outbreak of COVID-19 has affected the mental health of adolescents. To describe the Internet behavior-changing patterns of adolescents and to understand the impact of clinical features on changing patterns during the COVID-19 pandemic. MATERIALS AND METHODS We conducted a cross-sectional cohort study using data collected through online investigation in China. A total of 625 adolescents completed the online survey from May 15 to June 7, 2020. The adolescents were asked to retrospect to the Internet behaviors and game behaviors of three time periods as follows: before the COVID-19 outbreak in China, during the COVID-19 outbreak in China, and back to school. The clinical variables of the demographic data, family functionality, and emotional and behavioral symptoms were also collected. According to the Internet behaviors and game behaviors patterns across the three time periods, the subjects will be sub-grouped. RESULTS Four Internet behavior-changing patterns during the COVID-19 was identified: (1) Continuous Normal Group (55.52%); (2) Normal to Internet Addiction Group (5.28%); (3) Internet Addiction to Normal Group (14.56%); and (4) Continuous Internet Addiction Group (24.64%). Years of education, academic score ranking, family functionality, and emotional and behavioral symptoms were different across the four groups. Proportions of game behaviors, scores of Strengths and Difficulties Questionnaire (SDQ), and SDQ subscale during the period before the COVID-19 outbreak were significant in predicting changing patterns. CONCLUSION The Internet behavior patterns of adolescents during the COVID-19 period were various. Clinical features before the COVID-19 pandemic may predict changing patterns. The heterogeneity in characteristics between different changing patterns should be considered when intervening in adolescents' problematic Internet behavior.
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Affiliation(s)
- Qianying Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qihuan Ren
- Shanghai Hongkou Mental Health Center, Shanghai, China
| | - Na Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juwang Bao
- Jiangxi Maternal and Child Health Hospital, Maternal and Child Health Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yan Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianzhen Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China.,Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China.,CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, Shanghai, China
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11
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Nguyen MX, McNaughton Reyes HL, Pence BW, Muessig K, Hutton HE, Latkin CA, Dowdy D, Chander G, Lancaster KE, Frangakis C, Sripaipan T, Ha Tran V, Go VF. The longitudinal association between depression, anxiety symptoms and HIV outcomes, and the modifying effect of alcohol dependence among ART clients with hazardous alcohol use in Vietnam. J Int AIDS Soc 2021; 24 Suppl 2:e25746. [PMID: 34165258 PMCID: PMC8222856 DOI: 10.1002/jia2.25746] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/14/2021] [Accepted: 04/28/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Mental health disorders may negatively impact HIV outcomes, such as viral suppression (VS) and antiretroviral (ART) adherence among people with HIV (PWH) with hazardous alcohol use. This study evaluates the longitudinal association between depression, anxiety symptoms, VS and complete ART adherence among ART clients with hazardous alcohol use in Vietnam; and examines alcohol dependence as a modifier in this association. METHODS This was a secondary data analysis of a trial for hazardous drinking ART clients in Thai Nguyen, Vietnam. From March 2016 to May 2018, 440 ART clients with an Alcohol Use Disorders Identification Test-Concise (AUDIT-C) score ≥4 for men and ≥3 for women were enrolled. Individuals were randomized to either a combined intervention, a brief intervention or a standard of care. Data on sociodemographics, depression, anxiety symptoms, alcohol use, VS and ART adherence were collected at baseline, three, six, and twelve months. Generalized estimating equation models controlling for intervention exposure were used to estimate time-lagged associations. Risk ratios were estimated using Poisson regression with robust variance estimation. RESULTS The mean age of participants was 40.2. The majority was male (96.8%), had at least some secondary school education (85.0%) and had a history of injection drug use (80.9%). No overall effect of depression and anxiety symptoms on VS was observed. When stratified by time, increased anxiety symptoms at six months were associated with VS at 12 months (adjusted risk ratio (aRR) = 1.09; 95% CI 1.02 to 1.17). An increase in depression or anxiety symptoms was associated with a decreased probability of complete ART adherence (depression symptoms: aRR = 0.95; 95% CI: 0.91 to 0.99; anxiety symptoms: aRR = 0.93; 85% CI: 0.88 to 0.99). The negative effects of anxiety symptoms on ART adherence were stronger among participants with alcohol dependence, compared to those without. CONCLUSIONS Depression and anxiety symptoms had no overall effect on VS, although they were associated with a lower probability of complete ART adherence. Interventions focusing on mental healthcare for PWH with hazardous alcohol use are needed, and integration of mental healthcare and alcohol reduction should be implemented in HIV primary care settings.
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Affiliation(s)
- Minh X Nguyen
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - H. Luz McNaughton Reyes
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Brian W Pence
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kate Muessig
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Carl A Latkin
- Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - David Dowdy
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Kathryn E Lancaster
- Department of EpidemiologyCollege of Public HealthOhio State UniversityColumbusOHUSA
| | - Constantine Frangakis
- Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Teerada Sripaipan
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Viet Ha Tran
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Vivian F Go
- Department of Health BehaviorGillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
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12
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Pierre F, Forman LS, Winter M, Cheng D, Ngabirano C, Emenyonu N, Hunt PW, Huang Y, Muyindike W, Samet J, Hahn JA, So-Armah K. Alcohol Consumption and Tryptophan Metabolism Among People with HIV Prior to Antiretroviral Therapy Initiation: The Uganda ARCH Cohort Study. Alcohol Alcohol 2021; 57:219-225. [PMID: 34027552 PMCID: PMC8919408 DOI: 10.1093/alcalc/agab033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Alcohol is hypothesized to have effects on the kynurenine pathway of tryptophan catabolism, a potential mechanism for alcohol-induced depression and aggression. A biomarker of this pathway, the plasma kynurenine to tryptophan ratio (K/T ratio), has been associated with HIV progression, mortality and depression. Our aim was to assess whether hazardous alcohol consumption is associated higher K/T ratio among people with HIV. METHODS Participants were a subset of the Uganda Alcohol Research Collaboration on HIV/AIDS Cohort. Alcohol consumption was categorized (abstinent, moderate and hazardous alcohol use) using the Alcohol Use Disorders Identification Test-Consumption and phosphatidylethanol (PEth). K/T ratio was the primary outcome. We used linear regression adjusted for age, sex, FIB-4, hepatitis B surface antigen, log (HIV viral load) to estimate the association between alcohol consumption and K/T ratio. RESULTS Compared to abstinent participants, hazardous drinkers and moderate drinkers had higher K/T ratio but these differences did not reach statistical significance. CONCLUSIONS Our results suggest that hazardous alcohol consumption, in the context of untreated HIV infection, may not significantly alter kynurenine to tryptophan ratio as a measure of activity of the kynurenine pathway of tryptophan metabolism.
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Affiliation(s)
- Frantz Pierre
- Department of Epidemiology and Biostatistics, Boston University School of Public Health, 72 E Concord St, Boston, MA 02118, USA
| | - Leah S Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, M921, Boston, MA 02118, USA
| | - Michael Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street, M921, Boston, MA 02118, USA
| | - Debbie Cheng
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave Boston, MA 02119, USA
| | - Christine Ngabirano
- Mbarara University of Science and Technology Department of Internal Medicine P.O Box 1410 Mbarara Uganda, Uganda
| | - Nneka Emenyonu
- Department of Medicine, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA
| | - Peter W Hunt
- Division of HIV/AIDS, San Francisco General Hospital, San Francisco, CA, USA
| | - Yong Huang
- Department of Bioengineering and Therapeutics, University of California San Francisco, 1700 4th Street, San Francisco, CA 94158, USA
| | - Winnie Muyindike
- Mbarara University of Science and Technology Department of Internal Medicine P.O Box 1410 Mbarara, Uganda
| | - Jeffrey Samet
- Department of Medicine, Boston University School of Medicine and Boston Medical Center, 801 Massachusetts Ave Crosstown, 2nd Floor Boston, MA 02118, USA
| | - Judith A Hahn
- Departments of Medicine and Epidemiology & Biostatistics, University of California San Francisco, 550 16th St., 3rd floor San Francisco, CA 94158-2549, USA
| | - Kaku So-Armah
- Corresponding author: Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor Boston, MA 02118, USA. Tel.: 617 414 6624; E-mail:
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13
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Lesko CR, Nance RM, Lau B, Fojo AT, Hutton HE, Delaney JAC, Crane HM, Cropsey KL, Mayer KH, Napravnik S, Geng E, Mathews WC, McCaul ME, Chander G. Changing Patterns of Alcohol Use and Probability of Unsuppressed Viral Load Among Treated Patients with HIV Engaged in Routine Care in the United States. AIDS Behav 2021; 25:1072-1082. [PMID: 33064249 DOI: 10.1007/s10461-020-03065-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 01/13/2023]
Abstract
We examined HIV viral load non-suppression ([Formula: see text] 200 copies/mL) subsequent to person-periods (3-18 months) bookended by two self-reports of alcohol use on a standardized patient reported outcome assessment among adults in routine HIV care. We examined the relative risk (RR) of non-suppression associated with increases and decreases in alcohol use (relative to stable use), stratified by use at the start of the person-period. Increases in drinking from abstinence were associated with higher risk of viral non-suppression (low-risk without binge: RR 1.16, 95% CI 1.03, 1.32; low-risk with binge: RR 1.35, 95% CI 1.11, 1.63; high-risk: RR 1.89, 95% CI 1.16, 3.08). Decreases in drinking from high-risk drinking were weakly, and not statistically significantly associated with lower risk of viral non-suppression. Other changes in alcohol use were not associated with viral load non-suppression. Most changes in alcohol consumption among people using alcohol at baseline were not strongly associated with viral non-suppression.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Robin M Nance
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Heidi M Crane
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Karen L Cropsey
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AB, USA
| | - Kenneth H Mayer
- Fenway Health, Beth Israel Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Elvin Geng
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | | | - Mary E McCaul
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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14
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Nguyen MX, Dowdy D, Latkin CA, Hutton HE, Chander G, Frangakis C, Lancaster KE, Sripaipan T, Bui QX, Tran HV, Go VF. Social support modifies the association between hazardous drinking and depression symptoms among ART clients in Vietnam. Drug Alcohol Depend 2020; 215:108249. [PMID: 32871505 PMCID: PMC8277424 DOI: 10.1016/j.drugalcdep.2020.108249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/05/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hazardous drinking is widespread among people with HIV (PWH). PWH are also vulnerable to depression due to HIV-related social stigma, and social support can play an important role in improving mental health for this population. No studies have explored whether social support modifies the association of hazardous drinking and depressive symptoms among PWH. METHODS We used baseline data from a randomized controlled trial of two evidence-based alcohol reduction interventions among antiretroviral therapy clients in Vietnam. Hazardous alcohol use was defined as having a score ≥8 for men and ≥ 7 for women on the Alcohol Use Disorders Identification Test. The presence of depression symptoms was defined as a score ≥ 5 on the Patient Health Questionnaire-9. Social support was measured with a 5-question modified version of the Medical Outcomes Study Social Support Instrument. Crude (CPRs) and adjusted prevalence ratios (aPRs) of the association were presented. RESULTS Hazardous drinking was significantly associated with increased likelihood of having depressive symptoms (aPR = 1.26;95%CI 1.04-1.52). Hazardous drinking and depression symptoms were not associated among those with high social support (aPR = 1.01;95%CI 0.76-1.35), but were associated among those with medium (aPR = 1.24;95%CI 0.92-1.69) and low social support (aPR = 1.71;95%CI 1.25-2.34). CONCLUSIONS Social support significantly modified the association between hazardous drinking and depression symptoms among ART clients in Vietnam. Interventions to decrease hazardous alcohol use are broadly indicated for PWH in Vietnam and other low-resource settings, but special attention or modifications may be needed to support mental health among those with lower levels of social support.
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Affiliation(s)
- M X Nguyen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
| | - D Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - H E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Chander
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - C Frangakis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K E Lancaster
- Department of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | - T Sripaipan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Q X Bui
- UNC Project Vietnam, Hanoi, Vietnam
| | - H V Tran
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; UNC Project Vietnam, Hanoi, Vietnam
| | - V F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Sims OT, Wang K, Chandler R, Melton PA, Truong DN. A descriptive analysis of concurrent alcohol and substance use among patients living with HIV/HCV co-infection. SOCIAL WORK IN HEALTH CARE 2020; 59:525-541. [PMID: 32873213 PMCID: PMC9494867 DOI: 10.1080/00981389.2020.1814938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The objectives of this study were to estimate the prevalence of concurrent alcohol and substance use among patients living with HIV/HCV co-infection and to compare demographic and clinical characteristics of those with concurrent alcohol and substance to those with alcohol or substance use, and to those who were abstinent. We conducted an analysis of patient reported outcomes data of patients living with HIV/HCV co-infection (n = 327) who transitioned from primary care to sub-specialty care for evaluation of candidacy for HCV treatment at a university-affiliated HIV Clinic. The prevalence of self-reported concurrent alcohol and substance use was 33%. A higher proportion of those with concurrent alcohol and substance use were currently smoking tobacco, and those who were abstinent had higher ratings of health-related quality of life compared to those with alcohol or substance use. To reduce patients' risk for progression to advanced stages of HIV, HCV, and liver-related disease due to continued alcohol and substance and tobacco use, social workers and other health care professionals are encouraged to develop and implement intervention strategies to assist patients living with HIV/HCV co-infection in efforts to achieve behavioral change.
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Affiliation(s)
- Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham , Birmingham, AL, USA
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham , Birmingham, AL, USA
- Integrative Center for Healthy Aging, School of Medicine, University of Alabama at Birmingham , Birmingham, AL, USA
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham , Birmingham, AL, USA
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco , San Francisco, CA, USA
| | - Kaiying Wang
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham , Birmingham, AL, USA
- Department of Mathematics and Statistics, College of Arts and Sciences, Georgia State University , Atlanta, GA, USA
| | - Rasheeta Chandler
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California San Francisco , San Francisco, CA, USA
- School of Nursing, Emory University , Atlanta, GA, USA
| | - Pamela A Melton
- School of Social Work, Tulane University , New Orleans, LA, USA
| | - Duong N Truong
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham , Birmingham, AL, USA
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16
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Maffei VJ, Siggins RW, Luo M, Brashear MM, Mercante DE, Taylor CM, Molina P, Welsh DA. Alcohol Use Is Associated With Intestinal Dysbiosis and Dysfunctional CD8+ T-Cell Phenotypes in Persons With Human Immunodeficiency Virus. J Infect Dis 2020; 223:1029-1039. [PMID: 32725203 DOI: 10.1093/infdis/jiaa461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/23/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Inflammation persists among persons with human immunodeficiency virus (PWH) despite effective antiretroviral therapy and may contribute to T-cell dysfunction. Alcohol use is prevalent among PWH and promotes intestinal leak, dysbiosis, and a proinflammatory milieu. Whether alcohol use is associated with T-cell late differentiation remains to be investigated. METHODS Data and samples from PWH (N = 359 of 365) enrolled in the New Orleans Alcohol Use in HIV Study were used. Alcohol use was assessed by self-report (Alcohol Use Disorders Identification Test; lifetime alcohol exposure; 30-day Alcohol Timeline Followback) and phosphatidylethanol (PEth) quantitation. In a subset of participants, fecal bacterial content was assessed by ribosomal 16S marker gene deep sequencing and quantitative polymerase chain reaction. Intestinal leak was assessed by fecal-to-plasma α-1-antitrypsin (A1AT) enzyme-linked immunosorbent assay ratio. Peripheral T-cell populations were quantified by flow cytometry. RESULTS Alcohol Use Disorder Identification Test scores were positively associated with activated-senescent, exhausted, and terminal effector memory CD45RA+CD8+ but not CD4+ T cells (cells/μL) after confounder adjustment (P < .050). Phosphatidylethanol was positively associated with A1AT (P < .050). The PEth and activated-senescent CD8+ were associated with bacterial β-diversity (P < .050) and positively associated with the relative abundance of coabundant Prevotellaceae members (q < .100). CONCLUSIONS Alcohol use among PWH is associated with CD8+ T-cell late differentiation, intestinal leak, and dysbiosis. Alcohol-associated dysbiosis is implicated in CD8+ T-cell senescence.
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Affiliation(s)
- Vincent J Maffei
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.,Department of Microbiology, Immunology, and Parasitology, School of Graduate Studies, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Robert W Siggins
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.,Department of Physiology, School of Graduate Studies, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Meng Luo
- Department of Microbiology, Immunology, and Parasitology, School of Graduate Studies, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Meghan M Brashear
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.,Department of Physiology, School of Graduate Studies, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Donald E Mercante
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.,Department of Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Christopher M Taylor
- Department of Microbiology, Immunology, and Parasitology, School of Graduate Studies, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Patricia Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.,Department of Physiology, School of Graduate Studies, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - David A Welsh
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.,Department of Microbiology, Immunology, and Parasitology, School of Graduate Studies, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.,Department of Internal Medicine, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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17
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Satre DD, Sarovar V, Leyden W, Hare CB, Catz SL, Bryant KJ, Williams EC, Hojilla JC, Horberg MA, Silverberg MJ. Changes in Days of Unhealthy Alcohol Use and Antiretroviral Therapy Adherence, HIV RNA Levels, and Condomless Sex: A Secondary Analysis of Clinical Trial Data. AIDS Behav 2020; 24:1784-1792. [PMID: 31773444 DOI: 10.1007/s10461-019-02742-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In a sample of people with HIV (PWH) enrolled in an alcohol intervention trial and followed for 12 months, we examined the association of changes in days (i.e., decrease, increase, no change [reference]) of unhealthy drinking (consuming ≥ 4/≥ 5 drinks for women/men) with antiretroviral therapy adherence (≥ 95% adherent), viral suppression (HIV RNA < 75 copies/mL), condomless sex with HIV-negative/unknown status partners, and dual-risk outcome (HIV RNA ≥ 75 copies/mL plus condomless sex). The sample included 566 PWH (96.8% male; 63.1% White; 93.9% HIV RNA < 75 copies/mL) who completed baseline, 6-, and 12-month assessments. Decrease in days of unhealthy drinking was associated with increased likelihood of viral suppression (odds ratio [OR] 3.78; 95% confidence interval [CI] 1.06, 13.51, P = .04) versus no change. Increase in days of unhealthy drinking was associated with increased likelihood of condomless sex (OR 3.13; 95% CI 1.60, 6.12, P < .001). Neither increase nor decrease were associated with adherence or dual-risk outcome. On a continuous scale, for each increase by 1 day of unhealthy drinking in the prior month, the odds of being 95% adherent decreased by 6% (OR 0.94, 95% CI 0.88, 1.00, P = 0.04).
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Affiliation(s)
- Derek D Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Wendy Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Charles B Hare
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Emily C Williams
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - J Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
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18
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Madkour AS, Felker-Kantor E, Wallace M, Ferguson T, Welsh DA, Molina PE, Theall KP. Latent Alcohol Use Typologies and Health Status Among a Cohort of Adults Living with HIV. Alcohol Alcohol 2020; 54:584-592. [PMID: 31580404 DOI: 10.1093/alcalc/agz071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/15/2019] [Accepted: 08/02/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS To characterize latent typologies of alcohol use among persons living with human immunodeficiency virus (HIV) (PLWH) and test their relationship with physical and mental health status. METHODS Baseline data from 365 adult in-care PLWH enrolled in the New Orleans Alcohol Use in HIV study were analyzed. Indicators of current and former heavy drinking, intoxication, withdrawal and dependence symptoms, alcohol-related problems and past contact with alcohol use treatment were drawn from validated scales. Physical and mental health measures included SF-36 subscales, medication non-adherence and anxiety, depressive and post-traumatic stress disorder symptoms. Latent class analysis was conducted to characterize alcohol drinking typologies. Logistic and ordinary least-squares regression were employed to test associations between alcohol use and health status. RESULTS Four latent classes were identified: heavy drinkers (36%), former heavy drinkers (14%), heavy drinkers with problems (12%) and low-risk drinkers/abstainers (38%). Controlling for background characteristics, low-risk drinkers/abstainers showed significantly better health compared to heavy drinkers with problems across most domains. Although current and former heavy drinkers without alcohol-related problems were similar to heavy drinkers with problems in most health domains, they presented worse mental health and energy compared to low-risk drinkers/abstainers. CONCLUSIONS Heavy drinkers with alcohol-related problems evidenced the worst health status among PLWH, and should be considered for mental and physical health interventions. However, interventions to improve physical and mental health of PLWH should consider history of heavy alcohol use, as current alcohol use status alone may be insufficient for identifying groups at increased risk.
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Affiliation(s)
- Aubrey Spriggs Madkour
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | - Erica Felker-Kantor
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | - Maeve Wallace
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | - Tekeda Ferguson
- Department of Epidemiology, School of Public Health, Louisiana State University, 2020 Gravier Street, 3rd Floor, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - David A Welsh
- Section of Pulmonary/Critical Care, School of Medicine, Louisiana State University, 1901 Perdido Street, 3rd Floor, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - Patricia E Molina
- Department of Physiology Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - Katherine P Theall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
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19
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Abstract
BACKGROUND The average lifespan of persons living with HIV (PLWH) on antiretroviral therapy approximates the general population. However, PLWH are susceptible to early aging and frailty. Behaviors such as alcohol consumption may contribute to frailty among PLWH. OBJECTIVE To determine the relationships between recent and lifetime alcohol use and frailty among PLWH. DESIGN Cross-sectional, prospective cohort study of in-care PLWH (n = 365) participating in the New Orleans Alcohol Use in HIV Study. METHODS Recent alcohol exposure was measured by the 30-day alcohol timeline follow-back (TLFB) assessment and by whole-blood-spot phosphatidylethanol (PEth) quantitation. Lifetime alcohol exposure (LAE) was estimated by a modified lifetime drinking history instrument. Frailty was assessed by a 58-item deficit index (DI58) and the phenotypic frailty index (PFI). The Veterans Aging Cohort Study Risk Index 2.0 was calculated. RESULTS Using generalized linear regression, LAE was positively associated with the DI58 (95% CI 0.001--0.006) and PFI severity (95% CI 0.004--0.023) after adjustment for age and other factors. Conversely, recent alcohol exposure was negatively associated with the DI58 [TLFB 95% CI: (-0.126 to -0.034), PEth: (-0.163 to -0.058)] and PFI severity [TLFB 95% CI (-0.404 to -0.015), PEth (-0.406 to 0.034)]. The VACS was not associated with alcohol use. Median per-decade alcohol exposure peaked in the second decade and tapered with aging thereafter. Increasing LAE and decreasing TLFB were co-associated with a specific subset of health deficits. CONCLUSION Lifetime alcohol use is positively associated with frailty among PLWH. Specific health deficits may discourage alcohol consumption in some PLWH.
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Theall KP, Wallace M, Felker-Kantor E, Madkour AS, Brashear M, Ferguson T, Welsh D, Molina P. Neighborhood Alcohol Environment: Differential Effects on Hazardous Drinking and Mental Health by Sex in Persons Living with HIV (PLWH). AIDS Behav 2019; 23:3237-3246. [PMID: 31401740 PMCID: PMC7467156 DOI: 10.1007/s10461-019-02632-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite greater mental health co-morbidities and heavier alcohol use among PLWH, few studies have examined the role of the neighborhood alcohol environment on either alcohol consumption or mental health. Utilizing cross-sectional data from a cohort study in a southern U.S. metropolitan area, we examine the association between neighborhood alcohol environments on hazardous drinking and mental health among 358 in-care PLWH (84% African American, 31% female). Multilevel models were utilized to quantify associations between neighborhood alcohol exposure on hazardous drinking and effect modification by sex. Neighborhood alcohol density was associated with hazardous drinking among men but not women. Women living in alcohol dense neighborhoods were nearly two-fold likely to report depression compared to those in less dense neighborhoods, with no association between neighborhood alcohol density and depression among men. Neighborhood alcohol environments may be an important contextual factor to consider in reducing heavy alcohol consumption and improving mental health among PLWH.
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Affiliation(s)
- K P Theall
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
- Louisiana State University Health Sciences Center Comprehensive Alcohol and HIV Research Center (CARC), New Orleans, LA, USA.
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Mailstop 8319, New Orleans, LA, 70112, USA.
| | - M Wallace
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Louisiana State University Health Sciences Center Comprehensive Alcohol and HIV Research Center (CARC), New Orleans, LA, USA
| | - E Felker-Kantor
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - A S Madkour
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - M Brashear
- Louisiana State University Health Sciences Center Comprehensive Alcohol and HIV Research Center (CARC), New Orleans, LA, USA
| | - T Ferguson
- Louisiana State University Health Sciences Center Comprehensive Alcohol and HIV Research Center (CARC), New Orleans, LA, USA
- Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, USA
| | - D Welsh
- Louisiana State University Health Sciences Center Comprehensive Alcohol and HIV Research Center (CARC), New Orleans, LA, USA
| | - P Molina
- Louisiana State University Health Sciences Center Comprehensive Alcohol and HIV Research Center (CARC), New Orleans, LA, USA
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21
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Shokoohi M, Bauer GR, Kaida A, Logie CH, Carter A, Lacombe-Duncan A, Loutfy M. A Latent Class Analysis of the Social Determinants of Health Impacting Heavy Alcohol Consumption Among Women Living with HIV in Canada: The Canadian HIV Women's Sexual and Reproductive Health Cohort Study. AIDS Behav 2019; 23:3226-3236. [PMID: 30863979 DOI: 10.1007/s10461-019-02454-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
We used longitudinal data from the 2013-2017 Canadian HIV Women's Sexual and Reproductive Health Cohort Study (N = 1422) to assess the clustered impact of social determinants of health (SDoH) on hazardous drinking. Two measures of alcohol use were defined: (i) weekly alcohol use, with > 7 drinks/week as heavy drinking, and (ii) monthly binge drinking (≥ 6 drinks at one sitting), with ≥ 1/month as frequent binging. Twelve SDoH indicators were classified using latent class analysis: no/least adversities, discrimination/stigma, economic hardship, and most SDoH adversities. Inverse-probability weighted multinomial logistic regression was used to report relative-risk ratio (RRR). Women living with HIV (WLWH) in no/least adversity class had a substantially lower likelihood of both heavy weekly alcohol use and frequent binging than those in discrimination/stigma, economic hardship, and most SDoH adversities classes, with RRR estimates ranging from 0.02 to 0.18. Findings indicate the need to address SDoH to reduce hazardous drinking among WLWH.
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22
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Sims OT, Chiu CY, Chandler R, Melton P, Wang K, Richey C, Odlum M. Alcohol Use and Ethnicity Independently Predict Antiretroviral Therapy Nonadherence Among Patients Living with HIV/HCV Coinfection. J Racial Ethn Health Disparities 2019; 7:28-35. [PMID: 31435855 DOI: 10.1007/s40615-019-00630-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) is important to counter synergistic effects of HIV and hepatitis C (HCV) in patients living with coinfection. Predictors of ART nonadherence among patients living with HIV/HCV coinfection are not well established. This knowledge would be advantageous for clinicians and behavioral health specialists who provide care to patients living with HIV/HCV coinfection. OBJECTIVES The purpose of this study was to assess prevalence and predictors of ART nonadherence in a sample of patients living with HIV/HCV coinfection who were actively in HIV clinical care. METHOD A sample of patients living with HIV/HCV coinfection who received care at a university-affiliated HIV clinic (n = 137) between January 2013 and July 2017 were included in the study. Computerized patient-reported data or outcomes (PROs) and electronic medical record data of these respective patients were collected and analyzed. Binomial logistic regression was used to examine predictors of ART nonadherence. RESULTS The prevalence of ART nonadherence was 31%. In multivariate analysis, African American ethnicity (OR = 3.28, CI 1.241-8.653, p = 0.017) and a higher number of alcoholic drinks per drinking day (OR = 1.31, CI 1.054-1.639, p = 0.015) were positively associated with ART nonadherence. CONCLUSIONS Behavioral health providers are encouraged to incorporate alcohol use reduce interventions in HIV clinical settings to reduce ART nonadherence among patients living with HIV/HCV coinfection. Additionally, public health professionals and researchers, and clinicians are encouraged to use inductive methods to discover why ART nonadherence disproportionately impacts African American patients living with HIV/HCV coinfection and to develop approaches that are sensitive to those respective barriers.
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Affiliation(s)
- Omar T Sims
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
- Comprehensive Center for Healthy Aging, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Center for AIDS Research, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Franciso, CA, USA.
- The University of Alabama at Birmingham, Univesity Hall 3137, 1720 2nd AVE S, Birmingham, AL, 35294-1260, USA.
| | - Chia-Ying Chiu
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rasheeta Chandler
- Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Franciso, CA, USA
- School of Nursing, Emory University, Atlanta, GA, USA
| | - Pamela Melton
- Department of Social Work, College of Education, Humanities, and Behavioral Sciences, Alabama A&M University, 104 Bibb Graves Hall, Normal, AL, USA
| | - Kaiying Wang
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Caroline Richey
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle Odlum
- School of Nursing, Columbia University, 560 West 168th Street, New York, 10032, USA
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23
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Hutton HE, Lesko CR, Li X, Thompson CB, Lau B, Napravnik S, Mayer KH, Mathews WC, McCaul ME, Crane HM, Fredericksen RJ, Cropsey KL, Saag M, Christopoulos K, Chander G. Alcohol Use Patterns and Subsequent Sexual Behaviors Among Women, Men who have Sex with Men and Men who have Sex with Women Engaged in Routine HIV Care in the United States. AIDS Behav 2019; 23:1634-1646. [PMID: 30443807 PMCID: PMC6830881 DOI: 10.1007/s10461-018-2337-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Among people with HIV, alcohol use is associated with increased prevalence of sexual transmission behaviors. We examined associations between alcohol use in the prior year and sexual behaviors approximately six months later among 1857 women, 6752 men who have sex with men (MSM) and 2685 men who have sex with women (MSW). Any alcohol use was associated with increased risk of unsafe vaginal sex among women; anal sex and =>2 anal sex partners among MSM; and anal sex, =>2 anal or vaginal sex partners, and unsafe vaginal sex among MSW. In particular, among women >7 alcoholic drinks/week and among MSW =>5 alcoholic drinks/drinking day increased the likelihood of certain subsequent sexual behaviors. For all groups, especially women, the risk of sex under the influence of drugs/alcohol markedly increased with increases in quantity and frequency of alcohol consumption. These different patterns of drinking and sexual behaviors indicate the importance of tailored counseling messages to women, MSM and MSW.
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Affiliation(s)
- Heidi E Hutton
- Department of Psychiatry, Johns Hopkins University School of Medicine, Meyer 3-147, 600 N. Wolfe St, Baltimore, MD, 21287, USA.
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ximin Li
- Biostatics Center, Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Carol B Thompson
- Biostatics Center, Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Kenneth H Mayer
- Department of Global Health and Population, Harvard School of Public Health, Boston, USA
| | | | - Mary E McCaul
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - Rob J Fredericksen
- Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - Karen L Cropsey
- Department of Psychiatry, University of Alabama School of Medicine, Birmingham, USA
| | - Michael Saag
- Department of Medicine, University of Alabama School of Medicine, Birmingham, USA
| | - Katerina Christopoulos
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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