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Cook RL, Richards VL, Gullett JM, Lerner BDG, Zhou Z, Porges EC, Wang Y, Kahler CW, Barnett NP, Li Z, Pallikkuth S, Thomas E, Rodriguez A, Bryant KJ, Ghare S, Barve S, Govind V, Dévieux JG, Cohen RA. Experimentally Induced Reductions in Alcohol Consumption and Brain, Cognitive, and Clinical Outcomes in Older Persons With and Those Without HIV Infection (30-Day Challenge Study): Protocol for a Nonrandomized Clinical Trial. JMIR Res Protoc 2024; 13:e53684. [PMID: 38564243 PMCID: PMC11028398 DOI: 10.2196/53684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/09/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Both alcohol consumption and HIV infection are associated with worse brain, cognitive, and clinical outcomes in older adults. However, the extent to which brain and cognitive dysfunction is reversible with reduction or cessation of drinking is unknown. OBJECTIVE The 30-Day Challenge study was designed to determine whether reduction or cessation of drinking would be associated with improvements in cognition, reduction of systemic and brain inflammation, and improvement in HIV-related outcomes in adults with heavy drinking. METHODS The study design was a mechanistic experimental trial, in which all participants received an alcohol reduction intervention followed by repeated assessments of behavioral and clinical outcomes. Persons were eligible if they were 45 years of age or older, had weekly alcohol consumption of 21 or more drinks (men) or 14 or more drinks (women), and were not at high risk of alcohol withdrawal. After a baseline assessment, participants received an intervention consisting of contingency management (money for nondrinking days) for at least 30 days followed by a brief motivational interview. After this, participants could either resume drinking or not. Study questionnaires, neurocognitive assessments, neuroimaging, and blood, urine, and stool samples were collected at baseline, 30 days, 90 days, and 1 year after enrollment. RESULTS We enrolled 57 persons with heavy drinking who initiated the contingency management protocol (mean age 56 years, SD 4.6 years; 63%, n=36 male, 77%, n=44 Black, and 58%, n=33 people with HIV) of whom 50 completed 30-day follow-up and 43 the 90-day follow-up. The planned study procedures were interrupted and modified due to the COVID-19 pandemic of 2020-2021. CONCLUSIONS This was the first study seeking to assess changes in brain (neuroimaging) and cognition after alcohol intervention in nontreatment-seeking people with HIV together with people without HIV as controls. Study design strengths, limitations, and lessons for future study design considerations are discussed. Planned analyses are in progress, after which deidentified study data will be available for sharing. TRIAL REGISTRATION ClinicalTrials.gov NCT03353701; https://clinicaltrials.gov/study/NCT03353701. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53684.
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Affiliation(s)
- Robert L Cook
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, United States
| | - Veronica L Richards
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, United States
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, United States
| | - Joseph M Gullett
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, United States
| | | | - Zhi Zhou
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, United States
| | - Eric C Porges
- Center for Cognitive Aging and Memory, University of Florida, Gainesville, FL, United States
| | - Yan Wang
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, United States
| | - Christopher W Kahler
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
| | - Nancy P Barnett
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
| | - Zhigang Li
- Southern HIV and Alcohol Research Consortium, University of Florida, Gainesville, FL, United States
| | - Suresh Pallikkuth
- Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Emmanuel Thomas
- Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Allan Rodriguez
- Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Smita Ghare
- Department of Medicine, University of Louisville, Louisville, KY, United States
| | - Shirish Barve
- Department of Medicine, University of Louisville, Louisville, KY, United States
| | - Varan Govind
- Miami Center for AIDS Research, University of Miami Miller School of Medicine, Miami, FL, United States
| | | | - Ronald A Cohen
- Center for Cognitive Aging and Memory, University of Florida, Gainesville, FL, United States
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Kim TW, Bertholet N, Magane KM, Lloyd-Travaglini C, Winter MR, Samet JH, Erlandson KM, Stein MD, Bryant KJ, Saitz R, Heeren TC. Alcohol Consumption and Illicit Drug Use: Associations With Fall, Fracture, and Acute Health Care Utilization Among People With HIV Infection. J Acquir Immune Defic Syndr 2024; 95:391-398. [PMID: 38133581 PMCID: PMC10922845 DOI: 10.1097/qai.0000000000003372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Given alcohol and/or other drug (AOD) use occurs among people with HIV (PWH), we examined its association with falls and fall-related outcomes and whether frailty moderates the association. SETTING Northeastern US city. METHODS We analyzed an observational cohort of PWH with current or past AOD use. Alcohol measures were any past 14-day heavy use, average alcohol/day, and days with heavy use. Drug use measures were past 30-day illicit use of cocaine, opioids, and sedatives. Repeated cross-sectional associations were estimated with separate multivariable generalized estimating equation regression models for each fall-related outcome. RESULTS Among PWH (n = 251; mean age 52 [SD = 10]), 35% reported heavy alcohol use, 24% cocaine, 16% illicit opioids, 13% illicit sedatives, and 35% any fall; 27% were frail. Heavy alcohol use was associated with a fall (AOR = 1.49, 95% CI: 1.08 to 2.07), multiple falls (AOR = 1.55 95% CI: 1.10 to 2.19), and fall/fracture-related emergency department visit or hospitalization (AOR = 1.81, 95% CI: 1.10 to 2.97). Higher average alcohol/day and more heavy drinking days were associated with multiple falls. Illicit sedative use was associated with a fall, multiple falls, and emergency department visit/hospitalization and opioid use with fracture. Frailty moderated the association of heavy alcohol use and a fall (AOR = 2.26, 95% CI: 1.28 to 4.01 in those frail) but not in those not frail. CONCLUSION The effect of AOD use on falls and fall-related outcomes was most pronounced with alcohol, particularly among frail PWH. Heavy alcohol, illicit sedative, and illicit opioid use are high-priority targets for preventing falls and fall-related consequences for PWH.
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Affiliation(s)
- Theresa W Kim
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA
- Department of Medicine, Boston Medical Center, Boston, MA
| | - Nicolas Bertholet
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kara M Magane
- Boston University School of Public Health, Boston, MA
| | | | | | - Jeffrey H Samet
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA
- Department of Medicine, Boston Medical Center, Boston, MA
- Boston University School of Public Health, Boston, MA
| | - Kristine M Erlandson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; and
| | | | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD
| | - Richard Saitz
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA
- Department of Medicine, Boston Medical Center, Boston, MA
- Boston University School of Public Health, Boston, MA
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McGinnis KA, Justice AC, Marconi VC, Rodriguez-Barradas MC, Hauser RG, Oursler KK, Brown ST, Bryant KJ, Tate JP. Combining Charlson comorbidity and VACS indices improves prognostic accuracy for all-cause mortality for patients with and without HIV in the Veterans Health Administration. Front Med (Lausanne) 2024; 10:1342466. [PMID: 38356736 PMCID: PMC10864663 DOI: 10.3389/fmed.2023.1342466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/31/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction As people age with HIV (PWH), many comorbid diseases are more common than among age matched comparators without HIV (PWoH). While the Veterans Aging Cohort (VACS) Index 2.0 accurately predicts mortality in PWH using age and clinical biomarkers, the only included comorbidity is hepatitis C. We asked whether adding comorbid disease groupings from the Charlson Comorbidity Index (CCI) improves the accuracy of VACS Index. Methods To maximize our ability to model mortality among older age groups, we began with PWoH in Veterans Health Administration (VA) from 2007-2017, divided into development and validation samples. Baseline predictors included age, and components of CCI and VACS Index (excluding CD4 count and HIV RNA). Patients were followed until December 31, 2021. We used Cox models to develop the VACS-CCI score and estimated mortality using a parametric (gamma) survival model. We compared accuracy using C-statistics and calibration curves in validation overall and within subgroups (gender, age ≥65 years, race/ethnicity, and CCI score). We then applied VACS-CCI in PWH and compared its accuracy to age, VACS Index 2.0, CCI and VACS-CCI with CD4 and HIV RNA added. Results The analytic sample consisted of 6,588,688 PWoH and 30,539 PWH. Among PWoH/PWH, median age was 65/55 years; 6%/3% were women; 15%/48% were Black and 5%/7% Hispanic. VACS-CCI provided the best discrimination (C-statistic = 0.81) with excellent calibration (predicted and observed mortality largely overlapped) overall and within subgroups. When VACS-CCI was applied to PWH it demonstrated similar discrimination as VACS Index 2.0 (C-statistic = 0.77 for both) but superior calibration among those with CD4 < 200. Discrimination was improved when CD4 and HIV RNA were added VACS-CCI (C-statistic = 0.79). Liver and kidney disease, congestive heart failure, malignancy, and dementia were negatively associated with CD4 (p-trends all <0.0001). Discussion Among PWH and PWoH in VA care, age alone weakly discriminates risk of mortality. VACS Index 2.0, CCI, and VACS-CCI all provide better discrimination, but VACS-CCI is more consistently calibrated. The association of comorbid diseases with lower CD4 underscores the likely role of HIV in non-AIDS conditions. Future work will include adding CD4 and HIV RNA to VACS-CCI and validating it in independent data.
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Affiliation(s)
| | - Amy C. Justice
- VA Connecticut Healthcare System, West Haven, CT, United States
- Yale School of Medicine, New Haven, CT, United States
| | - Vincent C. Marconi
- The Atlanta Veterans Affairs Medical Center, Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, United States
- VA Medical Center, Decatur, GA, United States
| | - Maria C. Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Ronald G. Hauser
- VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Krisann K. Oursler
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- VA Salem Healthcare System, Salem, VA, United States
| | | | - Kendall J. Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Janet P. Tate
- VA Connecticut Healthcare System, West Haven, CT, United States
- Yale School of Medicine, New Haven, CT, United States
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4
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Edelman EJ, Dziura J, Deng Y, DePhilippis D, Fucito LM, Ferguson T, Bedimo R, Brown S, Marconi VC, Goetz MB, Rodriguez-Barradas MC, Simberkoff MS, Molina PE, Weintrob AC, Maisto SA, Paris M, Justice AC, Bryant KJ, Fiellin DA. Contingency management with stepped care for unhealthy alcohol use among individuals with HIV: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 131:107242. [PMID: 37230168 PMCID: PMC10460633 DOI: 10.1016/j.cct.2023.107242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Although unhealthy alcohol use is associated with increased morbidity and mortality among people with HIV (PWH), many are ambivalent about engaging in treatment and experience variable responses to treatment. We describe the rationale, aims, and study design for the Financial Incentives, Randomization, with Stepped Treatment (FIRST) Trial, a multi-site randomized controlled efficacy trial. METHODS PWH in care recruited from clinics across the United States who reported unhealthy alcohol use, had a phosphatidylethanol (PEth) >20 ng/mL, and were not engaged in formal alcohol treatment were randomized to integrated contingency management with stepped care versus treatment as usual. The intervention involved two steps; Step 1: Contingency management (n = 5 sessions) with potential rewards based on 1) short-term abstinence; 2) longer-term abstinence; and 3) completion of healthy activities to promote progress in addressing alcohol consumption or conditions potentially impacted by alcohol; Step 2: Addiction physician management (n = 6 sessions) plus motivational enhancement therapy (n = 4 sessions). Participants' treatment was stepped up at week 12 if they lacked evidence of longer-term abstinence. Primary outcome was abstinence at week 24. Secondary outcomes included alcohol consumption (assessed by TLFB and PEth) and the Veterans Aging Cohort Study (VACS) Index 2.0 scores; exploratory outcomes included progress in addressing medical conditions potentially impacted by alcohol. Protocol adaptations due to the COVID-19 pandemic are described. CONCLUSIONS The FIRST Trial is anticipated to yield insights on the feasibility and preliminary efficacy of integrated contingency management with stepped care to address unhealthy alcohol use among PWH. CLINICALTRIALS gov identifier: NCT03089320.
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Affiliation(s)
- E Jennifer Edelman
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA.
| | - James Dziura
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT, USA; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Dominick DePhilippis
- Veterans Affairs Office of Mental Health and Suicide Prevention, US Department of Veterans Affairs, Washington, DC, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa M Fucito
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Tekeda Ferguson
- Department of Epidemiology, Louisiana State University School of Public Health, New Orleans, LA, USA; Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Roger Bedimo
- Veterans Affairs North Texas Health Care System and UT Southwestern Dallas, TX, USA
| | - Sheldon Brown
- James J. Peters Veterans Affairs Medical Center and Manhattan VA Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vincent C Marconi
- Atlanta VAMC, Emory University School of Medicine, Rollins School of Public Health, Atlanta, GA, USA
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | | | - Michael S Simberkoff
- VA NY Harbor Healthcare System and New York University Grossman School of Medicine, New York, NY, USA
| | - Patricia E Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA; Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Amy C Weintrob
- Washington D.C. Veterans Affairs Medical Center and George Washington University, Washington, DC, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Manuel Paris
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Amy C Justice
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD, USA
| | - David A Fiellin
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Yale Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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5
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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6
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Bershteyn A, Richard E, Zhou Q, Khan MR, Scheidell JD, Manandhar-Sasaki P, Ban K, Crystal S, Gordon AJ, Justice AC, Bryant KJ, Braithwaite RS. Potential health benefits of integrated screening strategies for alcohol, tobacco, other substance use, depression, anxiety, and chronic pain among people living with HIV in the USA: a mathematical modelling study. Lancet HIV 2023; 10:e118-e125. [PMID: 36731986 DOI: 10.1016/s2352-3018(22)00361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Alcohol use, tobacco use, and other substance use often co-occur with depression, anxiety, and chronic pain, forming a constellation of alcohol, substance, and mood-related (CASM) conditions that disproportionately affects people with HIV in the USA. We used a microsimulation model to evaluate how alternative screening strategies accounting for CASM interdependence could affect life expectancy in people with HIV in the USA. METHODS We augmented a microsimulation model previously validated to predict US adult life expectancy, including in people with HIV. Using data from the Veterans Aging Cohort Study, we incorporated CASM co-occurrence, inferred causal relationships between CASM conditions, and assessed the effects of CASM on HIV treatment and preventive care. We simulated an in-care HIV cohort exposed to alternative CASM screening and diagnostic assessment strategies, ranging from currently recommended screenings (alcohol, tobacco, and depression, with diagnostic assessments for conditions screening positive) to a series of integrated strategies (screening for alcohol, tobacco, or depression with additional diagnostic assessments if any screened positive) to a maximal saturation strategy (diagnostic assessments for all CASM conditions). FINDINGS The saturation strategy increased life expectancy by 0·95 years (95% CI 0·93-0·98) compared with no screening. Recommended screenings provided much less benefit: 0·06 years (0·03-0·09) gained from alcohol screening, 0·08 years (0·06-0·11) from tobacco screening, 0·10 years (0·08-0·11) from depression screening, and 0·25 years (0·22-0·27) from all three screenings together. One integrated strategy (screening alcohol, tobacco, and depression with diagnostic assessment for all CASM conditions if any screened positive) produced near-maximal benefit (0·82 years [0·80-0·84]) without adding substantial screening burden, albeit requiring additional diagnostic assessments. INTERPRETATION Primary care providers for people with HIV should consider comprehensive diagnostic assessment of CASM conditions if one or more conditions screen positive. FUNDING US National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Emma Richard
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Qinlian Zhou
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Maria R Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Joy D Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Prima Manandhar-Sasaki
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Kaoon Ban
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Stephen Crystal
- Center for Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA) and Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Amy C Justice
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA; Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
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7
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Gordon KS, Becker WC, Bryant KJ, Crystal S, Maisto SA, Marshall BDL, McInnes DK, Satre DD, Williams EC, Edelman EJ, Justice AC. Patient-Reported Bothersome Symptoms Attributed to Alcohol Use Among People With and Without HIV. AIDS Behav 2022; 26:3589-3596. [PMID: 35553287 PMCID: PMC10084471 DOI: 10.1007/s10461-022-03628-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/26/2022]
Abstract
Helping people with HIV (PWH) and without HIV (PWoH) understand the relationship between physical symptoms and alcohol use might help motivate them to decrease use. In surveys collected in the Veterans Aging Cohort Study from 2002 to 2018, PWH and PWoH were asked about 20 common symptoms and whether they thought any were caused by alcohol use. Analyses were restricted to current alcohol users (AUDIT-C > 0). We applied generalized estimating equations. The outcome was having any Symptoms Attributed to Alcohol use (SxAA). Primary independent variables were each of the 20 symptoms and HIV status. Compared to PWoH, PWH had increased odds of SxAA (OR 1.54; 95% CI 1.27, 1.88). Increased AUDIT-C score was also associated with SxAA (OR 1.32; 95% CI 1.28, 1.36), as were trouble remembering, anxiety, and weight loss/wasting. Evidence that specific symptoms are attributed to alcohol use may help motive people with and without HIV decrease their alcohol use.
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Affiliation(s)
- Kirsha S Gordon
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - William C Becker
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Stephen Crystal
- Rutgers University School of Social Work, New Brunswick, NJ, USA
| | - Stephen A Maisto
- Syracuse University College of Arts and Sciences, Syracuse, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - D Keith McInnes
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
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McGinnis KA, Tate JP, Bryant KJ, Justice AC, O'Connor PG, Rodriguez-Barradas MC, Crystal S, Cutter CJ, Hansen NB, Maisto SA, Marconi VC, Williams EC, Cook RL, Gordon AJ, Gordon KS, Eyawo O, Edelman EJ, Fiellin DA. Change in Alcohol Use Based on Self-Report and a Quantitative Biomarker, Phosphatidylethanol, in People With HIV. AIDS Behav 2022; 26:786-794. [PMID: 34542779 DOI: 10.1007/s10461-021-03438-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
The timeline followback (TLFB) takes more resources to collect than the Alcohol Use Disorder Identification Test (AUDIT-C). We assessed agreement of TLFB and AUDIT-C with the biomarker phosphatidylethanol (PEth) and compared changes in TLFB and PEth among persons with HIV (PWH) using secondary data from randomized trials. We calculated operating characteristics and agreement between TLFB (> 1 and > 2 average drinks/day), AUDIT-C ≥ 4 and PEth ≥ 20 among 275 men with HIV. Median age was 57 years, 80% were African-American; and 17% white. Sixty-eight percent had PEth ≥ 20, 46% reported > 2 average drinks/day on TLFB, 61% reported > 1 average drinks/day on TLFB, and 72% had an AUDIT-C ≥ 4. Relative to PEth, sensitivity for AUDIT-C ≥ 4 was 84% (kappa = 0.36), and for TLFB > 1 average drink/day was 76% (kappa = 0.44). Change in alcohol use appeared greater using TLFB measures than PEth. Strategies to robustly assess alcohol use in PWH may require both self-report and biomarkers.
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Affiliation(s)
- Kathleen A McGinnis
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA.
| | - Janet P Tate
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | | | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey VAMC and Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | | | - Nathan B Hansen
- College of Public Health, University of Georgia, Athens, GA, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Vincent C Marconi
- School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health and Seattle-Denver Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Adam J Gordon
- University of Utah and Salt Lake City VA Health Care System, Salt Lake City, UT, USA
| | - Kirsha S Gordon
- VA Connecticut Healthcare System, US Department of Veterans Affairs, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | | | - E Jennifer Edelman
- Yale School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research On AIDS, Yale School of Public Health, New Haven, CT, USA
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9
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Davy-Mendez T, Sarovar V, Levine-Hall T, Lea AN, Sterling SA, Chi FW, Palzes VA, Bryant KJ, Weisner CM, Silverberg MJ, Satre DD. Treatment for alcohol use disorder among persons with and without HIV in a clinical care setting in the United States. Drug Alcohol Depend 2021; 229:109110. [PMID: 34700145 PMCID: PMC8671330 DOI: 10.1016/j.drugalcdep.2021.109110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/10/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Alcohol use disorders (AUD) can lead to poor health outcomes. Little is known about AUD treatment among persons with HIV (PWH). In an integrated health system in Northern California, 2014-2017, we compared AUD treatment rates between PWH with AUD and persons without HIV (PWoH) with AUD. METHODS Using Poisson regression with GEE, we estimated prevalence ratios (PRs) comparing the annual probability of receiving AUD treatment (behavioral intervention or dispensed medication), adjusted for sociodemographics, psychiatric comorbidities, insurance type, and calendar year. Among PWH, we examined independent AUD treatment predictors using PRs adjusted for calendar year only. RESULTS PWH with AUD (N = 633; 93% men, median age 49) were likelier than PWoH with AUD (N = 7006; 95% men, median age 52) to have depression (38% vs. 21%) and a non-alcohol substance use disorder (SUD, 48% vs. 25%) (both P < 0.01). Annual probabilities of receiving AUD treatment were 45.4% for PWH and 34.4% for PWoH. After adjusting, there was no difference by HIV status (PR 1.02 [95% CI 0.94-1.11]; P = 0.61). Of treated PWH, 59% received only a behavioral intervention, 5% only a medication, and 36% both, vs. 67%, 4%, 30% for treated PWoH, respectively. Irrespective of HIV status, the most common medication was gabapentin. Among PWH, receiving AUD treatment was associated with having depression (PR 1.78 [1.51-2.10]; P < 0.01) and another SUD (PR 2.68 [2.20-3.27]; P < 0.01). CONCLUSIONS PWH with AUD had higher AUD treatment rates than PWoH with AUD in unadjusted but not adjusted analyses, which may be explained by higher psychiatric comorbidity burden among PWH.
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Affiliation(s)
- Thibaut Davy-Mendez
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, 401 Parnassus Ave, San Francisco, CA 94143, USA; Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Alexandra N. Lea
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Stacy A. Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Felicia W. Chi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Vanessa A. Palzes
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Kendall J. Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD, 20892-7003, USA
| | - Constance M. Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA,Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
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10
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Bryant VE, Britton MK, Gullett JM, Porges EC, Woods AJ, Cook RL, Williamson J, Ennis N, Bryant KJ, Bradley C, Cohen RA. Reduced Working Memory is Associated with Heavier Alcohol Consumption History, Role Impairment and Executive Function Difficulties. AIDS Behav 2021; 25:2720-2727. [PMID: 33550519 PMCID: PMC8935631 DOI: 10.1007/s10461-021-03170-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 12/14/2022]
Abstract
Both HIV status and heavy alcohol use have been associated with reduced cognitive function, particularly in the domains of working memory and executive function. It is unclear what aspects of working memory and executive function are associated with HIV status and heavy alcohol use and whether performance on these measures are associated with functional impairment. We examined the relationship between HIV, history of heavy alcohol consumption, and HIV/alcohol interaction on speeded tests of frontal inhibitory abilities, a working memory task related to mental manipulation of letters and numbers, cognitive flexibility, and measures of functional impairment. Study participants included 284 individuals (151 HIV +) recruited from two different studies focusing on HIV associated brain dysfunction, one specific to the effects of alcohol, the other specific to the effects of aging. HIV status was not independently associated with working memory and executive function measures. Higher level of alcohol consumption was associated with reduced performance on Letter Number Sequencing. Poorer Letter Number Sequencing performance was associated with role impairment (an inability to do certain kinds of work, housework, or schoolwork) and executive function difficulties. Future studies should examine causal associations and interventions targeting working memory abilities.
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Affiliation(s)
- Vaughn E Bryant
- Department of Epidemiology, University of Florida, Emerging Pathogens Institute, 2055 Mowry Road, P.O. Box 100009, Gainesville, FL, 32610, USA.
- Department of Clinical and Health Psychology, University of Florida, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, 1225 Center Drive, Gainesville, FL, 32607, USA.
| | - Mark K Britton
- Department of Clinical and Health Psychology, University of Florida, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, 1225 Center Drive, Gainesville, FL, 32607, USA
| | - Joseph M Gullett
- Department of Clinical and Health Psychology, University of Florida, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, 1225 Center Drive, Gainesville, FL, 32607, USA
| | - Eric C Porges
- Department of Clinical and Health Psychology, University of Florida, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, 1225 Center Drive, Gainesville, FL, 32607, USA
| | - Adam J Woods
- Department of Clinical and Health Psychology, University of Florida, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, 1225 Center Drive, Gainesville, FL, 32607, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Emerging Pathogens Institute, 2055 Mowry Road, P.O. Box 100009, Gainesville, FL, 32610, USA
| | - John Williamson
- Department of Clinical and Health Psychology, University of Florida, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, 1225 Center Drive, Gainesville, FL, 32607, USA
| | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine, Florida State University, 2010 Levy Ave, Suite 254, Tallahassee, FL, 32310, USA
| | - Kendall J Bryant
- National Institute of Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD, 20892-6902, USA
| | - Carolyn Bradley
- Department of Epidemiology, University of Florida, Emerging Pathogens Institute, 2055 Mowry Road, P.O. Box 100009, Gainesville, FL, 32610, USA
| | - Ronald A Cohen
- Department of Clinical and Health Psychology, University of Florida, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, 1225 Center Drive, Gainesville, FL, 32607, USA
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11
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Chichetto NE, Kundu S, Freiberg MS, Koethe JR, Butt AA, Crystal S, So-Armah KA, Cook RL, Braithwaite RS, Justice AC, Fiellin DA, Khan M, Bryant KJ, Gaither JR, Barve SS, Crothers K, Bedimo RJ, Warner A, Tindle HA. Association of Syndemic Unhealthy Alcohol Use, Smoking, and Depressive Symptoms on Incident Cardiovascular Disease among Veterans With and Without HIV-Infection. AIDS Behav 2021; 25:2852-2862. [PMID: 34101074 PMCID: PMC8376776 DOI: 10.1007/s10461-021-03327-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
Unhealthy alcohol use, smoking, and depressive symptoms are risk factors for cardiovascular disease (CVD). Little is known about their co-occurrence - termed a syndemic, defined as the synergistic effect of two or more conditions-on CVD risk in people with HIV (PWH). We used data from 5621 CVD-free participants (51% PWH) in the Veteran's Aging Cohort Study-8, a prospective, observational study of veterans followed from 2002 to 2014 to assess the association between this syndemic and incident CVD by HIV status. Diagnostic codes identified cases of CVD (acute myocardial infarction, stroke, heart failure, peripheral artery disease, and coronary revascularization). Validated measures of alcohol use, smoking, and depressive symptoms were used. Baseline number of syndemic conditions was categorized (0, 1, ≥ 2 conditions). Multivariable Cox Proportional Hazards regressions estimated risk of the syndemic (≥ 2 conditions) on incident CVD by HIV-status. There were 1149 cases of incident CVD (52% PWH) during the follow-up (median 10.1 years). Of the total sample, 64% met our syndemic definition. The syndemic was associated with greater risk for incident CVD among PWH (Hazard Ratio [HR] 1.87 [1.47-2.38], p < 0.001) and HIV-negative veterans (HR 1.70 [1.35-2.13], p < 0.001), compared to HIV-negative with zero conditions. Among those with the syndemic, CVD risk was not statistically significantly higher among PWH vs. HIV-negative (HR 1.10 [0.89, 1.37], p = .38). Given the high prevalence of this syndemic combined with excess risk of CVD, these findings support linked-screening and treatment efforts.
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Affiliation(s)
- Natalie E Chichetto
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA.
| | - Suman Kundu
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
| | - Matthew S Freiberg
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - John R Koethe
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
| | - Adeel A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Medicine, Weill-Cornell Medical College, Doha, USA
- Hamad Medical Corporation, Doha, Qatar
| | - Stephen Crystal
- Health Care Policy, and Aging Research and School of Social Work, Institute for Health, Rutgers University, New Brunswick, NJ, USA
| | - Kaku A So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Robert L Cook
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, FL, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Amy C Justice
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System, New Haven, CT, USA
| | - David A Fiellin
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Maria Khan
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Kendall J Bryant
- National Institute On Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Julie R Gaither
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Shirish S Barve
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Roger J Bedimo
- Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alberta Warner
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CT, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Office 315, Nashville, TN, 37203, USA
- Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
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12
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Satre DD, Levine-Hall T, Sterling SA, Young-Wolff K, Lam JO, Alexeeff S, Hojilla JC, Williams A, Justice AC, Sterne J, Cavassini M, Bryant KJ, Williams EC, Horberg MA, Volberding P, Weisner C, Silverberg MJ. The relationship of smoking and unhealthy alcohol use to the HIV care continuum among people with HIV in an integrated health care system. Drug Alcohol Depend 2021; 219:108481. [PMID: 33429295 PMCID: PMC7869693 DOI: 10.1016/j.drugalcdep.2020.108481] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/12/2020] [Accepted: 12/03/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Smoking tobacco and unhealthy alcohol use may negatively influence HIV care continuum outcomes but have not been examined in combination. METHODS Participants were people with HIV (PWH) in Kaiser Permanente Northern California. Predictors included smoking status and unhealthy alcohol use (exceeding daily and/or weekly limits) reported by patients during primary care screening (index date). Outcomes were based on not achieving the following steps in the care continuum: linkage to HIV care (≥1 visit within 90 days of newly identified HIV diagnosis), retention (2+ in-person visits, 60+ days apart) and HIV RNA control (<75 copies/mL). Adjusted odds ratios (ORs) were obtained from separate logistic regression models for each outcome associated with smoking and unhealthy alcohol use independently and combined. RESULTS The overall sample (N = 8958) had a mean age of 48.0 years; was 91.3 % male; 54.0 % white, 17.6 % Latino, 15.1 % black, and 9.6 % other race/ethnicity. Smoking was associated with higher odds of not being linked to HIV care (OR = 1.60 [95 % CI 1.03-2.48]), not retained (OR = 1.30 [95 % CI 1.13-1.50]), and HIV RNA not in control (OR = 1.91 [95 % CI 1.60-2.27]). Alcohol measures were not independently associated with outcomes. The combination of unhealthy alcohol use and smoking (versus neither) was associated with higher odds of not being linked to care (OR = 2.83 [95 % CI 1.40-5.71]), although the interaction did not reach significance (p = 0.18). CONCLUSIONS In this large sample of PWH in an integrated health care system, smoking, both independently and in combination with unhealthy alcohol use, was associated with worse HIV care continuum outcomes.
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Affiliation(s)
- Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA,Kaiser Permanente Northern California, Oakland, CA, USA,Corresponding author: Derek D. Satre, Ph.D., Department of Psychiatry and Behavioral Sciences Weill Institute for Neurosciences University of California, San Francisco 401 Parnassus Avenue, Box 0984 San Francisco, CA 94143, , Phone: (415) 476-7382
| | | | | | - Kelly Young-Wolff
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA,Kaiser Permanente Northern California, Oakland, CA, USA
| | | | | | | | | | | | | | | | - Kendall J. Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Emily C. Williams
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, Seattle, WA,Department of Health Services, University of Washington, Seattle, WA
| | - Michael A. Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - Paul Volberding
- AIDS Research Institute, University of California, San Francisco, USA
| | - Constance Weisner
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA,Kaiser Permanente Northern California, Oakland, CA, USA
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13
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Williams EC, McGinnis KA, Rubinsky AD, Matson TE, Bobb JF, Lapham GT, Edelman EJ, Satre DD, Catz SL, Richards JE, Bryant KJ, Marshall BDL, Kraemer KL, Crystal S, Gordon AJ, Skanderson M, Fiellin DA, Justice AC, Bradley KA. Alcohol Use and Antiretroviral Adherence Among Patients Living with HIV: Is Change in Alcohol Use Associated with Change in Adherence? AIDS Behav 2021; 25:203-214. [PMID: 32617778 DOI: 10.1007/s10461-020-02950-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Alcohol use increases non-adherence to antiretroviral therapy (ART) among persons living with HIV (PLWH). Dynamic longitudinal associations are understudied. Veterans Aging Cohort Study (VACS) data 2/1/2008-7/31/16 were used to fit linear regression models estimating changes in adherence (% days with ART medication fill) associated with changes in alcohol use based on annual clinically-ascertained AUDIT-C screening scores (range - 12 to + 12, 0 = no change) adjusting for demographics and initial adherence. Among 21,275 PLWH (67,330 observations), most reported no (48%) or low-level (39%) alcohol use initially, with no (55%) or small (39% ≤ 3 points) annual change. Mean initial adherence was 86% (SD 21%), mean annual change was - 3.1% (SD 21%). An inverted V-shaped association was observed: both increases and decreases in AUDIT-C were associated with greater adherence decreases relative to stable scores [p < 0.001, F (4, 21,274)]. PLWH with dynamic alcohol use (potentially indicative of alcohol use disorder) should be considered for adherence interventions.
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Affiliation(s)
- Emily C Williams
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA.
- Department of Health Services, University of Washington, Seattle, WA, USA.
| | - Kathleen A McGinnis
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Anna D Rubinsky
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA
- Kidney Health Research Collaborative, University of California, San Francisco and VA San Francisco Health Care System, San Francisco, CA, USA
| | - Theresa E Matson
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Gwen T Lapham
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - E Jennifer Edelman
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Derek D Satre
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA, USA
| | - Julie E Richards
- Department of Health Services, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kendall J Bryant
- National Institute On Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Kevin L Kraemer
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Stephen Crystal
- Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - Adam J Gordon
- Division of Epidemiology, Department of Internal Medicine, Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Salt Lake City, UT, USA
- Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Melissa Skanderson
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - David A Fiellin
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Amy C Justice
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - Katharine A Bradley
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Center of Excellence in Substance Abuse Treatment and Education (CESATE) VA Puget Sound Healthcare System-Seattle Division, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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14
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Silverberg MJ, Levine-Hall T, Hood N, Anderson AN, Alexeeff SE, Lam JO, Slome SB, Flamm JA, Hare CB, Ross T, Justice A, Sterne JA, Williams A, Bryant KJ, Weisner CM, Horberg MA, Sterling SA, Satre DD. Health System-Based Unhealthy Alcohol Use Screening and Treatment Comparing Demographically Matched Participants With and Without HIV. Alcohol Clin Exp Res 2020; 44:2545-2554. [PMID: 33067802 PMCID: PMC7725961 DOI: 10.1111/acer.14481] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/08/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Unhealthy alcohol use among persons living with HIV (PLWH) is linked to significant morbidity, and use of alcohol services may differ by HIV status. Our objective was to compare unhealthy alcohol use screening and treatment by HIV status in primary care. METHODS Cohort study of adult (≥18 years) PLWH and HIV-uninfected participants frequency matched 20:1 to PLWH by age, sex, and race/ethnicity who were enrolled in a large integrated healthcare system in the United States, with information ascertained from an electronic health record. Outcomes included unhealthy alcohol screening, prevalence, provider-delivered brief interventions, and addiction specialty care visits. Other predictors included age, sex, race/ethnicity, neighborhood deprivation index, depression, smoking, substance use disorders, Charlson comorbidity index, prior outpatient visits, insurance type, and medical facility. Cox proportional hazards models were used to compute hazard ratios (HR) for the outcomes of time to unhealthy alcohol use screening and time to first addiction specialty visit. Poisson regression with robust standard errors was used to compute prevalence ratios (PR) for other outcomes. RESULTS 11,235 PLWH and 227,320 HIV-uninfected participants were included. By 4.5 years after baseline, most participants were screened for unhealthy alcohol use (85% of PLWH and 93% of HIV-uninfected), but with a lower rate among PLWH (adjusted HR 0.84, 95% CI 0.82 to 0.85). PLWH were less likely, compared with HIV-uninfected participants, to report unhealthy drinking among those screened (adjusted PR 0.74, 95% CI 0.69 to 0.79), and among those who screened positive, less likely to receive brief interventions (adjusted PR 0.82, 95% CI 0.75 to 0.90), but more likely (adjusted HR 1.7, 95% CI 1.2 to 2.4) to have an addiction specialty visit within 1 year. CONCLUSIONS Unhealthy alcohol use was lower in PLWH, but the treatment approach by HIV status differed. PLWH reporting unhealthy alcohol use received less brief interventions and more addiction specialty care than HIV-uninfected participants.
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Affiliation(s)
- Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California (KPNC), 2000 Broadway, Oakland CA, 94612, USA
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California (KPNC), 2000 Broadway, Oakland CA, 94612, USA
| | - Nicole Hood
- Division of Research, Kaiser Permanente Northern California (KPNC), 2000 Broadway, Oakland CA, 94612, USA
| | - Alexandra N. Anderson
- Division of Research, Kaiser Permanente Northern California (KPNC), 2000 Broadway, Oakland CA, 94612, USA
| | - Stacey E. Alexeeff
- Division of Research, Kaiser Permanente Northern California (KPNC), 2000 Broadway, Oakland CA, 94612, USA
| | - Jennifer O. Lam
- Division of Research, Kaiser Permanente Northern California (KPNC), 2000 Broadway, Oakland CA, 94612, USA
| | - Sally B. Slome
- Oakland Medical Center, KPNC, 3801 Howe Street, Oakland, CA 94611, USA
| | - Jason A. Flamm
- Sacramento Medical Center, KPNC, 2345 Fair Oaks Boulevard, Sacramento, CA 95825, USA
| | - C. Bradley Hare
- San Francisco Medical Center, KPNC, 2238 Geary Boulevard, San Francisco, CA 94115, USA
| | - Thekla Ross
- Division of Research, Kaiser Permanente Northern California (KPNC), 2000 Broadway, Oakland CA, 94612, USA
| | - Amy Justice
- Yale School of Medicine, Yale University, 950 Campbell Avenue, West Haven, CT 06516, USA
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA
| | - Jonathan A.C. Sterne
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Andrew Williams
- Tufts Medical Center, 35 Kneeland Street, Boston MA 02111, USA
| | - Kendall J. Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 6700B Rockledge Drive, Bethesda, MD 20892-6902, USA
| | - Constance M. Weisner
- Division of Research, Kaiser Permanente Northern California (KPNC), 2000 Broadway, Oakland CA, 94612, USA
| | - Michael A. Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, 2101 East Jefferson Street, 3 West, Rockville, MD 20852, USA
| | - Stacy A. Sterling
- Division of Research, Kaiser Permanente Northern California (KPNC), 2000 Broadway, Oakland CA, 94612, USA
| | - Derek D. Satre
- Division of Research, Kaiser Permanente Northern California (KPNC), 2000 Broadway, Oakland CA, 94612, USA
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94131, USA
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Caniglia EC, Stevens ER, Khan M, Young KE, Ban K, Marshall BDL, Chichetto NE, Gaither JR, Crystal S, Edelman EJ, Fiellin DA, Gordon AJ, Bryant KJ, Tate J, Justice AC, Braithwaite RS. Does Reducing Drinking in Patients with Unhealthy Alcohol Use Improve Pain Interference, Use of Other Substances, and Psychiatric Symptoms? Alcohol Clin Exp Res 2020; 44:2257-2265. [PMID: 33030753 DOI: 10.1111/acer.14455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/27/2020] [Accepted: 09/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND We aimed to investigate the impact of reducing drinking in patients with unhealthy alcohol use on improvement of chronic pain interference, substance use, and psychiatric symptoms. METHODS We analyzed longitudinal data from 2003 to 2015 in the Veterans Aging Cohort Study, a prospective, multisite observational study of US veterans, by emulating a hypothetical randomized trial (a target trial). Alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire, and outcome conditions were assessed via validated survey items. Individuals were followed from the first time their AUDIT score was ≥ 8 (baseline), a threshold consistent with unhealthy alcohol use. We compared individuals who reduced drinking (AUDIT < 8) at the next follow-up visit with individuals who did not (AUDIT ≥ 8). We fit separate logistic regression models to estimate odds ratios for improvement of each condition 2 years postbaseline among individuals who had that condition at baseline: moderate or severe pain interference symptoms, tobacco smoking, cannabis use, cocaine use, depressive symptoms, and anxiety symptoms. Inverse probability weighting was used to account for potential selection bias and confounding. RESULTS Adjusted 2-year odds ratios (95% confidence intervals) for associations between reducing drinking and improvement or resolution of each condition were as follows: 1.49 (0.91, 2.42) for pain interference symptoms, 1.57 (0.93, 2.63) for tobacco smoking, 1.65 (0.92, 2.95) for cannabis use, 1.83 (1.03, 3.27) for cocaine use, 1.11 (0.64, 1.92) for depressive symptoms, and 1.33 (0.80, 2.22) for anxiety symptoms. CONCLUSIONS We found some evidence for improvement of pain interference symptoms and substance use after reducing drinking among US veterans with unhealthy alcohol use, but confidence intervals were wide.
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Affiliation(s)
- Ellen C Caniglia
- From the, Department of Population Health, (ECC, ERS, MK, KEY, KB, RSB), NYU School of Medicine, New York, New York, USA
| | - Elizabeth R Stevens
- From the, Department of Population Health, (ECC, ERS, MK, KEY, KB, RSB), NYU School of Medicine, New York, New York, USA
| | - Maria Khan
- From the, Department of Population Health, (ECC, ERS, MK, KEY, KB, RSB), NYU School of Medicine, New York, New York, USA
| | - Kailyn E Young
- From the, Department of Population Health, (ECC, ERS, MK, KEY, KB, RSB), NYU School of Medicine, New York, New York, USA
| | - Kaoon Ban
- From the, Department of Population Health, (ECC, ERS, MK, KEY, KB, RSB), NYU School of Medicine, New York, New York, USA
| | - Brandon D L Marshall
- Department of Epidemiology, (BDLM), Brown University School of Public Health, Providence, Rhode Island, USA
| | | | - Julie R Gaither
- Yale School of Medicine, (JRG, EJE,DAF,JT,ACJ), New Haven, Connecticut, USA
| | - Stephen Crystal
- Rutgers School of Social Work, (SC), New Brunswick, New Jersey, USA
| | | | - David A Fiellin
- Yale School of Medicine, (JRG, EJE,DAF,JT,ACJ), New Haven, Connecticut, USA
| | - Adam J Gordon
- School of Medicine, (AJG), University of Utah, Salt Lake City, Utah, USA
| | | | - Janet Tate
- Yale School of Medicine, (JRG, EJE,DAF,JT,ACJ), New Haven, Connecticut, USA
| | - Amy C Justice
- Yale School of Medicine, (JRG, EJE,DAF,JT,ACJ), New Haven, Connecticut, USA
| | - Ronald Scott Braithwaite
- From the, Department of Population Health, (ECC, ERS, MK, KEY, KB, RSB), NYU School of Medicine, New York, New York, USA
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16
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Rentsch CT, Morford KL, Fiellin DA, Bryant KJ, Justice AC, Tate JP. Safety of Gabapentin Prescribed for Any Indication in a Large Clinical Cohort of 571,718 US Veterans with and without Alcohol Use Disorder. Alcohol Clin Exp Res 2020; 44:1807-1815. [PMID: 32628784 PMCID: PMC7540277 DOI: 10.1111/acer.14408] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/18/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Gabapentin is prescribed for seizures and pain and has efficacy for treating alcohol use disorder (AUD) starting at doses of 900 milligrams per day (mg/d). Recent evidence suggests safety concerns associated with gabapentin including adverse neurologic effects. Individuals with hepatitis C (HCV), HIV, or AUD may be at increased risk due to comorbidities and potential medication interactions. METHODS We identified patients prescribed gabapentin for ≥ 60 days for any indication between 2002 and 2015. We propensity-score matched each gabapentin-exposed patient with up to 5 gabapentin-unexposed patients. We followed patients for 2 years or until diagnosed with (i) falls or fractures, or (ii) altered mental status using validated ICD-9 diagnostic codes. We used Poisson regression to estimate incidence rates and relative risk (RR) of these adverse events in association with gabapentin exposure overall and stratified by age, race/ethnicity, sex, HCV, HIV, AUD, and dose. RESULTS Incidence of falls or fractures was 1.81 per 100 person-years (PY) among 140,310 gabapentin-exposed and 1.34/100 PY among 431,408 gabapentin-unexposed patients (RR 1.35, 95% confidence interval [CI] 1.28 to 1.44). Incidence of altered mental status was 1.08/100 PY among exposed and 0.97/100 PY among unexposed patients, RR of 1.12 (95% CI 1.04 to 1.20). Excess risk of falls or fractures associated with gabapentin exposure was observed in all subgroups except patients with HCV, HIV, or AUD; however, these groups had elevated incidence regardless of exposure. There was a clear dose-response relationship for falls or fractures with highest risk observed among those prescribed ≥ 2,400 mg/d (RR 1.90, 95% CI 1.50 to 2.40). Patients were at increased risk for altered mental status at doses 600 to 2,399 mg/d; however, low number of events in the highest dose category limited power to detect a statistically significant association ≥ 2,400 mg/d. CONCLUSIONS Gabapentin is associated with falls or fractures and altered mental status. Clinicians should be monitoring gabapentin safety, especially at doses ≥ 600 mg/d, in patients with and without AUD.
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Affiliation(s)
- Christopher T. Rentsch
- Faculty of Epidemiology & Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
- Veterans Aging Cohort Study Coordinating CenterVA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | - Kenneth L. Morford
- Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - David A. Fiellin
- Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
- Center for Interdisciplinary Research on AIDSYale School of Public HealthNew HavenConnecticutUSA
| | - Kendall J. Bryant
- Director of HIV/AIDS ResearchNational Institute on Alcohol Abuse and AlcoholismBethesdaMarylandUSA
| | - Amy C. Justice
- Veterans Aging Cohort Study Coordinating CenterVA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
- Center for Interdisciplinary Research on AIDSYale School of Public HealthNew HavenConnecticutUSA
| | - Janet P. Tate
- Veterans Aging Cohort Study Coordinating CenterVA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Department of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
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Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Dziura J, Deng Y, Fiellin LE, O'Connor PG, Bedimo R, Gibert CL, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Tate JP, Justice AC, Bryant KJ, Fiellin DA. Integrated stepped alcohol treatment for patients with HIV and at-risk alcohol use: a randomized trial. Addict Sci Clin Pract 2020; 15:28. [PMID: 32727618 PMCID: PMC7388231 DOI: 10.1186/s13722-020-00200-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/09/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND At-risk levels of alcohol use threaten the health of patients with HIV (PWH), yet evidence-based strategies to decrease alcohol use and improve HIV-related outcomes in this population are lacking. We examined the effectiveness of integrated stepped alcohol treatment (ISAT) on alcohol use and HIV outcomes among PWH and at-risk alcohol use. METHODS In this multi-site, randomized trial conducted between January 28, 2013 through July 14, 2017, we enrolled PWH and at-risk alcohol use [defined as alcohol consumption of ≥ 14 drinks per week or ≥ 4 drinks per occasion in men ≤ 65 years old or ≥ 7 drinks per week or ≥ 3 drinks per occasion in women or men > 65 years old]. ISAT (n = 46) involved: Step 1- Brief Negotiated Interview with telephone booster, Step 2- Motivational Enhancement Therapy, and Step 3- Addiction Physician Management. Treatment as usual (TAU) (n = 47) involved receipt of a health handout plus routine care. Analyses were conducted based on intention to treat principles. RESULTS Despite a multi-pronged approach, we only recruited 37% of the target population (n = 93/254). Among ISAT participants, 50% advanced to Step 2, among whom 57% advanced to Step 3. Participants randomized to ISAT and TAU had no observed difference in drinks per week over the past 30 days at week 24 (primary outcome) [least square means (Ls mean) (95% CI) = 8.8 vs. 10.6; adjusted mean difference (AMD) (95% CI) = - 0.4 (- 3.9, 3.0)]. CONCLUSION An insufficient number of patients were interested in participating in the trial. Efforts to enhance motivation of PWH with at-risk alcohol use to engage in alcohol-related research and build upon ISAT are needed. Trial registration Clinicaltrials.gov: NCT01410123, First posted August 4, 2011.
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Affiliation(s)
- E Jennifer Edelman
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA. .,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06510, USA.
| | | | - Nathan B Hansen
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06510, USA.,College of Public Health, University of Georgia, Athens, GA, 30602, USA
| | | | - James Dziura
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT, 06511, USA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT, 06511, USA
| | - Lynn E Fiellin
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Patrick G O'Connor
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA
| | - Roger Bedimo
- Veterans Affairs North Texas Health Care System and UT Southwestern, Dallas, TX, 75216, USA
| | - Cynthia L Gibert
- D.C. VAMC and George, Washington University School of Medicine and Health Sciences, Washington, D.C, 20422, USA
| | - Vincent C Marconi
- Atlanta VAMC and Emory University School of Medicine, Atlanta, GA, 30033, USA
| | - David Rimland
- Atlanta VAMC and Emory University School of Medicine, Atlanta, GA, 30033, USA
| | | | - Michael S Simberkoff
- VA NY Harbor Healthcare System and New York University School of Medicine, New York, NY, 10010, USA
| | - Janet P Tate
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.,VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT, 06516, USA
| | - Amy C Justice
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.,VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT, 06516, USA
| | - Kendall J Bryant
- National Institute On Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD, 20892-7003, USA
| | - David A Fiellin
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06510, USA
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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19
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Kim TW, Ventura AS, Winter MR, Heeren TC, Holick MF, Walley AY, Bryant KJ, Saitz R. Alcohol and Bone Turnover Markers among People Living with HIV and Substance Use Disorder. Alcohol Clin Exp Res 2020; 44:992-1000. [PMID: 32124466 PMCID: PMC7263383 DOI: 10.1111/acer.14303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although unhealthy alcohol use and low bone density are prevalent among people living with HIV (PLWH), it is not clear whether alcohol use is associated with bone turnover markers (BTMs), and if so, at what quantity and frequency. The study objective was to examine the association between alcohol and BTMs in PLWH with substance use disorder. METHODS We studied a prospective cohort recruited from 2 HIV clinics who met criteria for DSM-IV substance dependence or reported ever injection drug use. Outcomes were BTM of (i) bone formation (serum procollagen type 1 N-terminal propeptide [P1NP]) and (ii) bone resorption (serum C-telopeptide type 1 collagen [CTx]). Alcohol consumption measures included (i) mean number of drinks/d (Timeline Follow-Back [TLFB]) (primary predictor), (ii) any alcohol use on ≥20 of the past 30 days, and phosphatidylethanol (PEth), a biomarker of recent alcohol consumption. Linear regression analysis examined associations between (i) each alcohol measure and each BTM and (ii) change in alcohol and change in BTM over 12 months. RESULTS Among 198 participants, baseline characteristics were as follows: The median age was 50 years; 38% were female; 93% were prescribed antiretroviral medications; 13% had ≥20 drinking days/month; mean drinks/day was 1.93 (SD 3.89); change in mean drinks/day was -0.42 (SD 4.18); mean P1NP was 73.1 ng/ml (SD 34.5); and mean CTx was 0.36 ng/ml (SD 0.34). Higher drinks/day was significantly associated with lower P1NP (slope -1.09 ng/ml; 95% confidence interval [CI] -1.94, -0.23, per each additional drink). On average, those who drank on ≥ 20 days/month had lower P1NP (-15.45 ng/ml; 95% CI: -26.23, -4.67) than those who did not. Similarly, PEth level ≥ 8ng/ml was associated with lower P1NP. An increase in drinks/d was associated with a decrease in P1NP nonsignificantly (-1.14; 95% CI: -2.40, +0.12; p = 0.08, per each additional drink). No significant associations were detected between either alcohol measure and CTx. CONCLUSIONS In this sample of PLWH with substance use disorder, greater alcohol consumption was associated with lower serum levels of bone formation markers.
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Affiliation(s)
- Theresa W. Kim
- Clinical Addiction Research and Education (CARE) UnitSection of General Internal MedicineBoston Medical CenterBoston University School of MedicineBostonMassachusetts
| | - Alicia S. Ventura
- Clinical Addiction Research and Education (CARE) UnitSection of General Internal MedicineBoston Medical CenterBoston University School of MedicineBostonMassachusetts
| | - Michael R. Winter
- Biostatistics and Epidemiology Data Analytics CenterBoston University School Public HealthBostonMassachusetts
| | - Timothy C. Heeren
- Department of BiostatisticsBoston University School Public HealthBostonMassachusetts
| | - Michael F. Holick
- Section of Endocrinology, Diabetes, and NutritionBoston Medical CenterBoston University School of MedicineBostonMassachusetts
| | - Alexander Y. Walley
- Clinical Addiction Research and Education (CARE) UnitSection of General Internal MedicineBoston Medical CenterBoston University School of MedicineBostonMassachusetts
| | - Kendall J. Bryant
- HIV/AIDS ResearchNational Institute on Alcohol Abuse and AlcoholismBethesdaMaryland
| | - Richard Saitz
- Clinical Addiction Research and Education (CARE) UnitSection of General Internal MedicineBoston Medical CenterBoston University School of MedicineBostonMassachusetts
- Department of Community Health SciencesBoston University School Public HealthBostonMassachusetts
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20
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Khan MR, Young KE, Caniglia EC, Fiellin DA, Maisto SA, Marshall BDL, Edelman EJ, Gaither JR, Chichetto NE, Tate J, Bryant KJ, Severe M, Stevens ER, Justice A, Braithwaite SR. Association of Alcohol Screening Scores With Adverse Mental Health Conditions and Substance Use Among US Adults. JAMA Netw Open 2020; 3:e200895. [PMID: 32163167 PMCID: PMC7068229 DOI: 10.1001/jamanetworkopen.2020.0895] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Alcohol screening may be associated with health outcomes that cluster with alcohol use (ie, alcohol-clustering conditions), including depression, anxiety, and use of tobacco, marijuana, and illicit drugs. OBJECTIVE To quantify the extent to which alcohol screening provides additional information regarding alcohol-clustering conditions and to compare 2 alcohol use screening tools commonly used for this purpose. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study used data from the Veterans Aging Cohort Study. Data were collected at 8 Veterans Health Administration facilities from 2003 through 2012. A total of 7510 participants were enrolled, completed a baseline survey, and were followed up. Veterans with HIV were matched with controls without HIV by age, race, sex, and site of care. Data were analyzed from January 2019 to December 2019. EXPOSURES The Alcohol Use Disorders Identification Test (AUDIT) and Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) were used to assess alcohol use, with 4 risk groups delineated for each test: score 0 to 7 (reference), score 8 to 15, score 16 to 19, and score 20 to 40 (maximum score) for the full AUDIT and score 0 to 3 (reference), score 4 to 5, score 6 to 7, and score 8 to 12 (maximum score) for the AUDIT-C. MAIN OUTCOMES AND MEASURES Alcohol-clustering conditions, including self-reported symptoms of depression and anxiety and use of tobacco, marijuana, cocaine, other stimulants, opioids, and injection drugs. RESULTS A total of 6431 US patients (6104 [95%] men; median age during survey years 2003-2004, 50 years [range, 28-86 years; interquartile range, 44-55 years]) receiving care in the Veterans Health Administration completed 1 or more follow-up surveys when the AUDIT was administered and were included in the present analyses. Of the male participants, 4271 (66%) were African American, 1498 (24%) were white, and 590 (9%) were Hispanic. The AUDIT and AUDIT-C scores were associated with each alcohol-clustering condition. In particular, an AUDIT score of 20 or higher (vs <8, the reference) was associated with symptoms of depression (odds ratio [OR], 8.37; 95% CI, 6.20-11.29) and anxiety (OR, 8.98; 95% CI, 6.39-12.60) and with self-reported use of tobacco (OR, 14.64; 95% CI, 8.94-23.98), marijuana (OR, 12.41; 95% CI, 8.61-17.90), crack or cocaine (OR, 39.47; 95% CI, 27.38-56.90), other stimulants (OR, 21.31; 95% CI, 12.73-35.67), and injection drugs (OR, 8.67; 95% CI, 5.32-14.13). An AUDIT score of 20 or higher yielded likelihood ratio (sensitivity / 1 - specificity) values greater than 3.5 for depression, anxiety, crack or cocaine use, and other stimulant use. Associations between AUDIT-C scores and alcohol-clustering conditions were more modest. CONCLUSIONS AND RELEVANCE Alcohol screening can inform decisions about further screening and diagnostic assessment for alcohol-clustering conditions, particularly for depression, anxiety, crack or cocaine use, and other stimulant use. Future studies using clinical diagnoses rather than screening tools to assess alcohol-clustering conditions may be warranted.
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Affiliation(s)
- Maria R. Khan
- Department of Population Health, New York University School of Medicine, New York
| | - Kailyn E. Young
- Department of Population Health, New York University School of Medicine, New York
| | - Ellen C. Caniglia
- Department of Population Health, New York University School of Medicine, New York
| | - David A. Fiellin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | | | - E. Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Julie R. Gaither
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Natalie E. Chichetto
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Janet Tate
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - MacRegga Severe
- Department of Population Health, New York University School of Medicine, New York
| | - Elizabeth R. Stevens
- Department of Population Health, New York University School of Medicine, New York
| | - Amy Justice
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Scott R. Braithwaite
- Department of Population Health, New York University School of Medicine, New York
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21
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Gordon KS, McGinnis K, Dao C, Rentsch CT, Small A, Smith RV, Kember RL, Gelernter J, Kranzler HR, Bryant KJ, Tate JP, Justice AC. Differentiating Types of Self-Reported Alcohol Abstinence. AIDS Behav 2020; 24:655-665. [PMID: 31435887 DOI: 10.1007/s10461-019-02638-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We contrast three types of abstinence: quit after alcohol associated problems (Q-AP), quit for other reasons (Q-OR), and lifetime abstainer (LTA). We summarized the characteristics of people living with HIV (PLWH), and matched uninfected individuals, by levels of alcohol use and types of abstinence. We then identified factors that differentiate abstinence and determined whether the association with an alcohol biomarker or a genetic polymorphism is improved by differentiating abstinence. Among abstainers, 34% of PLWH and 38% of uninfected were Q-AP; 53% and 53% were Q-OR; and 12% and 10% were LTA. Logistic regression models found smoking, alcohol, cocaine, and hepatitis C increased odds of Q-AP, whereas smoking and marijuana decreased odds of LTA. Differentiating types of abstinence improved association. Q-APs and LTAs can be readily differentiated by an alcohol biomarker and genetic polymorphism. Differentiating type of abstinence may enhance understanding of alcohol health effects.
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Affiliation(s)
- Kirsha S Gordon
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA.
- Yale University School of Medicine, New Haven, CT, 06510, USA.
| | - Kathleen McGinnis
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Cecilia Dao
- Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Christopher T Rentsch
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Aeron Small
- Yale University School of Medicine, New Haven, CT, 06510, USA
| | | | - Rachel L Kember
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center VISN4 MIRECC, Philadelphia, PA, 19104, USA
| | - Joel Gelernter
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Henry R Kranzler
- Corporal Michael J. Crescenz Veterans Affairs Medical Center VISN4 MIRECC, Philadelphia, PA, 19104, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Janet P Tate
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, 11ACSL-G, 950 Campbell Avenue, West Haven, CT, 06516, USA
- Yale University School of Medicine, New Haven, CT, 06510, USA
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22
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Bryant VE, Gullett JM, Porges EC, Cook RL, Bryant KJ, Woods AJ, Williamson J, Ennis N, Cohen RA. History of Alcohol Consumption and HIV Status Related to Functional Connectivity Differences in the Brain During Working Memory Performance. Curr HIV Res 2020; 18:181-193. [PMID: 32065091 PMCID: PMC7315564 DOI: 10.2174/1570162x18666200217100123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/25/2020] [Accepted: 02/01/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Poorer working memory function has previously been associated with alcohol misuse, Human Immunodeficiency Virus (HIV) positive status, and risky behavior. Poorer working memory performance relates to alterations in specific brain networks. OBJECTIVE The current study examined if there was a relationship between brain networks involved in working memory and reported level of alcohol consumption during an individual's period of heaviest use. Furthermore, we examined whether HIV status and the interaction between HIV and alcohol consumption was associated with differences in these brain networks. METHODS Fifty adults, 26 of whom were HIV positive, engaged in an n-back working memory task (0-back and 2-back trials) administered in a magnetic resonance imaging (MRI) scanner. The Kreek- McHugh-Schluger-Kellogg (KMSK) scale of alcohol consumption was used to characterize an individual's period of heaviest use and correlates well with their risk for alcohol dependence. Connectivity analyses were conducted using data collected during n-back task. RESULTS Functional connectivity differences associated with greater alcohol consumption included negative connectivity, primarily from parietal attention networks to frontal networks. Greater alcohol consumption was also associated with positive connectivity from working memory nodes to the precuneus and paracingulate. HIV positive status was associated with more nodes of negative functional connectivity relative to alcohol consumption history alone, particularly in the frontoparietal networks. The HIV positive individuals with heavier drinking history related to negative fronto-parietal connectivity, along with positive connectivity from working memory nodes to mesolimbic regions. CONCLUSION Findings allow for a better understanding of brain networks affected by HIV and alcohol and may provide avenues for interventions.
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Affiliation(s)
- Vaughn E Bryant
- Department of Epidemiology, Southern HIV and Alcohol Research Consortium and Center, University of Florida, Gainesville, FL, United States
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Joseph M Gullett
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Eric C Porges
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Robert L Cook
- Department of Epidemiology, Southern HIV and Alcohol Research Consortium and Center, University of Florida, Gainesville, FL, United States
| | - Kendall J Bryant
- National Institute of Alcohol Abuse and Alcoholism, MD, United States
| | - Adam J Woods
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - John Williamson
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Nicole Ennis
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, United States
| | - Ronald A Cohen
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, United States
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23
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Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Dziura J, Deng Y, Fiellin LE, O'Connor PG, Bedimo R, Gibert CL, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Tate JP, Justice AC, Bryant KJ, Fiellin DA. Integrated stepped alcohol treatment for patients with HIV and liver disease: A randomized trial. J Subst Abuse Treat 2019; 106:97-106. [PMID: 31540617 DOI: 10.1016/j.jsat.2019.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is no known safe level of alcohol use among patients with HIV and liver disease. We examined the effectiveness of integrated stepped alcohol treatment (ISAT) on alcohol use, HIV, and liver outcomes among patients with HIV and liver disease. METHODS In this multi-site, randomized trial conducted between January 28, 2013 through July 15, 2016, we enrolled 95 patients with HIV and liver disease [defined as having active hepatitis C infection or FIB-4 score > 1.45]. ISAT (n = 49) involved: Step 1- Brief Negotiated Interview with telephone booster, Step 2- Motivational Enhancement Therapy, and Step 3- Addiction Physician Management. Treatment as usual (TAU) (n = 46) involved receipt of a health handout plus routine care. Analyses were conducted based on intention to treat. RESULTS Among ISAT participants, 55% advanced to Step 2, among whom 70% advanced to Step 3. Participants randomized to ISAT and TAU increased abstinence (primary outcome) over time. Abstinence rates were non-significantly higher by self-report (38% vs. 23%, adjusted odds ratio [AOR] [95% CI] = 2.6 [0.8, 9.0]) and phosphatidylethanol (43% vs. 32%, AOR [95% CI] = 1.8 [0.5, 6.3] among those randomized to ISAT vs. TAU at week 24. VACS Index scores (AMD [95% CI] = 1.1 [-3.2, 5.5]) and the proportion with an undetectable HIV viral load (AOR [95% CI] = 0.3 [0.1, 1.3]) did not differ by group at week 24 (p values >0.05). ISAT had non-significantly lower FIB-4 scores (adjusted mean difference [AMD] [95% CI] = -0.2 [-0.9, 0.5]), ALT (AMD [95% CI] = -7 [-20, 7]) and AST (AMD [95% CI] = -4 [-15, 7]) at week 24 compared to TAU. CONCLUSION ISAT is feasible and potentially effective at enhancing delivery of evidence-based alcohol treatment to promote alcohol abstinence and improve liver biomarkers among patients with HIV and liver disease.
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Affiliation(s)
- E Jennifer Edelman
- Yale School of Medicine, New Haven, CT 06510, United States of America; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT 06510, United States of America.
| | - Stephen A Maisto
- Syracuse University, Syracuse, NY 13244, United States of America
| | - Nathan B Hansen
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT 06510, United States of America; College of Public Health, University of Georgia, Athens, GA 30602, United States of America
| | | | - James Dziura
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT 06511, United States of America
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, CT 06511, United States of America
| | - Lynn E Fiellin
- Yale School of Medicine, New Haven, CT 06510, United States of America; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT 06510, United States of America
| | | | - Roger Bedimo
- Veterans Affairs North Texas Health Care System, UT Southwestern, Dallas, TX 75216, United States of America
| | - Cynthia L Gibert
- D.C. VAMC, George Washington University School of Medicine and Health Sciences, Washington, DC 20422, United States of America
| | - Vincent C Marconi
- Atlanta VAMC, Emory University School of Medicine, Atlanta, GA 30033, United States of America
| | - David Rimland
- Atlanta VAMC, Emory University School of Medicine, Atlanta, GA 30033, United States of America
| | | | - Michael S Simberkoff
- VA NY Harbor Healthcare System, New York University School of Medicine, New York, NY 10010, United States of America
| | - Janet P Tate
- Yale School of Medicine, New Haven, CT 06510, United States of America
| | - Amy C Justice
- Yale School of Medicine, New Haven, CT 06510, United States of America; VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT 06516, United States of America
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD 20892-7003, United States of America
| | - David A Fiellin
- Yale School of Medicine, New Haven, CT 06510, United States of America; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT 06510, United States of America
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24
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Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Dziura J, Deng Y, Fiellin LE, O'Connor PG, Bedimo R, Gibert CL, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Tate JP, Justice AC, Bryant KJ, Fiellin DA. Integrated stepped alcohol treatment for patients with HIV and alcohol use disorder: a randomised controlled trial. Lancet HIV 2019; 6:e509-e517. [PMID: 31109915 DOI: 10.1016/s2352-3018(19)30076-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/21/2019] [Accepted: 03/05/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND We examined the effectiveness of integrated stepped alcohol treatment (ISAT) on alcohol use and HIV outcomes among patients living with HIV and alcohol use disorder. METHODS In this multisite, randomised controlled trial, conducted in five Veterans Affairs-based HIV clinics in the USA (Atlanta, GA; Brooklyn-Manhattan, NY; Dallas and Houston, TX; and Washington, DC), we recruited people living with HIV and an alcohol use disorder who were not otherwise receiving formal alcohol treatment. Patients were eligible if they were aged 18 years or older, HIV positive, English speaking, and met criteria for alcohol use disorder by the Diagnostic and Statistical Manual for Mental Disorders-IV criteria for alcohol abuse or dependence. Key exclusion criteria included if the patient was acutely suicidal or had a psychiatric condition that affected their ability to participate in counselling interventions, or if they had any medical conditions that would preclude completing the study or cause harm during the course of the study. Using a web-based clinical trial management system, we randomly assigned participants (1:1) to receive ISAT or treatment as usual; patients, investigators, and clinicians were unmasked to allocation. ISAT involved three steps: step 1, addiction physician management, comprising eight sessions; step 2, addiction physician management plus motivational enhancement therapy, comprising four sessions; and step 3, specialty referral. Participants were stepped up at weeks 4 and 12 if they exceeded a priori drinking criteria. Treatment as usual involved referral to substance use treatment services. The primary outcome was number of drinks per week over the past 30 days at week 24 by use of the timeline followback method, assessed in the intention-to-treat population. Adverse events were tracked throughout the study period in all randomly assigned participants. This trial is registered at ClinicalTrials.gov, number NCT01410123. FINDINGS Between Jan 28, 2013, and July 14, 2017, 128 of 351 patients assessed for eligibility were eligible and randomly assigned to receive ISAT (n=63) or treatment as usual (n=65). Mean age was 54 years (range 23-70), 125 (98%) of 128 participants were men, and 101 (79%) were black. 25 (20%) were lost to follow-up. In the ISAT group, of 57 participants who did not die or withdraw, 30 (52%) advanced to step 2, and 17 (57%) of 30 advanced to step 3. 32 (51%) of 63 participants assigned to ISAT versus 17 (26%) of 65 assigned to treatment as usual received at least one alcohol treatment medication (p=0·004). Participants in both groups decreased their alcohol consumption, but at week 24 we did not detect a difference in number of drinks per week between the groups (least squares mean 10·4 drinks per week [SD 16·5] in the ISAT group vs 15·6 drinks per week [SD 17·6] in the treatment as usual group; adjusted mean difference -4·2, 95% CI -9·4 to 0·9; p=0·11). One adverse event occurred that was possibly related to treatment occurred in the ISAT group (headache). INTERPRETATION ISAT increases the receipt of alcohol treatment medications and counselling without changes in drinking at week 24. Strategies to implement and enhance ISAT are needed. Future efforts should focus on promoting ISAT with attention to enhancing patient engagement and retention in alcohol-related care. FUNDING US National Institute on Alcohol Abuse and Alcoholism.
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Affiliation(s)
- E Jennifer Edelman
- Yale School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA.
| | | | - Nathan B Hansen
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA; College of Public Health, University of Georgia, Athens, GA, USA
| | | | - James Dziura
- Yale School of Medicine, New Haven, CT, USA; Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Lynn E Fiellin
- Yale School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | | | - Roger Bedimo
- Veterans Affairs North Texas Health Care System and UT Southwestern, Dallas, TX, USA
| | - Cynthia L Gibert
- Washington DC Veterans Affairs Medical Center and George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Vincent C Marconi
- Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, Atlanta, GA, USA
| | - David Rimland
- Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, Atlanta, GA, USA
| | | | - Michael S Simberkoff
- Veterans Affairs NY Harbor Healthcare System and New York University School of Medicine, New York, NY, USA
| | - Janet P Tate
- Yale School of Medicine, New Haven, CT, USA; Veterans Affairs Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT, USA
| | - Amy C Justice
- Yale School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA; Veterans Affairs Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD, USA
| | - David A Fiellin
- Yale School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
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25
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Chichetto NE, Kundu S, Freiberg MS, Butt AA, Crystal S, So-Armah KA, Cook RL, Braithwaite RS, Fiellin DA, Khan MR, Bryant KJ, Gaither JR, Barve SS, Crothers K, Bedimo RJ, Warner AL, Tindle HA. Association of Syndemic Unhealthy Alcohol Use, Cigarette Use, and Depression With All-Cause Mortality Among Adults Living With and Without HIV Infection: Veterans Aging Cohort Study. Open Forum Infect Dis 2019; 6:ofz188. [PMID: 31211153 PMCID: PMC6559272 DOI: 10.1093/ofid/ofz188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/15/2019] [Indexed: 11/24/2022] Open
Abstract
Background The prevalence and risk of concurrent unhealthy drinking, cigarette use, and depression on mortality among persons living with HIV (PLWH) is unclear. This study applied a syndemic framework to assess whether these co-occurring conditions increase mortality and whether such risk is differential by HIV status. Methods We evaluated 6721 participants (49.8% PLWH) without baseline cancer from the Veterans Aging Cohort Study, a prospective, observational cohort of PLWH and matched uninfected veterans enrolled in 2002 and followed through 2015. Multivariable Cox proportional hazards regressions estimated risk of a syndemic score (number of conditions: that is, unhealthy drinking, cigarette use, and depressive symptoms) on all-cause mortality by HIV status, adjusting for demographic, health status, and HIV-related factors. Results Fewer than 10% of participants had no conditions; 25.6% had 1, 51.0% had 2, and 15.0% had all 3. There were 1747 deaths (61.9% PLWH) during the median follow-up (11.4 years). Overall, age-adjusted mortality rates/1000 person-years increased with a greater number of conditions: (0: 12.0; 1: 21.2; 2: 30.4; 3: 36.3). For 3 conditions, the adjusted hazard ratio of mortality was 36% higher among PLWH compared with uninfected participants with 3 conditions (95% confidence interval, 1.07–1.72; P = .013), after adjusting for health status and HIV disease progression. Among PLWH and uninfected participants, mortality risk persisted after adjustment for time-updated health status. Conclusions Syndemic unhealthy drinking, cigarette use, and depression are common and are associated with higher mortality risk among PLWH, underscoring the need to screen for and treat these conditions.
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Affiliation(s)
| | - Suman Kundu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matt S Freiberg
- Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Adeel A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Weill-Cornell Medical College, Doha, Qatar, and New York City, New York.,Hamad Medical Corporation, Doha, Qatar
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Kaku A So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Robert L Cook
- Department of Epidemiology, Colleges of Public Health and Health Professions and Medicine, University of Florida, Gainesville, Florida
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, New York
| | - David A Fiellin
- Yale University Schools of Medicine and Public Health, New Haven, Connecticut
| | - Maria R Khan
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Julie R Gaither
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Shirish S Barve
- Departments of Medicine and Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Kristina Crothers
- Department of Medicine, University of Washington, Seattle, Washington
| | - Roger J Bedimo
- Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alberta L Warner
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Hilary A Tindle
- Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research Education and Clinical Centers (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
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26
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Edelman EJ, Gordon KS, Crothers K, Akgün K, Bryant KJ, Becker WC, Gaither JR, Gibert CL, Gordon AJ, Marshall BDL, Rodriguez-Barradas MC, Samet JH, Justice AC, Tate JP, Fiellin DA. Association of Prescribed Opioids With Increased Risk of Community-Acquired Pneumonia Among Patients With and Without HIV. JAMA Intern Med 2019; 179:297-304. [PMID: 30615036 PMCID: PMC6439696 DOI: 10.1001/jamainternmed.2018.6101] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Some opioids are known immunosuppressants; however, the association of prescribed opioids with clinically relevant immune-related outcomes is understudied, especially among people living with HIV. OBJECTIVE To assess the association of prescribed opioids with community-acquired pneumonia (CAP) by opioid properties and HIV status. DESIGN, SETTING, AND PARTICIPANTS This nested case-control study used data from patients in the Veterans Aging Cohort Study (VACS) from January 1, 2000, through December 31, 2012. Participants in VACS included patients living with and without HIV who received care in Veterans Health Administration (VA) medical centers across the United States. Patients with CAP requiring hospitalization (n = 4246) were matched 1:5 with control individuals without CAP (n = 21 146) by age, sex, race/ethnicity, length of observation, and HIV status. Data were analyzed from March 15, 2017, through August 8, 2018. EXPOSURES Prescribed opioid exposure during the 12 months before the index date was characterized by a composite variable based on timing (none, past, or current); low (<20 mg), medium (20-50 mg), or high (>50 mg) median morphine equivalent daily dose; and opioid immunosuppressive properties (yes vs unknown or no). MAIN OUTCOME AND MEASURE CAP requiring hospitalization based on VA and Centers for Medicare & Medicaid data. RESULTS Among the 25 392 VACS participants (98.9% male; mean [SD] age, 55 [10] years), current medium doses of opioids with unknown or no immunosuppressive properties (adjusted odds ratio [AOR], 1.35; 95% CI, 1.13-1.62) and immunosuppressive properties (AOR, 2.07; 95% CI, 1.50-2.86) and current high doses of opioids with unknown or no immunosuppressive properties (AOR, 2.07; 95% CI, 1.50-2.86) and immunosuppressive properties (AOR, 3.18; 95% CI, 2.44-4.14) were associated with the greatest CAP risk compared with no prescribed opioids or any past prescribed opioid with no immunosuppressive (AOR, 1.24; 95% CI, 1.09-1.40) and immunosuppressive properties (AOR, 1.42; 95% CI, 1.21-1.67), especially with current receipt of immunosuppressive opioids. In stratified analyses, CAP risk was consistently greater among people living with HIV with current prescribed opioids, especially when prescribed immunosuppressive opioids (eg, AORs for current immunosuppressive opioids with medium dose, 1.76 [95% CI, 1.20-2.57] vs 2.33 [95% CI, 1.60-3.40]). CONCLUSIONS AND RELEVANCE Prescribed opioids, especially higher-dose and immunosuppressive opioids, are associated with increased CAP risk among persons with and without HIV.
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Affiliation(s)
- E Jennifer Edelman
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut
| | - Kirsha S Gordon
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,Veterans Affairs Connecticut Healthcare System, West Haven
| | | | - Kathleen Akgün
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,Veterans Affairs Connecticut Healthcare System, West Haven
| | - Kendall J Bryant
- HIV/AIDS Program, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - William C Becker
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,Veterans Affairs Connecticut Healthcare System, West Haven
| | - Julie R Gaither
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Cynthia L Gibert
- DC Veterans Affairs Medical Center, Washington, DC.,Department of Medicine, George Washington University, Washington, DC
| | - Adam J Gordon
- Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Medicine, University of Utah, Salt Lake City
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | | | - Jeffrey H Samet
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Amy C Justice
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut.,Veterans Affairs Connecticut Healthcare System, West Haven
| | - Janet P Tate
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,Veterans Affairs Connecticut Healthcare System, West Haven
| | - David A Fiellin
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut
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27
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Rentsch CT, Fiellin DA, Bryant KJ, Justice AC, Tate JP. Association Between Gabapentin Receipt for Any Indication and Alcohol Use Disorders Identification Test-Consumption Scores Among Clinical Subpopulations With and Without Alcohol Use Disorder. Alcohol Clin Exp Res 2019; 43:522-530. [PMID: 30620410 DOI: 10.1111/acer.13953] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/28/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current medications for alcohol use disorder (AUD) have limited efficacy and utilization. Some clinical trials have shown efficacy for gabapentin among treatment-seeking individuals. The impact of gabapentin on alcohol consumption in a more general sample remains unknown. METHODS We identified patients prescribed gabapentin for ≥180 consecutive days for any clinical indication other than substance use treatment between 2009 and 2015 in the Veterans Aging Cohort Study. We propensity-score matched each gabapentin-exposed patient with up to 5 unexposed patients. Multivariable difference-in-difference (DiD) linear regression models estimated the differential change in Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores during follow-up between exposed and unexposed patients, by baseline level of alcohol consumption and daily gabapentin dose. Analyses were stratified by AUD history. Clinically meaningful changes were a priori considered a DiD ≥1 point. RESULTS Among patients with AUD, AUDIT-C scores decreased 0.39 points (95% confidence interval [CI] 0.05, 0.73) more among exposed than unexposed patients (p < 0.03). Potentially clinically meaningful differences were observed among those with AUD and exposed to ≥1,500 mg/d (DiD 0.77, 95% CI 0.15, 1.38, p < 0.02). No statistically significant effects were found among patients with AUD at doses lower than 1,500 mg/d or baseline AUDIT-C ≥4. Among patients without AUD, we found no overall difference in changes in AUDIT-C scores, nor in analyses stratified by baseline level of alcohol consumption. CONCLUSIONS Patients exposed to doses of gabapentin consistent with those used in clinical trials, particularly those with AUD, experienced a greater decrease in AUDIT-C scores than matched unexposed patients.
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Affiliation(s)
- Christopher T Rentsch
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David A Fiellin
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut
| | - Kendall J Bryant
- Director of HIV/AIDS Research (KJB), National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Amy C Justice
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut
| | - Janet P Tate
- Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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28
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Edelman EJ, Moore BA, Holt SR, Hansen N, Kyriakides TC, Virata M, Brown ST, Justice AC, Bryant KJ, Fiellin DA, Fiellin LE. Efficacy of Extended-Release Naltrexone on HIV-Related and Drinking Outcomes Among HIV-Positive Patients: A Randomized-Controlled Trial. AIDS Behav 2019; 23:211-221. [PMID: 30073637 DOI: 10.1007/s10461-018-2241-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We sought to test the efficacy of extended-release naltrexone (XR-NTX) on HIV-related and drinking outcomes. From April 2011-February 2015, we conducted a 4-site randomized double-blind placebo controlled clinical trial involving 51 HIV-positive patients with heavy drinking and < 95% antiretroviral (ART) adherence. All participants received counseling. The primary outcome was proportion with ≥ 95% ART adherence. Secondary outcomes included HIV biomarkers, VACS Index score, and past 30-day heavy drinking days. Based on receipt of ≥ 5 injections, 23 participants were retained at 24 weeks. We did not detect an effect of XR-NTX on ART adherence (p = 0.38); undetectable HIV viral load (p = 0.26); CD4 cell count (p = 0.75) or VACS Index score (p = 0.70). XR-NTX was associated with fewer heavy drinking days (p = 0.03). While XR-NTX decreases heavy drinking days, we did not detect improvements in ART adherence or HIV outcomes. Strategies to improve retention in alcohol treatment and HIV-related outcomes among heavy drinking HIV-positive patients are needed.
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Zhang X, Hu Y, Aouizerat BE, Peng G, Marconi VC, Corley MJ, Hulgan T, Bryant KJ, Zhao H, Krystal JH, Justice AC, Xu K. Machine learning selected smoking-associated DNA methylation signatures that predict HIV prognosis and mortality. Clin Epigenetics 2018; 10:155. [PMID: 30545403 PMCID: PMC6293604 DOI: 10.1186/s13148-018-0591-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/26/2018] [Indexed: 12/20/2022] Open
Abstract
Background The effects of tobacco smoking on epigenome-wide methylation signatures in white blood cells (WBCs) collected from persons living with HIV may have important implications for their immune-related outcomes, including frailty and mortality. The application of a machine learning approach to the analysis of CpG methylation in the epigenome enables the selection of phenotypically relevant features from high-dimensional data. Using this approach, we now report that a set of smoking-associated DNA-methylated CpGs predicts HIV prognosis and mortality in an HIV-positive veteran population. Results We first identified 137 epigenome-wide significant CpGs for smoking in WBCs from 1137 HIV-positive individuals (p < 1.70E−07). To examine whether smoking-associated CpGs were predictive of HIV frailty and mortality, we applied ensemble-based machine learning to build a model in a training sample employing 408,583 CpGs. A set of 698 CpGs was selected and predictive of high HIV frailty in a testing sample [(area under curve (AUC) = 0.73, 95%CI 0.63~0.83)] and was replicated in an independent sample [(AUC = 0.78, 95%CI 0.73~0.83)]. We further found an association of a DNA methylation index constructed from the 698 CpGs that were associated with a 5-year survival rate [HR = 1.46; 95%CI 1.06~2.02, p = 0.02]. Interestingly, the 698 CpGs located on 445 genes were enriched on the integrin signaling pathway (p = 9.55E−05, false discovery rate = 0.036), which is responsible for the regulation of the cell cycle, differentiation, and adhesion. Conclusion We demonstrated that smoking-associated DNA methylation features in white blood cells predict HIV infection-related clinical outcomes in a population living with HIV. Electronic supplementary material The online version of this article (10.1186/s13148-018-0591-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xinyu Zhang
- Department of Psychiatry, Yale School of Medicine, 300 George Street, 950 Campbell Ave, West Haven, New Haven, CT, 06511, USA.,VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
| | - Ying Hu
- Center for Biomedical Bioinformatics, National Cancer Institute, Rockville, MD, 20852, USA
| | - Bradley E Aouizerat
- Bluestone Center for Clinical Research, New York University, New York, NY, 10010, USA
| | - Gang Peng
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, 065116, USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, 30303, USA
| | - Michael J Corley
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii, Suite 1016B, Honolulu, 96813, USA
| | - Todd Hulgan
- School of Medicine, Vanderbilt University, Nashville, TN, 37232, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20852, USA
| | - Hongyu Zhao
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, 065116, USA
| | - John H Krystal
- Department of Psychiatry, Yale School of Medicine, 300 George Street, 950 Campbell Ave, West Haven, New Haven, CT, 06511, USA.,VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA.,Yale University School of Medicine, New Haven, CT, 06516, USA
| | - Ke Xu
- Department of Psychiatry, Yale School of Medicine, 300 George Street, 950 Campbell Ave, West Haven, New Haven, CT, 06511, USA. .,VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA.
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Adams JW, Bryant KJ, Edelman EJ, Fiellin DA, Gaither JR, Gordon AJ, Gordon KS, Kraemer KL, Mimiaga MJ, Operario D, Tate JP, van den Berg JJ, Justice AC, Marshall BDL. Correction to: Association of Cannabis, Stimulant, and Alcohol use with Mortality Prognosis Among HIV-Infected Men. AIDS Behav 2018. [PMID: 29520509 DOI: 10.1007/s10461-018-2075-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In the original publication of the article, the given and family name of the third author was not correct. The name has been corrected with this erratum.
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Saitz R, Mesic A, Ventura AS, Winter MR, Heeren TC, Sullivan MM, Walley AY, Patts GJ, Meli SM, Holick MF, Kim TW, Bryant KJ, Samet JH. Alcohol Consumption and Bone Mineral Density in People with HIV and Substance Use Disorder: A Prospective Cohort Study. Alcohol Clin Exp Res 2018; 42:10.1111/acer.13801. [PMID: 29873812 PMCID: PMC6281811 DOI: 10.1111/acer.13801] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 05/22/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND People living with HIV (PLWH) commonly have low bone mineral density (BMD) (low bone mass and osteoporosis) and are at high risk for fractures. Fractures and low BMD are significant causes of morbidity and mortality, increasingly relevant as PLWH age. Alcohol use is common among PLWH and known to affect bone health. The association between alcohol use and changes in BMD among PLWH is not well understood. METHODS We conducted a 3.5-year prospective cohort study of 250 PLWH with substance use disorder or ever injection drug use. Annual alcohol consumption was measured as a mean of grams per day of alcohol, mean number of heavy drinking days per month, mean number of days abstinent per month, and any heavy drinking, using the 30-day Timeline Followback method twice each year. The primary outcome was annual change in BMD measured each year by dual energy X-ray absorptiometry in grams per square centimeter (g/cm2 ) at the femoral neck. Additional dependent variables included annual change in total hip and lumbar spine BMD, >6% annual decrease in BMD at any site, and incident fractures in the past year. Regression models adjusted for relevant covariates. RESULTS The median age of participants was 50 years. The median duration of HIV infection was 16.5 years and the mean time since antiretroviral therapy initiation was 12.3 years. At study entry, 67% of participants met criteria for low BMD (46% low bone mass, 21% osteoporosis). Median follow-up was 24 months. We found no significant associations between any measure of alcohol consumption and changes in BMD (g/cm2 ) at the femoral neck (adjusted β for g/d of alcohol = -0.0032, p = 0.7487), total hip, or lumbar spine. There was no significant association between any measure of alcohol consumption and >6% annual decrease in BMD at any site, or incident fractures. CONCLUSIONS In this sample of PLWH and substance use disorders or ever injection drug use, we detected no association between any of the alcohol measures used in the study and changes in BMD or incident fractures.
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Affiliation(s)
- Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts
| | - Aldina Mesic
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Alicia S Ventura
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts
| | - Michael R Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Meg M Sullivan
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Alexander Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts
| | - Gregory J Patts
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Seville M Meli
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Michael F Holick
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts
| | - Theresa W Kim
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts
| | - Kendall J Bryant
- HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Jeffrey H Samet
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts
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Adams JW, Bryant KJ, Edelman EJ, Fiellin DA, Gaither JR, Gordon AJ, Gordon KS, Kraemer KL, Mimiaga MJ, Operario D, Tate JP, van den Berg JJ, Justice AC, Marshall BDL. Association of Cannabis, Stimulant, and Alcohol use with Mortality Prognosis Among HIV-Infected Men. AIDS Behav 2018; 22:1341-1351. [PMID: 28887669 DOI: 10.1007/s10461-017-1905-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Questionnaires over a 9-year study period (2002-2010) were used to characterize cannabis, stimulant, and alcohol use among 3099 HIV-infected men participating in the Veterans Aging Cohort Study (VACS) to determine whether use of these substances is associated with changes in the VACS Index, a validated prognostic indicator for all-cause mortality. At baseline, 18% of participants reported no substance use in the past year, 24% lower risk alcohol use only, 18% unhealthy alcohol use only, 15% cannabis use (with or without alcohol), and 24% stimulant use (with or without alcohol or cannabis). In adjusted longitudinal analyses, cannabis use [β = -0.97 (95% CI -1.93, 0.00), p = 0.048] was not associated with mortality risk, while stimulant use [1.08 (0.16, 2.00), p = 0.021] was associated with an increased mortality risk, compared to lower risk alcohol use. Our findings show no evidence of a negative effect of cannabis use on mortality risk, while stimulant use was associated with increased mortality risk among HIV-infected men. Interventions to reduce stimulant use in this patient population may reduce mortality.
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Affiliation(s)
- Joëlla W Adams
- Brown University School of Public Health, Providence, RI, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, MD, USA
| | - E Jennifer Edelman
- Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine, New Haven, CT, USA
| | - David A Fiellin
- Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine, New Haven, CT, USA
| | - Julie R Gaither
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Adam J Gordon
- Center for Health Equity Research and Promotion, Pittsburgh VA Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kirsha S Gordon
- Veterans Aging Cohort Study Coordinating Center, Veterans Administration Connecticut Healthcare System, West Haven, CT, USA
| | | | | | - Don Operario
- Brown University School of Public Health, Providence, RI, USA
| | - Janet P Tate
- Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine, New Haven, CT, USA
- Veterans Aging Cohort Study Coordinating Center, Veterans Administration Connecticut Healthcare System, West Haven, CT, USA
| | | | - Amy C Justice
- Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine, New Haven, CT, USA
- Veterans Aging Cohort Study Coordinating Center, Veterans Administration Connecticut Healthcare System, West Haven, CT, USA
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Bensley KM, McGinnis KA, Fiellin DA, Gordon AJ, Kraemer KL, Bryant KJ, Edelman EJ, Crystal S, Gaither JR, Korthuis PT, Marshall BDL, Ornelas IJ, Chan KCG, Dombrowski JC, Fortney JC, Justice AC, Williams EC. Racial/ethnic differences in the association between alcohol use and mortality among men living with HIV. Addict Sci Clin Pract 2018; 13:2. [PMID: 29353555 PMCID: PMC6389249 DOI: 10.1186/s13722-017-0103-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 12/05/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Increasing alcohol use is associated with increased risk of mortality among patients living with HIV (PLWH). This association varies by race/ethnicity among general outpatients, but racial/ethnic variation has not been investigated among PLWH, among whom racial/ethnic minorities are disproportionately represented. METHODS VA electronic health record data from the Veterans Aging Cohort Study (2008-2012) were used to describe and compare mortality rates across race/ethnicity and levels of alcohol use defined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire. Within each racial/ethnic group, Cox proportional hazards models, adjusted for age, disease severity, and comorbidities, compared mortality risk for moderate-risk (AUDIT-C = 4-7) and high-risk (AUDIT-C ≥ 8) relative to lower-risk (AUDIT-C = 1-3) alcohol use. RESULTS Mean follow-up time among black (n = 8518), Hispanic (n = 1353), and white (n = 7368) male PLWH with documented AUDIT-C screening (n = 17,239) was 4.3 years. Black PLWH had the highest mortality rate among patients reporting lower-risk alcohol use (2.9/100 person-years) relative to Hispanic and white PLWH (1.8 and 2.3, respectively) (p value for overall comparison = 0.011). Mortality risk was increased for patients reporting high-risk relative to lower-risk alcohol use in all racial/ethnic groups [black adjusted hazard ratio (AHR) = 1.36, 95% confidence interval (CI) 1.12-1.66; Hispanic AHR = 2.18, 95% CI 1.30-3.64; and white AHR = 2.04, 95% CI 1.61-2.58]. For only white PLWH, mortality risk was increased for patients reporting moderate-relative to lower-risk alcohol use (black AHR = 1.09, 95% CI 0.93-1.27; Hispanic AHR = 1.36, 95% CI 0.89-2.09; white AHR = 1.51, 95% CI 1.28-1.77). CONCLUSION Among all PLWH, mortality risk was increased among patients reporting high-risk alcohol use across all racial/ethnic groups, but mortality risk was only increased among patients reporting moderate-risk relative to lower-risk alcohol use among white PLWH, and black patients appeared to have higher mortality risk relative to white patients at lower-risk levels of alcohol use. Findings of the present study further underscore the need to address unhealthy alcohol use among PLWH, and future research is needed to understand mechanisms underlying observed differences.
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Affiliation(s)
- Kara M Bensley
- Department of Health Services, Magnuson Health Sciences Center, University of Washington School of Public Health, 1959 NE Pacific St, Box 357660, Seattle, WA, 98195-7660, USA. .,VA Health Services Research and Development (HSRD) Denver Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, 1660 S. Columbian Way, Mailstop S-152, Seattle, WA, 98108, USA.
| | - Kathleen A McGinnis
- VA Connecticut Healthcare System, West Haven Campus, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - David A Fiellin
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - Adam J Gordon
- Salt Lake City VA, 500 Foothill Dr, Salt Lake City, UT, 84148, USA.,University of Utah, 201 Presidents Cir, Salt Lake City, UT, 84112, USA
| | - Kevin L Kraemer
- VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA.,University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Ln, Rockville, MD, 20852, USA
| | | | - Stephen Crystal
- Rutgers University, 7 College Ave, New Brunswick, NJ, 08901, USA
| | - Julie R Gaither
- VA Connecticut Healthcare System, West Haven Campus, 950 Campbell Avenue, West Haven, CT, 06516, USA.,Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - P Todd Korthuis
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Brandon D L Marshall
- Brown University School of Public Health, 121 S Main St, Providence, RI, 02903, USA
| | - India J Ornelas
- Department of Health Services, Magnuson Health Sciences Center, University of Washington School of Public Health, 1959 NE Pacific St, Box 357660, Seattle, WA, 98195-7660, USA
| | - K C Gary Chan
- Department of Health Services, Magnuson Health Sciences Center, University of Washington School of Public Health, 1959 NE Pacific St, Box 357660, Seattle, WA, 98195-7660, USA
| | - Julia C Dombrowski
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - John C Fortney
- Brown University School of Public Health, 121 S Main St, Providence, RI, 02903, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, West Haven Campus, 950 Campbell Avenue, West Haven, CT, 06516, USA.,Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - Emily C Williams
- Department of Health Services, Magnuson Health Sciences Center, University of Washington School of Public Health, 1959 NE Pacific St, Box 357660, Seattle, WA, 98195-7660, USA.,VA Health Services Research and Development (HSRD) Denver Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, 1660 S. Columbian Way, Mailstop S-152, Seattle, WA, 98108, USA
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Idrisov B, Lunze K, Cheng DM, Blokhina E, Gnatienko N, Quinn E, Bridden C, Walley AY, Bryant KJ, Lioznov D, Krupitsky E, Samet JH. Role of substance use in HIV care cascade outcomes among people who inject drugs in Russia. Addict Sci Clin Pract 2017; 12:30. [PMID: 29198185 PMCID: PMC5713116 DOI: 10.1186/s13722-017-0098-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 11/08/2017] [Indexed: 12/11/2022] Open
Abstract
Background Engaging people who drink alcohol or inject drugs in HIV care can be challenging, particularly in Eastern Europe. Healthcare facilities in Russia are organized by specialty; therefore linking patients from addiction care to HIV hospitals has been difficult. The HIV care cascade outlines stages of HIV care (e.g., linkage to care, prescribed antiretroviral therapy [ART], and achieving HIV viral suppression). We hypothesized that unhealthy alcohol use, injection drug use, and opioid craving are associated with unfavorable HIV care cascade outcomes. Methods We analyzed data from a cohort (n = 249) of HIV-positive Russians who have been in addiction hospital treatment in the past year and had a lifetime history of injection drug use (IDU). We evaluated the association between unhealthy alcohol use (AUDIT score > 7 [both hazardous drinking and dependence]), past-month injection drug use (IDU), and opioid craving (visual analogue scale from 1 to 100) with HIV care cascade outcomes. The primary outcome was linkage to HIV care within 12 months. Other outcomes were prescription of ART (secondary) and achievement of undetectable HIV viral load (HVL < 500 copies/mL) within 12 months (exploratory); the latter was analyzed on a subset in which HVL was measured (n = 48). We assessed outcomes via medical record review (linkage, ART) and serum tests (HVL). To examine the primary outcome, we used multiple logistic regression models controlling for potential confounders. Results Among 249 study participants, unhealthy alcohol use (n = 148 [59%]) and past-month IDU (n = 130 [52%]) were common. The mean opioid craving score was 49 (SD: 38). We were unable to detect significant associations between the independent variables (i.e., unhealthy alcohol use, IDU and opioid craving) and any HIV care cascade outcomes in unadjusted and adjusted analyses. Conclusion In this cohort of HIV-positive Russians with a history of IDU, individual substance use factors were not significantly associated with achieving HIV care cascade milestones (i.e., linkage to HIV care; prescription for ART; or suppressed viral load). Given no detection of an association of cascade outcomes with recent unhealthy use of alcohol or injection drugs in this cohort, examining systemic factors to understand determinants of HIV care engagement for people with drug use would be important.
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Affiliation(s)
- Bulat Idrisov
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA.,Department of Infectious Diseases, Bashkir State Medical University, 3 Lenina St., Ufa, Bashkortostan Republic, Russian Federation, 450000
| | - Karsten Lunze
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA.,Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - Elena Blokhina
- First St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg, Russian Federation, 197022
| | - Natalia Gnatienko
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA
| | - Emily Quinn
- Data Coordinating Center, Boston University School of Public Health, 85 E Newton St M921, Boston, MA, 02118, USA
| | - Carly Bridden
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA
| | - Alexander Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA
| | - Kendall J Bryant
- HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, National Institute of Health, 5365 Fishers Lane, Bethesda, MD, 20892, USA
| | - Dmitry Lioznov
- First St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg, Russian Federation, 197022.,Pasteur Research Institute of Epidemiology and Microbiology, Mira St. 14, St. Petersburg, Russian Federation, 197101
| | - Evgeny Krupitsky
- First St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg, Russian Federation, 197022.,St. Petersburg Bekhterev Research Psychoneurological Institute, Bekhtereva St., 3, St. Petersburg, Russian Federation, 192019
| | - Jeffrey H Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA. .,Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA.
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Holloway AS, Ferguson J, Landale S, Cariola L, Newbury-Birch D, Flynn A, Knight JR, Sherritt L, Harris SK, O’Donnell AJ, Kaner E, Hanratty B, Loree AM, Yonkers KA, Ondersma SJ, Gilstead-Hayden K, Martino S, Adam A, Schwartz RP, Wu LT, Subramaniam G, Sharma G, McNeely J, Berman AH, Kolaas K, Petersén E, Bendtsen P, Hedman E, Linderoth C, Müssener U, Sinadinovic K, Spak F, Gremyr I, Thurang A, Mitchell AM, Finnell D, Savage CL, Mahmoud KF, Riordan BC, Conner TS, Flett JAM, Scarf D, McRee B, Vendetti J, Gallucci KS, Robaina K, Clark BJ, Jones J, Reed KD, Hodapp RM, Douglas I, Burnham EL, Aagaard L, Cook PF, Harris BR, Yu J, Wolff M, Rogers M, Barbosa C, Wedehase BJ, Dunlap LJ, Mitchell SG, Dusek KA, Gryczynski J, Kirk AS, Oros MT, Hosler C, O’Grady KE, Brown BS, Angus C, Sherborne S, Gillespie D, Meier P, Brennan A, de Vargas D, Soares J, Castelblanco D, Doran KM, Wittman I, Shelley D, Rotrosen J, Gelberg L, Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Deng Y, Dziura J, Fiellin LE, O’Connor PG, Bedimo R, Gibert C, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Justice AC, Bryant KJ, Fiellin DA, Giles EL, Coulton S, Deluca P, Drummond C, Howel D, McColl E, McGovern R, Scott S, Stamp E, Sumnall H, Vale L, Alabani V, Atkinson A, Boniface S, Frankham J, Gilvarry E, Hendrie N, Howe N, McGeechan GJ, Ramsey A, Stanley G, Clephane J, Gardiner D, Holmes J, Martin N, Shevills C, Soutar M, Chi FW, Weisner C, Ross TB, Mertens J, Sterling SA, Shorter GW, Heather N, Bray J, Cohen HA, McPherson TL, Adam C, López-Pelayo H, Gual A, Segura-Garcia L, Colom J, Ornelas IJ, Doyle S, Donovan D, Duran B, Torres V, Gaume J, Grazioli V, Fortini C, Paroz S, Bertholet N, Daeppen JB, Satterfield JM, Gregorich S, Alvarado NJ, Muñoz R, Kulieva G, Vijayaraghavan M, Adam A, Cunningham JA, Díaz E, Palacio-Vieira J, Godinho A, Kushir V, O’Brien KHM, Aguinaldo LD, Sellers CM, Spirito A, Chang G, Blake-Lamb T, LaFave LRA, Thies KM, Pepin AL, Sprangers KE, Bradley M, Jorgensen S, Catano NA, Murray AR, Schachter D, Andersen RM, Rey GN, Vahidi M, Rico MW, Baumeister SE, Johansson M, Sinadinovic C, Hermansson U, Andreasson S, O’Grady MA, Kapoor S, Akkari C, Bernal C, Pappacena K, Morley J, Auerbach M, Neighbors CJ, Kwon N, Conigliaro J, Morgenstern J, Magill M, Apodaca TR, Borsari B, Hoadley A, Scott Tonigan J, Moyers T, Fitzgerald NM, Schölin L, Barticevic N, Zuzulich S, Poblete F, Norambuena P, Sacco P, Ting L, Beaulieu M, Wallace PG, Andrews M, Daley K, Shenker D, Gallagher L, Watson R, Weaver T, Bruguera P, Oliveras C, Gavotti C, Barrio P, Braddick F, Miquel L, Suárez M, Bruguera C, Brown RL, Capell JW, Paul Moberg D, Maslowsky J, Saunders LA, McCormack RP, Scheidell J, Gonzalez M, Bauroth S, Liu W, Lindsay DL, Lincoln P, Hagle H, Wallhed Finn S, Hammarberg A, Andréasson S, King SE, Vargo R, Kameg BN, Acquavita SP, Van Loon RA, Smith R, Brehm BJ, Diers T, Kim K, Barker A, Jones AL, Skinner AC, Hinman A, Svikis DS, Thacker CL, Resnicow K, Beatty JR, Janisse J, Puder K, Bakshi AS, Milward JM, Kimergard A, Garnett CV, Crane D, Brown J, West R, Michie S, Rosendahl I, Andersson C, Gajecki M, Blankers M, Donoghue K, Lynch E, Maconochie I, Phillips C, Pockett R, Phillips T, Patton R, Russell I, Strang J, Stewart MT, Quinn AE, Brolin M, Evans B, Horgan CM, Liu J, McCree F, Kanovsky D, Oberlander T, Zhang H, Hamlin B, Saunders R, Barton MB, Scholle SH, Santora P, Bhatt C, Ahmed K, Hodgkin D, Gao W, Merrick EL, Drebing CE, Larson MJ, Sharma M, Petry NM, Saitz R, Weisner CM, Young-Wolff KC, Lu WY, Blosnich JR, Lehavot K, Glass JE, Williams EC, Bensley KM, Chan G, Dombrowski J, Fortney J, Rubinsky AD, Lapham GT, Forray A, Olmstead TA, Gilstad-Hayden K, Kershaw T, Dillon P, Weaver MF, Grekin ER, Ellis JD, McGoron L, McGoron L. Proceedings of the 14th annual conference of INEBRIA. Addict Sci Clin Pract 2017. [PMCID: PMC5606215 DOI: 10.1186/s13722-017-0087-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Dziura J, Fiellin LE, O'Connor PG, Bedimo R, Gibert C, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Justice AC, Bryant KJ, Fiellin DA. Corrigendum to "The Starting Treatment for Ethanol in Primary care Trials (STEP Trials): Protocol for three parallel multi-site stepped care effectiveness studies for unhealthy alcohol use in HIV-positive patients" [Contemp. Clin. Trials 52 (2017) 80-90]. Contemp Clin Trials 2017; 60:125. [PMID: 28712767 DOI: 10.1016/j.cct.2017.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E Jennifer Edelman
- Yale University School of Medicine, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States
| | | | - Nathan B Hansen
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States; College of Public Health, University of Georgia, Athens, GA 30602, United States
| | | | - James Dziura
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT 06511, United States
| | - Lynn E Fiellin
- Yale University School of Medicine, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States
| | | | - Roger Bedimo
- Veterans Affairs North Texas Health Care System and UT Southwestern, Dallas, TX 75216, United States
| | - Cynthia Gibert
- D.C. Veterans Affairs Medical Center and George Washington University School of Medicine and Health Sciences, Washington, D.C. 20422, United States
| | - Vincent C Marconi
- Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, Decatur, GA 30033, United States
| | - David Rimland
- Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, Decatur, GA 30033, United States
| | - Maria C Rodriguez-Barradas
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX 77030, United States
| | - Michael S Simberkoff
- VA NY Harbor Healthcare System and New York University School of Medicine, New York, NY 10010, United States
| | - Amy C Justice
- Yale University School of Medicine, New Haven, CT 06510, United States; VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT 06516, United States
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD 20892-7003, United States
| | - David A Fiellin
- Yale University School of Medicine, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States
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Ruggles KV, Fang Y, Tate J, Mentor SM, Bryant KJ, Fiellin DA, Justice AC, Braithwaite RS. What are the Patterns Between Depression, Smoking, Unhealthy Alcohol Use, and Other Substance Use Among Individuals Receiving Medical Care? A Longitudinal Study of 5479 Participants. AIDS Behav 2017; 21:2014-2022. [PMID: 27475945 DOI: 10.1007/s10461-016-1492-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To evaluate and characterize the structure of temporal patterns of depression, smoking, unhealthy alcohol use, and other substance use among individuals receiving medical care, and to inform discussion about whether integrated screening and treatment strategies for these conditions are warranted. Using the Veterans Aging Cohort Study (VACS) we measured depression, smoking, unhealthy alcohol use and other substance use (stimulants, marijuana, heroin, opioids) and evaluated which conditions tended to co-occur within individuals, and how this co-occurrence was temporally structured (i.e. concurrently, sequentially, or discordantly). Current depression was associated with current use of every substance examined with the exception of unhealthy alcohol use. Current unhealthy alcohol use and marijuana use were also consistently associated. Current status was strongly predicted by prior status (p < 0.0001; OR = 2.99-22.34) however, there were few other sequential relationships. Associations in the HIV infected and uninfected subgroups were largely the same with the following exceptions. Smoking preceded unhealthy alcohol use and current smoking was associated with current depression in the HIV infected subgroup only (p < 0.001; OR = 1.33-1.41 and p < 0.001; OR = 1.25-1.43). Opioid use and current unhealthy alcohol use were negatively associated only in the HIV negative subgroup (p = 0.01; OR = 0.75). Patterns of depression, smoking, unhealthy alcohol use, and other substance use were temporally concordant, particularly with regard to depression and substance use. These patterns may inform future development of more integrated screening and treatment strategies.
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Affiliation(s)
- Kelly V Ruggles
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Yixin Fang
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Janet Tate
- Yale University School of Medicine, New Haven, CT, USA
| | - Sherry M Mentor
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | | | - Amy C Justice
- Yale University School of Medicine, New Haven, CT, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, NY, USA.
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Gordon KS, Edelman EJ, Justice AC, Fiellin DA, Akgün K, Crystal S, Duggal M, Goulet JL, Rimland D, Bryant KJ. Minority Men Who Have Sex with Men Demonstrate Increased Risk for HIV Transmission. AIDS Behav 2017; 21:1497-1510. [PMID: 27771818 DOI: 10.1007/s10461-016-1590-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Black and Hispanic (minority) MSM have a higher incidence of HIV than white MSM. Multiple sexual partners, being under the influence of drugs and/or alcohol during sex, having a detectable HIV-1 RNA, and non-condom use are factors associated with HIV transmission. Using data from the Veterans Aging Cohort Study, we consider minority status and sexual orientation jointly to characterize and compare these factors. White non-MSM had the lowest prevalence of these factors (p < 0.001) and were used as the comparator group in calculating odds ratios (OR). Both MSM groups were more likely to report multiple sex partners (white MSM OR 7.50; 95 % CI 5.26, 10.71; minority MSM OR 10.24; 95 % CI 7.44, 14.08), and more likely to be under the influence during sex (white MSM OR 2.15; 95 % CI 1.49, 3.11; minority MSM OR 2.94; 95 % CI 2.16, 4.01). Only minority MSM were more likely to have detectable HIV-1 RNA (OR 1.87; 95 % CI 1.12, 3.11). Both MSM groups were more likely to use condoms than white non-MSM. These analyses suggest that tailored interventions to prevent HIV transmission among minority MSM are needed, with awareness of the potential co-occurrence of risk factors.
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Affiliation(s)
- Kirsha S Gordon
- VA Connecticut Healthcare System, 950 Campbell Ave. Blg. 35A 2nd FL, 11-ACSLG, West Haven, CT, 06516, USA.
| | - E Jennifer Edelman
- General Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520-8088, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, 06520, USA
| | - Amy C Justice
- VA Connecticut Healthcare System, 950 Campbell Ave. Blg. 35A 2nd FL, 11-ACSLG, West Haven, CT, 06516, USA
- General Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520-8088, USA
| | - David A Fiellin
- General Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520-8088, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, 06520, USA
| | - Kathleen Akgün
- VA Connecticut Healthcare System, 950 Campbell Ave. Blg. 35A 2nd FL, 11-ACSLG, West Haven, CT, 06516, USA
- General Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520-8088, USA
| | | | - Mona Duggal
- VA Connecticut Healthcare System, 950 Campbell Ave. Blg. 35A 2nd FL, 11-ACSLG, West Haven, CT, 06516, USA
| | - Joseph L Goulet
- VA Connecticut Healthcare System, 950 Campbell Ave. Blg. 35A 2nd FL, 11-ACSLG, West Haven, CT, 06516, USA
- General Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520-8088, USA
| | - David Rimland
- Atlanta Veterans Affairs Medical Center, Decatur, GA, 30033, USA
- Emory University School of Medicine, Atlanta, GA, 30303, USA
| | - Kendall J Bryant
- National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, 20892, USA
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Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Dziura J, Fiellin LE, O'Connor PG, Bedimo R, Gibert C, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Justice AC, Bryant KJ, Fiellin DA. The Starting Treatment for Ethanol in Primary care Trials (STEP Trials): Protocol for Three Parallel Multi-Site Stepped Care Effectiveness Studies for Unhealthy Alcohol Use in HIV-Positive Patients. Contemp Clin Trials 2016; 52:80-90. [PMID: 27876616 DOI: 10.1016/j.cct.2016.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 01/20/2023]
Abstract
Unhealthy alcohol use is common among HIV-positive patients, yet effective evidence-based treatments are rarely provided in clinical settings providing HIV care. Further, given patient variability in response to initial treatments, stepped care approaches may be beneficial. We describe the rationale, aims and study design for the current StartingTreatment forEthanol inPrimary care Trials (STEP Trials); three parallel randomized controlled effectiveness trials being conducted in five Infectious Disease Clinics. Participants meeting criteria for: 1) at-risk drinking, 2) moderate alcohol use with liver disease (MALD), or 3) alcohol use disorder (AUD) are randomized to integrated stepped care versus treatment as usual. For those with at-risk drinking or MALD, integrated stepped care starts with a one session brief intervention and follow-up 2-week telephone booster. Based on pre-specified nonresponse criteria, participants may be "stepped up" at week 4 to receive four sessions of motivational enhancement therapy (MET) and "stepped up" again at week 12 for addiction physician management (APM) and consideration of alcohol pharmacotherapy. For those with AUD, integrated stepped care begins with APM. Non-responders may be "stepped up" at week 4 to receive MET and again at week 12 for a higher level of care (e.g. intensive outpatient program). The primary outcome is alcohol consumption assessed at 24weeks, and secondary outcome is the VACS Index, a validated measure of HIV morbidity and mortality risk. Results from the STEP Trials should inform future research and the implementation of interventions to address unhealthy alcohol use among HIV-positive individuals.
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Affiliation(s)
- E Jennifer Edelman
- Yale University School of Medicine, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States.
| | | | - Nathan B Hansen
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States; College of Public Health, University of Georgia, Athens, GA 30602, United States
| | | | - James Dziura
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT 06511, United States
| | - Lynn E Fiellin
- Yale University School of Medicine, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States
| | | | - Roger Bedimo
- Veterans Affairs North Texas Health Care System and UT Southwestern, Dallas, TX 75216, United States
| | - Cynthia Gibert
- D.C. Veterans Affairs Medical Center and George Washington University School of Medicine and Health Sciences, Washington, D.C. 20422, United States
| | - Vincent C Marconi
- Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, Decatur, GA 30033, United States
| | - David Rimland
- Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, Decatur, GA 30033, United States
| | - Maria C Rodriguez-Barradas
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas Houston, TX 77030, United States
| | - Michael S Simberkoff
- VA NY Harbor Healthcare System and New York University School of Medicine, New York, NY 10010, United States
| | - Amy C Justice
- Yale University School of Medicine, New Haven, CT 06510, United States; VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT 06516, United States
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD 20892-7003, United States
| | - David A Fiellin
- Yale University School of Medicine, New Haven, CT 06510, United States; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT 06510, United States
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McGinnis KA, Tate JP, Williams EC, Skanderson M, Bryant KJ, Gordon A, Kraemer KL, Maisto SA, Crystal S, Fiellin DA, Justice AC. Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients. Drug Alcohol Depend 2016; 168:196-202. [PMID: 27694059 PMCID: PMC5086273 DOI: 10.1016/j.drugalcdep.2016.09.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/12/2016] [Accepted: 09/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Using electronic medical record (EMR) data for clinical decisions, quality improvement, and research is common. While unhealthy alcohol use is particularly risky among HIV infected individuals (HIV+), the validity of EMR data for identifying unhealthy alcohol use among HIV+ is unclear. Among HIV+ and uninfected, we: (1) assess agreement of EMR and research AUDIT-C at validated cutoffs for unhealthy alcohol use; (2) explore EMR cutoffs that maximize agreement; and (3) assess subpopulation variation in agreement. METHODS Using data from the Veterans Aging Cohort Study (VACS), EMR AUDIT-C cutoffs of 2+, 3+, and 4+ for men (2+ and 3+ for women) were compared to research AUDIT-C 4+ for men (3+ for women). Agreement was compared by demographics, HIV, hepatitis C infection, and alcohol related diagnosis. RESULTS Among 1082 HIV+ and 1160 uninfected men, 14% and 22% had an EMR and research AUDIT-C 4+, respectively. Among 32 HIV+ and 115 uninfected women, 9% and 14% had an EMR and research AUDIT-C 3+. For men, EMR agreement with the research AUDIT-C 4+ was highest at a cutoff of 3+ (kappa=0.49). For women, EMR agreement with AUDIT-C 3+ was highest at a cutoff of 2+ (kappa=0.46). Moderate agreement was consistent across subgroups. CONCLUSIONS EMR AUDIT-C underestimates unhealthy alcohol use compared to research AUDIT-C in both HIV+ and uninfected individuals. Methods for improving quality of clinical screening may be in need of investigation. Researchers and clinicians may consider alternative EMR cutoffs that maximize agreement given limitations of clinical screening.
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Affiliation(s)
- Kathleen A. McGinnis
- Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT
| | - Janet P. Tate
- Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT,Division of General Internal Medicine, Yale University School of Medicine, New Haven CT,Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven CT
| | - Emily C. Williams
- Health Services Research & Development; Veterans Affairs Puget Sound Health Care System, Seattle, WA, Department of Health Services, University of Washington, Seattle, WA
| | - Melissa Skanderson
- Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT
| | | | - Adam Gordon
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Kevin L. Kraemer
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Steven Crystal
- Health Services Research, Rutgers University, New Brunswick, NJ
| | - David A. Fiellin
- Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT,Division of General Internal Medicine, Yale University School of Medicine, New Haven CT,Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven CT
| | - Amy C. Justice
- Veterans Aging Cohort Study Coordinating Center, VA CT Healthcare System, West Haven, CT,Division of General Internal Medicine, Yale University School of Medicine, New Haven CT,Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven CT
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Watson R, Morris J, Isitt J, Barrio P, Ortega L, Gual A, Conner K, Stecker T, Maisto S, Paroz S, Graap C, Grazioli VS, Daeppen JB, Collins SE, Bertholet N, McNeely J, Kushnir V, Cunningham JA, Crombie IK, Cunningham KB, Irvine L, Williams B, Sniehotta FF, Norrie J, Melson A, Jones C, Briggs A, Rice P, Achison M, McKenzie A, Dimova E, Slane PW, Grazioli VS, Collins SE, Paroz S, Graap C, Daeppen JB, Baggio S, Dupuis M, Studer J, Gmel G, Magill M, Grazioli VS, Tait RJ, Teoh L, Kelty E, Geelhoed E, Mountain D, Hulse GK, Renko E, Mitchell SG, Lounsbury D, Li Z, Schwartz RP, Gryczynski J, Kirk AS, Oros M, Hosler C, Dusek K, Brown BS, Finnell DS, Holloway A, Wu LT, Subramaniam G, Sharma G, Wallhed Finn S, Andreasson S, Dvorak RD, Kramer MP, Stevenson BL, Sargent EM, Kilwein TM, Harris SK, Sherritt L, Copelas S, Knight JR, Mdege ND, McCambridge J, Bischof G, Bischof A, Freyer-Adam J, Rumpf HJ, Fitzgerald N, Schölin L, Toner P, Böhnke JR, Veach LJ, Currin O, Dongre LZ, Miller PR, White E, Williams EC, Lapham GT, Bobb JJ, Rubinsky AD, Catz SL, Shortreed S, Bensley KM, Bradley KA, Milward J, Deluca P, Khadjesari Z, Watson R, Fincham-Campbell S, Drummond C, Angus K, Bauld L, Baumann S, Haberecht K, Schnuerer I, Meyer C, Rumpf HJ, John U, Gaertner B, Barrault-Couchouron M, Béracochéa M, Allafort V, Barthélémy V, Bonnefoi H, Bussières E, Garguil V, Auriacombe M, Saint-Jacques M, Dorval M, M’Bailara K, Segura-Garcia L, Ibañez-Martinez N, Mendive-Arbeloa JM, Anoro-Perminger M, Diaz-Gallego P, Piñar-Mateos MA, Colom-Farran J, Deligianni M, Yersin B, Adam A, Weisner C, Chi F, Lu W, Sterling S, Kraemer KL, McGinnis KA, Fiellin DA, Skanderson M, Gordon AJ, Robbins J, Zickmund S, Korthuis PT, Edelman EJ, Hansen NB, Cutter CJ, Dziura J, Fiellin LE, O’Connor PG, Maisto SA, Bedimo R, Gilbert C, Marconi VC, Rimland D, Rodriguez-Barradas M, Simberkoff M, Justice AC, Bryant KJ, Berman AH, Shorter GW, Bray JW, Barbosa C, Johansson M, Hester R, Campbell W, Souza Formigoni MLO, Andrade ALM, Sartes LMA, Sundström C, Eék N, Kraepelien M, Kaldo V, Fahlke C, Hernandez L, Becker SJ, Jones RN, Graves HR, Spirito A, Diestelkamp S, Wartberg L, Arnaud N, Thomasius R, Gaume J, Grazioli V, Fortini C, Malan Z, Mash B, Everett-Murphy K, Grazioli VS, Studer J, Mohler-Kuo M, Bertholet N, Gmel G, Doi L, Cheyne H, Jepson R, Luna V, Echeverria L, Morales S, Barroso T, Abreu Â, Aguiar C, Stewart D, Abreu A, Brites RM, Jomar R, Marinho G, Parreira P, Seale JP, Johnson JA, Henry D, Chalmers S, Payne F, Tuck L, Morris A, Gonçalves C, Besser B, Casajuana C, López-Pelayo H, Balcells MM, Teixidó L, Miquel L, Colom J, Hepner KA, Hoggatt KJ, Bogart A, Paddock SM, Hardoon SL, Petersen I, Hamilton FL, Nazareth I, White IR, Marston L, Wallace P, Godfrey C, Murray E, Sovinová H, Csémy L. Proceedings of the 13th annual conference of INEBRIA. Addict Sci Clin Pract 2016; 11:13. [PMID: 27654147 PMCID: PMC5032602 DOI: 10.1186/s13722-016-0062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lee JH, Gamarel KE, Bryant KJ, Zaller ND, Operario D. Discrimination, Mental Health, and Substance Use Disorders Among Sexual Minority Populations. LGBT Health 2016; 3:258-65. [PMID: 27383512 DOI: 10.1089/lgbt.2015.0135] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Sexual minority (lesbian, gay, bisexual) populations have a higher prevalence of mental health and substance use disorders compared to their heterosexual counterparts. Such disparities have been attributed, in part, to minority stressors, including distal stressors such as discrimination. However, few studies have examined associations between discrimination, mental health, and substance use disorders by gender among sexual minority populations. METHODS We analyzed data from 577 adult men and women who self-identified as lesbian, gay, or bisexual and participated in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Six questions assessed discrimination due to sexual orientation. Weighted multivariable logistic regression examined associations between experiences of sexual orientation discrimination and both mental health and substance use disorders. Analyses were conducted separately for sexual minority men and women, adjusting for sociodemographic covariates. RESULTS Sexual minority men who ever experienced discrimination (57.4%) reported higher odds of any lifetime drug use disorder and cannabis use disorder compared to sexual minority men who never experienced discrimination. Sexual minority women who ever experienced discrimination (42.9%) reported higher odds of any lifetime mood disorder and any lifetime anxiety disorder compared to sexual minority women who never experienced discrimination. CONCLUSION The findings suggest that discrimination is differentially associated with internalizing (mental health) and externalizing (substance use) disorders for sexual minority men and women. These findings indicate a need to consider how homophobia and heteronormative discrimination may contribute to distinct health outcomes for lesbian and bisexual women compared with gay and bisexual men.
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Affiliation(s)
- Ji Hyun Lee
- 1 Brown University School of Public Health , Providence, Rhode Island
| | - Kristi E Gamarel
- 2 Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University , Providence, Rhode Island
| | - Kendall J Bryant
- 3 National Institute on Alcohol Abuse and Alcoholism , Rockville, Maryland
| | - Nickolas D Zaller
- 4 Fay W. Boozman College of Public Health, University of Arkansas , Little Rock, Arkansas
| | - Don Operario
- 1 Brown University School of Public Health , Providence, Rhode Island
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Justice AC, McGinnis KA, Tate JP, Braithwaite RS, Bryant KJ, Cook RL, Edelman EJ, Fiellin LE, Freiberg MS, Gordon AJ, Kraemer KL, Marshall BD, Williams EC, Fiellin DA. Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men. Drug Alcohol Depend 2016; 161:95-103. [PMID: 26861883 PMCID: PMC4792710 DOI: 10.1016/j.drugalcdep.2016.01.017] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND HIV infected (HIV+) individuals may be more susceptible to alcohol-related harm than uninfected individuals. METHODS We analyzed data on HIV+ and uninfected individuals in the Veterans Aging Cohort Study (VACS) with an Alcohol Use Disorders Identification Test-Consumption AUDIT-C score from 2008 to 2012. We used Cox proportional hazards models to examine the association between alcohol exposure and mortality through July, 2014; and linear regression models to assess the association between alcohol exposure and physiologic injury based on VACS Index Scores. Models were adjusted for age, race/ethnicity, smoking, and hepatitis C infection. RESULTS The sample included 18,145 HIV+ and 42,228 uninfected individuals. Among HIV+ individuals, 76% had undetectable HIV-1 RNA (<500 copies/ml). The threshold for an association of alcohol use with mortality and physiologic injury differed by HIV status. Among HIV+ individuals, AUDIT-C score ≥4 (hazard ratio [HR] 1.25, 95% CI 1.09-1.44) and ≥30 drinks per month (HR, 1.30, 95% CI 1.14-1.50) were associated with increased risk of mortality. Among uninfected individuals, AUDIT-C score ≥5 (HR, 1.19, 95% CI 1.07-1.32) and ≥70 drinks per month (HR 1.13, 95% CI 1.00-1.28) were associated with increased risk. Similarly, AUDIT-C threshold scores of 5-7 were associated with physiologic injury among HIV+ individuals (beta 0.47, 95% CI 0.22, 0.73) and a score of 8 or more was associated with injury in uninfected (beta 0.29, 95% CI 0.16, 0.42) individuals. CONCLUSIONS Despite antiretroviral therapy, HIV+ individuals experienced increased mortality and physiologic injury at lower levels of alcohol use compared with uninfected individuals. Alcohol consumption limits should be lower among HIV+ individuals.
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Affiliation(s)
- Amy C. Justice
- Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA,Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, Connecticut, 06510, USA,Corresponding author at: VA Connecticut Healthcare System, Yale University School of Medicine, 950 Campbell Avenue, Building 35a Room 2-212 (11-ACSLG), West Haven, CT 06516, Tel.: 203.932.5711 x3541, Fax: 203.937.4926
| | - Kathleen A. McGinnis
- VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, Pennsylvania, 15240, USA
| | - Janet P. Tate
- Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA,Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, Connecticut, 06510, USA
| | - R. Scott Braithwaite
- Department of Population Health New York University School of Medicine, 227 East 30 street, New York, NY 10016, USA
| | - Kendall J. Bryant
- National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, MSC 9304, Bethesda, MD 20892-9304, USA
| | - Robert L. Cook
- Department of Epidemiology, University of Florida, PO Box 100231, Gainesville, FL, USA
| | - E. Jennifer Edelman
- Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA,Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, Connecticut, 06510, USA
| | - Lynn E. Fiellin
- Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, Connecticut, 06510, USA
| | - Matthew S. Freiberg
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA,Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, 2525 West End Avenue, Nashville, TN, USA
| | - Adam J. Gordon
- VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, Pennsylvania, 15240, USA,Division of General Internal Medicine, University of Pittsburgh School of Medicine, Suite 600, 230 McKee Place, Pittsburgh, Pennsylvania, 15213, USA
| | - Kevin L. Kraemer
- VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, Pennsylvania, 15240, USA,Division of General Internal Medicine, University of Pittsburgh School of Medicine, Suite 600, 230 McKee Place, Pittsburgh, Pennsylvania, 15213, USA
| | - Brandon D.L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA, 02912
| | - Emily C. Williams
- University of Washington School of Public Health, 325 Ninth Avenue, Box 359762, Seattle, WA, USA
| | - David A. Fiellin
- Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA,Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, Connecticut, 06510, USA
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Braithwaite RS, Fang Y, Tate J, Mentor SM, Bryant KJ, Fiellin DA, Justice AC. Do Alcohol Misuse, Smoking, and Depression Vary Concordantly or Sequentially? A Longitudinal Study of HIV-Infected and Matched Uninfected Veterans in Care. AIDS Behav 2016; 20:566-72. [PMID: 26187007 DOI: 10.1007/s10461-015-1117-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We analyzed temporal patterns of alcohol misuse, smoking, and depression among veterans in care to determine whether these conditions vary concordantly or sequentially. Using the Veterans Aging Cohort Study, harmful alcohol use (AUDIT-C ≥ 4), current smoking, and depression (PHQ-9 ≥ 8), were measured. In regression analyses, predictors included each outcome condition at baseline, the other two conditions in the same survey, the other two conditions in the immediately preceding survey, number of years since enrollment, and HIV status. We found that current smoking and depression were more common among HIV infected individuals. Harmful alcohol use was more common among uninfected individuals. Temporal analyses suggested a concurrent pattern: each condition was associated with the other two conditions (p < 0.03, OR 1.12-1.66) as well as with the prior presence of the same condition (p < 0.0001; OR 6.38-22.02). Smoking was associated with prior depression after controlling for current depression (OR 1.16; p = 0.003). In conclusion, alcohol misuse, smoking, and depression were temporally concordant and persistent, raising the question of whether they constitute a common syndrome in HIV infected patients and others with chronic diseases.
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Affiliation(s)
- R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6 Room 615, New York, NY, 10016, USA.
| | - Yixin Fang
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6 Room 615, New York, NY, 10016, USA
| | - Janet Tate
- Yale University School of Medicine, New Haven, CT, USA
| | - Sherry M Mentor
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, Floor 6 Room 615, New York, NY, 10016, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | | | - Amy C Justice
- Yale University School of Medicine, New Haven, CT, USA
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Rentsch C, Tate JP, Akgün KM, Crystal S, Wang KH, Ryan Greysen S, Wang EA, Bryant KJ, Fiellin DA, Justice AC, Rimland D. Erratum to: Alcohol-Related Diagnoses and All-Cause Hospitalization Among HIV-Infected and Uninfected Patients: A Longitudinal Analysis of United States Veterans from 1997 to 2011. AIDS Behav 2016; 20:565. [PMID: 25972072 DOI: 10.1007/s10461-015-1072-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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46
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Rentsch C, Tate JP, Akgün KM, Crystal S, Wang KH, Ryan Greysen S, Wang EA, Bryant KJ, Fiellin DA, Justice AC, Rimland D. Alcohol-Related Diagnoses and All-Cause Hospitalization Among HIV-Infected and Uninfected Patients: A Longitudinal Analysis of United States Veterans from 1997 to 2011. AIDS Behav 2016; 20:555-64. [PMID: 25711299 DOI: 10.1007/s10461-015-1025-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Individuals with HIV infection are living substantially longer on antiretroviral therapy, but hospitalization rates continue to be relatively high. We do not know how overall or diagnosis-specific hospitalization rates compare between HIV-infected and uninfected individuals or what conditions may drive hospitalization trends. Hospitalization rates among United States Veterans were calculated and stratified by HIV serostatus and principal diagnosis disease category. Because alcohol-related diagnoses (ARD) appeared to have a disproportional effect, we further stratified our calculations by ARD history. A multivariable Cox proportional hazards model was fitted to assess the relative risk of hospitalization controlling for demographic and other comorbidity variables. From 1997 to 2011, 46,428 HIV-infected and 93,997 uninfected patients were followed for 1,497,536 person-years. Overall hospitalization rates decreased among HIV-infected and uninfected patients. However, cardiovascular and renal insufficiency admissions increased for all groups while gastrointestinal and liver, endocrine, neurologic, and non-AIDS cancer admissions increased among those with an alcohol-related diagnosis. After multivariable adjustment, HIV-infected individuals with an ARD had the highest risk of hospitalization (hazard ratio 3.24, 95 % CI 3.00, 3.49) compared to those free of HIV infection and without an ARD. Still, HIV alone also conferred increased risk (HR 2.08, 95 % CI 2.04, 2.13). While decreasing overall, risk of all-cause hospitalization remains higher among HIV-infected than uninfected individuals and is strongly influenced by the presence of an ARD.
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47
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Edelman EJ, Hansen NB, Cutter CJ, Danton C, Fiellin LE, O'Connor PG, Williams EC, Maisto SA, Bryant KJ, Fiellin DA. Implementation of integrated stepped care for unhealthy alcohol use in HIV clinics. Addict Sci Clin Pract 2016; 11:1. [PMID: 26763048 PMCID: PMC4711105 DOI: 10.1186/s13722-015-0048-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 12/23/2015] [Indexed: 11/19/2022] Open
Abstract
Background
Effective counseling and pharmacotherapy for unhealthy alcohol use are rarely provided in HIV treatment settings to patients. Our goal was to describe factors influencing implementation of a stepped care model to address unhealthy alcohol use in HIV clinics from the perspectives of social workers, psychologists and addiction psychiatrists. Methods We conducted two focus groups with Social Workers (n = 4), Psychologists (n = 2), and Addiction Psychiatrists (n = 4) involved in an ongoing randomized controlled trial evaluating the effectiveness of integrated stepped care for unhealthy alcohol use in HIV-infected patients at five Veterans Health Administration (VA) HIV clinics. Data collection and analyses were guided by the Consolidated Framework for Implementation Research (CFIR) domains, with a focus on the three domains which we considered to be most relevant: intervention characteristics (i.e. motivational interviewing, pharmacotherapy), the inner setting (i.e. HIV clinics), and characteristics of individuals (i.e. the providers). A multidisciplinary team used directed content analysis to identify major themes. Results From the providers’ perspective, the major implementation themes that emerged by CFIR domain included: (1) Intervention characteristics: providers valued tools and processes for facilitating patient motivation for treatment of unhealthy alcohol use given their perceived lack of motivation, but expressed a desire for greater flexibility; (2) Inner setting: treating unhealthy alcohol use in HIV clinics was perceived by providers to be consistent with VA priorities; and (3) Characteristics of individuals: there was high self-efficacy to conduct the intervention, an expressed need for more consistent utilization to maintain skills, and consideration of alternative models for delivering the components of the intervention. Conclusions Use of the CFIR framework reveals that implementation of integrated stepped care for unhealthy alcohol use in HIV clinics is facilitated by tools to help providers enhance patient motivation or address unhealthy alcohol use among patients perceived to be unmotivated. Implementation may be facilitated by its consistency with organizational values and existing models of care and attention to optimizing provider self-efficacy and roles (i.e. approaches to treatment integration).
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Affiliation(s)
- E Jennifer Edelman
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA. .,Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
| | - Nathan B Hansen
- Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, 135 College Street, New Haven, CT, 06510, USA. .,College of Public Health, University of Georgia, 131 Wright Hall, Health Sciences Campus, Athens, GA, 30602, USA.
| | - Christopher J Cutter
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.
| | - Cheryl Danton
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.
| | - Lynn E Fiellin
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA. .,Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
| | - Patrick G O'Connor
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.
| | - Emily C Williams
- VA Puget Sound Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, 1100 Olive Way, Suite 1400, Seattle, WA, 98101, USA. .,Department of Health Services, University of Washington, 1959 NE Pacific Street, Magnuson Health Sciences Center, Room H-664, Seattle, WA, 98195, USA.
| | - Stephen A Maisto
- Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA.
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism HIV/AIDS Program, 5635 Fishers Lane, Bethesda, MD, 20892-7003, USA.
| | - David A Fiellin
- Yale University School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA. .,Center for Interdisciplinary Research On AIDS, Yale University School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
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48
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Lan CW, Fiellin DA, Barry DT, Bryant KJ, Gordon AJ, Edelman EJ, Gaither JR, Maisto SA, Marshall BDL. The epidemiology of substance use disorders in US Veterans: A systematic review and analysis of assessment methods. Am J Addict 2015; 25:7-24. [PMID: 26693830 DOI: 10.1111/ajad.12319] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/09/2015] [Accepted: 12/02/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs), which encompass alcohol and drug use disorders (AUDs, DUDs), constitute a major public health challenge among US veterans. SUDs are among the most common and costly of all health conditions among veterans. OBJECTIVES This study sought to examine the epidemiology of SUDs among US veterans, compare the prevalence of SUDs in studies using diagnostic and administrative criteria assessment methods, and summarize trends in the prevalence of SUDs reported in studies sampling US veterans over time. METHODS Comprehensive electronic database searches were conducted. A total of 3,490 studies were identified. We analyzed studies sampling US veterans and reporting prevalence, distribution, and examining AUDs and DUDs. RESULTS Of the studies identified, 72 met inclusion criteria. The studies were published between 1995 and 2013. Studies using diagnostic criteria reported higher prevalence of AUDs (32% vs. 10%) and DUDs (20% vs. 5%) than administrative criteria, respectively. Regardless of assessment method, both the lifetime and past year prevalence of AUDs in studies sampling US veterans has declined gradually over time. CONCLUSION The prevalence of SUDs reported in studies sampling US veterans are affected by assessment method. Given the significant public health problems of SUDs among US veterans, improved guidelines for clinical screening using validated diagnostic criteria to assess AUDs and DUDs in US veteran populations are needed. SCIENTIFIC SIGNIFICANCE These findings may inform VA and other healthcare systems in prevention, diagnosis, and intervention for SUDs among US veterans.
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Affiliation(s)
- Chiao-Wen Lan
- Department of Community Health Sciences, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California
| | - David A Fiellin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Declan T Barry
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Pain Treatment Services, APT Foundation, Inc., New Haven, Connecticut
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Adam J Gordon
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Mental Health Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Julie R Gaither
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University, School of Public Health, Providence, Rhode Island
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Wray TB, Grin B, Dorfman L, Glynn TR, Kahler CW, Marshall BDL, van den Berg JJ, Zaller ND, Bryant KJ, Operario D. Systematic review of interventions to reduce problematic alcohol use in men who have sex with men. Drug Alcohol Rev 2015; 35:148-57. [PMID: 25866929 DOI: 10.1111/dar.12271] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/01/2015] [Indexed: 12/11/2022]
Abstract
ISSUES Rates of heavy drinking, alcohol problems and alcohol-related disorders are high among men who have sex with men (MSM) and are an important public health issue. Associations between heavy drinking and human immunodeficiency virus (HIV) acquisition among MSM also suggest that drinking may have more severe and chronic consequences for this population relative to others. Consequently, effective interventions to reduce heavy drinking and alcohol-related risk factors among MSM are needed. APPROACH We conducted a systematic review of randomised controlled trials of interventions to reduce heavy drinking and/or alcohol-related problems among MSM. We searched five electronic databases, screened 3722 records and identified 5 studies involving 1022 participants that satisfied inclusion criteria, which included having: (i) incorporated a comparison condition; (ii) randomised participants to groups; and (iii) reported quantitative outcomes. KEY FINDINGS The methodological quality of studies varied, and meta-analysis was not conducted because of heterogeneity in intervention approaches and outcomes. Studies provided preliminary support for the use of motivational interviewing/motivational enhancement-based interventions (MI) and hybrid MI and cognitive behavioural therapy treatments for heavy drinking among MSM over no treatment. Perhaps the most important conclusion of this review, however, is that well-designed, theoretically informed research focused on establishing the efficacy of interventions for hazardous drinking and alcohol use disorders among MSM is alarmingly scarce. CONCLUSIONS Effective interventions to reduce hazardous drinking among MSM and prevent key alcohol-related outcomes, including risk for HIV transmission and health problems among HIV-positive MSM, are needed to mitigate health disparities in this population.
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Affiliation(s)
- Tyler B Wray
- Department of Behavioral and Social Sciences and Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, USA
| | - Benjamin Grin
- Department of Behavioral and Social Sciences and Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, USA
| | - Leah Dorfman
- Department of Behavioral and Social Sciences and Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, USA
| | - Tiffany R Glynn
- Department of Behavioral and Social Sciences and Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, USA
| | - Christopher W Kahler
- Department of Behavioral and Social Sciences and Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Jacob J van den Berg
- Division of Infectious Diseases, The Miriam Hospital, The Warren Alpert School of Brown University, Providence, USA
| | - Nickolas D Zaller
- Division of Infectious Diseases, The Miriam Hospital, The Warren Alpert School of Brown University, Providence, USA
| | - Kendall J Bryant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, USA
| | - Don Operario
- Department of Behavioral and Social Sciences and Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, USA
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50
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Marshall BD, Operario D, Bryant KJ, Cook RL, Edelman EJ, Gaither JR, Gordon AJ, Kahler CW, Maisto SA, McGinnis KA, van den Berg JJ, Zaller ND, Justice AC, Fiellin DA. Drinking trajectories among HIV-infected men who have sex with men: a cohort study of United States veterans. Drug Alcohol Depend 2015; 148:69-76. [PMID: 25596785 PMCID: PMC4330114 DOI: 10.1016/j.drugalcdep.2014.12.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/12/2014] [Accepted: 12/15/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although high rates of alcohol consumption and related problems have been observed among HIV-infected men who have sex with men (MSM), little is known about the long-term patterns of and factors associated with hazardous alcohol use in this population. We sought to identify alcohol use trajectories and correlates of hazardous alcohol use among HIV-infected MSM. METHODS Sexually active, HIV-infected MSM participating in the Veterans Aging Cohort Study were eligible for inclusion. Participants were recruited from VA infectious disease clinics in Atlanta, Baltimore, New York, Houston, Los Angeles, Pittsburgh, and Washington, DC. Data from annual self-reported assessments and group-based trajectory models were used to identify distinct alcohol use trajectories over an eight-year study period (2002-2010). We then used generalized estimate equations (GEE) to examine longitudinal correlates of hazardous alcohol use (defined as an AUDIT-C score ≥4). RESULTS Among 1065 participants, the mean age was 45.5 (SD=9.2) and 606 (58.2%) were African American. Baseline hazardous alcohol use was reported by 309 (29.3%). Group-based trajectory modeling revealed a distinct group (12.5% of the sample) with consistently hazardous alcohol use, characterized by a mean AUDIT-C score of >5 at every time point. In a GEE-based multivariable model, hazardous alcohol use was associated with earning <$6000 annually, having an alcohol-related diagnosis, using cannabis, and using cocaine. CONCLUSIONS More than 1 in 10 HIV-infected MSM US veterans reported consistent, long-term hazardous alcohol use. Financial insecurity and concurrent substance use were predictors of consistently hazardous alcohol use, and may be modifiable targets for intervention.
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Affiliation(s)
- Brandon D.L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA,Send correspondence to: Brandon D.L. Marshall, Assistant Professor, Department of Epidemiology Brown University School of Public Health, 121 South Main Street (Box G-S-121-2), Providence, RI, 02912, T: 401-863-6427, F: 401-863-3713
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA
| | - Kendall J. Bryant
- National Institute on Alcohol Abuse and Alcoholism, 6000 Executive Blvd, Rockville, MD, 20852, USA
| | - Robert L. Cook
- Department of Epidemiology, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610, USA
| | - E. Jennifer Edelman
- Department of Internal Medicine, Yale University School of Medicine, 367 Cedar Street, PO Box 20802, New Haven, CT, 06520-8025, USA,Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510-2483
| | - Julie R. Gaither
- Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510-2483,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, CT, 06520-8034
| | - Adam J. Gordon
- University of Pittsburgh School of Medicine (Mailcode 151-C-H), 7180 Highland Drive, Pittsburgh, PA, 15206,VA Pittsburgh Healthcare System, University Drive (151-C), Pittsburgh, PA, 15240
| | - Christopher W. Kahler
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA,Center for Alcohol and Addiction Studies and the Alcohol Research Center of HIV (ARCH), Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA
| | - Stephen A. Maisto
- Department of Psychology, Syracuse University, 430 University Avenue, Syracuse, NY, 13244,VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Avenue, Syracuse, NY, 13210
| | - Kathleen A. McGinnis
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Jacob J. van den Berg
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA,Division of Infectious Diseases, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Nickolas D. Zaller
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, 4301 West Markham #820, Little Rock, AR, 72205, USA
| | - Amy C. Justice
- Department of Internal Medicine, Yale University School of Medicine, 367 Cedar Street, PO Box 20802, New Haven, CT, 06520-8025, USA,Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510-2483,VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - David A. Fiellin
- Department of Internal Medicine, Yale University School of Medicine, 367 Cedar Street, PO Box 20802, New Haven, CT, 06520-8025, USA,Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT, 06510-2483
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