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Comparative Study
. 2016 Apr 1:161:95-103.
doi: 10.1016/j.drugalcdep.2016.01.017. Epub 2016 Jan 29.

Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men

Amy C Justice  1 , Kathleen A McGinnis  2 , Janet P Tate  3 , R Scott Braithwaite  4 , Kendall J Bryant  5 , Robert L Cook  6 , E Jennifer Edelman  3 , Lynn E Fiellin  7 , Matthew S Freiberg  8 , Adam J Gordon  9 , Kevin L Kraemer  9 , Brandon D L Marshall  10 , Emily C Williams  11 , David A Fiellin  3
Affiliations
Comparative Study

Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men

Amy C Justice et al. Drug Alcohol Depend. .

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.

Keywords: AUDIT-C; Alcohol; HIV; Morbidity; Mortality; VACS Index; Veteran.

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Conflict of interest statement

Conflicts of interest

The manuscript has not been previously published and is not being considered for publication elsewhere. The authors have all approved the manuscript and have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Figure 1a–c. Mortality per 100 Person Years (PYs) by AUDIT-C Level and HIV Status
Figure 2
Figure 2
Figure 2a–c. Mean VACS Index by AUDIT-C Level and HIV Status
See this image and copyright information in PMC

References

    1. Veterans Health Administration; Department of Veterans Affairs, editor. VistA. 2006. Innovations in American Government Award Fact Sheet; pp. 1–3.
    1. Akgun KM, Gordon K, Pisani M, Fried T, McGinnis KA, Tate JP, Butt AA, Gibert CL, Huang L, Rodriguez-Barradas MC, Rimland D, Justice AC, Crothers K. Risk factors for hospitalization and medical intensive care unit (MICU) admission among HIV infected Veterans. J Acquir Immune Defic Syndr. 2013a;62:52–59. - PMC - PubMed
    1. Akgun KM, Tate JP, Crothers K, Crystal S, Leaf DA, Womack JA, Brown TT, Justice AC, Oursler KK. An adapted frailty-related phenotype and the VACS index as predictors of hospitalization and mortality in HIV-infected and uninfected individuals. J Acquir Immune Defic Syndr. 2014;67:397–404. - PMC - PubMed
    1. Akgun KM, Tate JP, Pisani M, Fried T, Butt AA, Gibert CL, Huang L, Rodriguez-Barradas MC, Rimland D, Justice AC, Crothers K. Medical ICU admission diagnoses and outcomes in human immunodeficiency virus-infected and virus-uninfected veterans in the combination antiretroviral era. Crit Care Med. 2013b;41:1458–1467. - PMC - PubMed
    1. Anderson JP, Tchetgen Tchetgen EJ, Lo RV, III, Tate JP, Williams PL, Seage GR, III, Horsburgh CR, Lim JK, Goetz MB, Rimland D, Rodriguez-Barradas MC, Butt AA, Klein MB, Justice AC. Antiretroviral therapy reduces the rate of hepatic decompensation among HIV- and hepatitis C virus-coinfected veterans. Clin Infect Dis. 2014;58:719–727. - PMC - PubMed

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