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. 2023 Sep:85:6-12.
doi: 10.1016/j.annepidem.2023.07.002. Epub 2023 Jul 12.

Alcohol use and the longitudinal HIV care continuum for people with HIV who enrolled in care between 2011 and 2019

Catherine R Lesko  1 , Jeanine S Gnang  2 , Anthony T Fojo  3 , Heidi E Hutton  3 , Mary E McCaul  3 , Joseph A Delaney  4 , Edward R Cachay  5 , Kenneth H Mayer  6 , Heidi M Crane  7 , D Scott Batey  8 , Sonia Napravnik  9 , Katerina A Christopoulos  10 , Bryan Lau  11 , Geetanjali Chander  12
Affiliations

Alcohol use and the longitudinal HIV care continuum for people with HIV who enrolled in care between 2011 and 2019

Catherine R Lesko et al. Ann Epidemiol. 2023 Sep.

Abstract

Purpose: We described the impact of alcohol use on longitudinal engagement in HIV care including loss to follow-up, durability of viral suppression, and death.

Methods: We followed a cohort of 1781 people with HIV from enrolled in care at one of seven US clinics, 2011-2019 through 102 months. We used a multistate, time-varying Markov process and restricted mean time to summarize engagement in HIV care over follow-up according to baseline self-reported alcohol use (none, moderate, or unhealthy).

Results: Our sample (86% male, 54% White) had median age of 35 years. Over 102 months, people with no, moderate, and unhealthy alcohol use averaged 62.3, 61.1, and 59.5 months virally suppressed, respectively. People who reported unhealthy or moderate alcohol use spent 5.1 (95% confidence intervals (CI): 0.8, 9.3) and 7.6 (95%CI: 3.1, 11.7) more months lost to care than nondrinkers. Compared to no use, unhealthy alcohol use was associated with 3.4 (95%CI: -5.6, -1.6) fewer months in care, not virally suppressed. There were no statistically significant differences after adjustment for demographic and clinical characteristics.

Conclusions: Moderate or unhealthy drinking at enrollment in HIV care was associated with poor retention in care. Alcohol use was not associated with time spent virally suppressed.

Keywords: Alcohol use; Competing risks; Descriptive; HIV care; Multistate model; Survival; Viral suppression.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1.
Figure 1.
Multistate model of the HIV care continuum and valid transition. “In care” was defined as having at least one HIV primary care visit, CD4 count, or viral load in the prior 12 months. “Lost to clinic” is its complement. Viral suppression was defined as most recent viral load ≤400 copies/mL. Antiretroviral therapy (ART) initiation was defined as initiating ≥3 antiretroviral medications on the same day or initiating an approved 2-drug regimen.
Figure 2.
Figure 2.
State occupation probabilities (proportion of the sample estimated to be in each HIV care continuum state) over 8.5 years of follow-up stratified by baseline alcohol use among 1781 antiretroviral therapy-naïve persons who enrolled in the Center for AIDS Clinical Research Network of Integrated Clinical Systems, 2011–2019, and who self-reported alcohol consumption within 1 year of enrollment a Note that while the proportion of the cohort that experiences “Death before ART” is plotted in these figures, it is so small that is is not visible on the graphs
See this image and copyright information in PMC

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