Changes in alcohol use associated with changes in HIV disease severity over time: A national longitudinal study in the Veterans Aging Cohort

Williams, Emily C.; McGinnis, Kathleen A.; Bobb, Jennifer F.; Rubinsky, Anna D.; Lapham, Gwen T.; Skanderson, Melissa; Catz, Sheryl L.; Bensley, Kara M.; Richards, Julie; Bryant, Kendall; Edelman, E. Jennifer; Satre, Derek D.; Marshall, Brandon D.L.; Kraemer, Kevin L.; Blosnich, John R.; Crystal, Stephen; Gordon, Adam J.; Fiellin, David A.; Justice, Amy C.; Bradley, Katharine A.

doi:10.1016/j.drugalcdep.2018.04.022

Cited by 33 publications

(21 citation statements)

References 37 publications

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“…Furthermore, though alcohol screening is prompted by clinical reminders routinely in VA primary care settings, their use may be more variable across rurality and in infectious disease and/or HIV clinics where veterans with HIV may receive much of their care, especially in rural settings. Although a previous study conducted in a national sample of VA outpatients found that over 90% of patients received an annual screen, and 1 study in a sample of VA patients with HIV found that 87% received at least 1 annual AUDIT‐C screen during the study period, differences in screening rates across rurality have not been described among PLWH. If veterans living with HIV in rural areas are less likely than their urban counterparts to receive alcohol screening, then alcohol use may be undercaptured among PLWH living in rural areas.…”

Section: Discussionmentioning

confidence: 92%

Patterns of Alcohol Use Among Patients Living With HIV in Urban, Large Rural, and Small Rural Areas

Bensley

McGinnis

Fortney

et al. 2018

The Journal of Rural Health

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Background For people living with HIV (PLWH), alcohol use is harmful and may be influenced by unique challenges faced by PLWH living in rural areas. We describe patterns of alcohol use across rurality among PLWH. Methods Veterans Aging Cohort Study electronic health record data were used to identify patients with HIV (ICD‐9 codes for HIV or AIDS) who completed AUDIT‐C alcohol screening between February 1, 2008, and September 30, 2014. Regression models estimated and compared 4 alcohol use outcomes (any use [AUDIT‐C > 0] and alcohol use disorder [AUD; ICD‐9 codes for abuse or dependence] diagnoses among all PLWH, and AUDIT‐C risk categories: lower‐ [1‐3 men/1‐2 women], moderate‐ [4‐5 men/3‐5 women], higher‐ 6‐7]), and severe‐risk [8‐12], and heavy episodic drinking (HED; ≥1 past‐year occasion) among PLWH reporting use) across rurality (urban, large rural, small rural) and census‐defined region. Findings Among 32,699 PLWH (29,540 urban, 1,301 large rural, and 1,828 small rural), both any alcohol use and AUD were highest in urban areas, although this varied across region. Predicted prevalence of any alcohol use was 54.1% (53.5%‐54.7%) in urban, 49.6% (46.9%‐52.3%) in large rural, and 50.6% (48.3%‐52.9%) in small rural areas (P < .01). Predicted prevalence of AUD was 14.4% (14.0%‐14.8%) in urban, 11.8% (10.0%‐13.5%) in large rural, and 12.3% (10.8%‐13.8%) in small rural areas (P < .01). Approximately 12% and 25% had higher‐ or severe‐risk drinking and HED, respectively, but neither differed across rurality. Conclusion Though some variation across rurality and region was observed, alcohol‐related interventions are needed for PLWH across all geographic locations.

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Section: Discussionmentioning

confidence: 92%

Patterns of Alcohol Use Among Patients Living With HIV in Urban, Large Rural, and Small Rural Areas

Bensley

McGinnis

Fortney

et al. 2018

The Journal of Rural Health

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“…Our data suggest that a reduction in drinking to less than unhealthy levels can result in improved HIV‐related clinical outcomes for women, regardless of the specific medication used. While other observational data from clinical trials or longitudinal cohorts have shown increases in drinking to be associated with worse HIV clinical outcomes, little evidence suggests that reductions in drinking are associated with improved HIV‐related outcomes such as HIV viral suppression (Barai et al., ; Williams et al., ). One challenge with traditional longitudinal alcohol studies is that persons may reduce drinking because they have become sicker, causing it to appear that quitting drinking may be more harmful than beneficial (Williams et al., ).…”

Section: Discussionmentioning

confidence: 99%

“…Alcohol consumption is also associated with chronic disease outcomes that are more common in persons with HIV, including liver disease, cardiovascular disease, and cancer (Cao et al., ; Gao and Bataller, ; Kelso et al., ; Park et al., ; Smith et al., ). Longitudinal studies suggest that increases in drinking among WLWH can result in worse HIV‐related clinical outcomes (Barai et al., ; Williams et al., ). However, little hard evidence suggests that reductions in drinking will correlate with improved HIV‐related health outcomes.…”

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confidence: 99%

Reduction in Drinking was Associated With Improved Clinical Outcomes in Women With HIV Infection and Unhealthy Alcohol Use: Results From a Randomized Clinical Trial of Oral Naltrexone Versus Placebo

Cook

Zhou

Míguez

et al. 2019

Alcoholism Clin & Exp Res

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Background: Alcohol consumption is associated with poor health outcomes in women living with HIV (WLWH), but whether medication can help to reduce drinking in non-treatment-seeking women or whether reduction in drinking improves HIV outcomes is unclear. We conducted a randomized clinical trial (RCT) of daily oral naltrexone (50 mg) versus placebo in WLWH who met criteria for current unhealthy alcohol use.Methods: WLWH with current unhealthy alcohol use (>7 drinks/wk or >3 drinks/occasion) were randomly assigned to daily oral naltrexone 50 mg (n = 96) or placebo (n = 98) for 4 months. Drinking outcomes, including the proportion of women who reduced (

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“…In the national Veterans Health Administration (VA)—the largest integrated health care system in the US—delivery of both alcohol screening (to identify patients with unhealthy alcohol use) and brief intervention (for those screening positive for unhealthy alcohol use) are incentivized by national performance measures . The vast majority of VA outpatients is annually screened for unhealthy alcohol use with the 3‐item Alcohol Use Disorders Identification Test Consumption (AUDIT‐C), including patients with HIV . And, though not incentivized by performance measures, specialty addictions treatment and AUD medications are recommended in VA's clinical guideline for treatment of substance use disorders and routinely monitored as part of quality improvement .…”

mentioning

confidence: 99%

“…4,20,21 The vast majority of VA outpatients is annually screened for unhealthy alcohol use with the 3-item Alcohol Use Disorders Identification Test Consumption (AUDIT-C), 21 including patients with HIV. 22 And, though not incentivized by performance measures, specialty addictions treatment and AUD medications are recommended in VA's clinical guideline for treatment of substance use disorders and routinely monitored as part of quality improvement. 23 The VA is also the largest provider of HIV care in the United States.…”

mentioning

confidence: 99%

Differences in Receipt of Alcohol‐Related Care Across Rurality Among VA Patients Living With HIV With Unhealthy Alcohol Use

Bensley

Fortney

Chan

et al. 2019

The Journal of Rural Health

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Purpose It is unknown whether receipt of evidence‐based alcohol‐related care varies by rurality among people living with HIV (PLWH) with unhealthy alcohol use—a population for whom such care is particularly important. Methods All positive screens for unhealthy alcohol use (AUDIT‐C ≥ 5) among PLWH were identified using Veterans Health Administration electronic health record data (10/1/09–5/30/13). Three domains of alcohol‐related care were assessed: brief intervention (BI) within 14 days, and specialty addictions treatment or alcohol use disorder (AUD) medications (filled prescription for naltrexone, disulfiram, acamprosate, or topiramate) within 1 year of positive screen. Adjusted Poisson models and recycled predictions were used to estimate predicted prevalence of outcomes across rurality (urban, large rural, small rural), clustered on facility. Secondary analyses assessed outcomes in the subsample with documented AUD. Findings 4,581 positive screens representing 3,458 PLWH (3,112 urban, 130 large rural, and 216 small rural) were included; 49.1% had diagnosed AUD. PLWH in large rural areas had highest receipt of BI (urban 56.6%, 95% CI: 55.0‐58.2; large rural 66.0%, CI: 58.6‐73.5; small rural 60.7%, CI: 54.6‐67.0). PLWH in urban areas had highest receipt of specialty addictions treatment (urban 28.2%, CI: 26.7‐29.8; large rural 19.7%, CI: 13.1‐26.2; small rural 19.6%, CI: 14.1‐25.0). There was no difference in receipt of AUD medications, although overall receipt was low (3%‐4%). Results were similar in the subsample with AUD. Conclusion Among PLWH with unhealthy alcohol use, those in rural areas may be vulnerable to under‐receipt of specialty addictions treatment. Targeted interventions may help ensure PLWH receive recommended care regardless of rurality.

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Changes in alcohol use associated with changes in HIV disease severity over time: A national longitudinal study in the Veterans Aging Cohort

Abstract: Improvement in HIV severity was greatest among PLWH with relatively stable drinking, most of whom initially did not drink or drank at low levels. Those with large changes (especially increases) in drinking appear at greatest risk for poor HIV control.

Cited by 33 publications

References 37 publications

Patterns of Alcohol Use Among Patients Living With HIV in Urban, Large Rural, and Small Rural Areas

Patterns of Alcohol Use Among Patients Living With HIV in Urban, Large Rural, and Small Rural Areas

Reduction in Drinking was Associated With Improved Clinical Outcomes in Women With HIV Infection and Unhealthy Alcohol Use: Results From a Randomized Clinical Trial of Oral Naltrexone Versus Placebo

Differences in Receipt of Alcohol‐Related Care Across Rurality Among VA Patients Living With HIV With Unhealthy Alcohol Use

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