Characterizing the Association Between Alcohol and HIV Virologic Failure in a Military Cohort on Antiretroviral Therapy

Abstract

Background The effects of at-risk drinking on HIV infection remain controversial. We investigated the impact of self-reported alcohol consumption on surrogate markers of HIV progression among individuals initiated on highly active antiretroviral therapy (HAART). Methods We analyzed individuals who were surveyed on alcohol use within a year of HAART initiation between 2006-14. At-risk drinking was defined as consumption of at least three or four drinks/day, or seven and 14 drinks/week among women and men, respectively. We performed time-updated generalized estimating equation (GEE) logistic regression to determine the effect of at-risk drinking on virologic failure (VF) and mixed-effects linear regression on CD4 count reconstitution, controlling for potential confounders. Results Of 907 individuals initiated on HAART, 752 individuals with alcohol survey data were included in the analysis. Of these, 45% (n=336) met criteria for at-risk drinking at HAART initiation on at least one survey. The rates of VF were 4.30 per 100 person-years (95%CI [2.86, 6.21]) for at-risk drinkers and 2.45 per 100 person-years (95%CI [(1.57,3.65)] for individuals without at-risk drinking. At-risk drinking was not significantly associated with VF (OR 1.73, 95% CI [0.92, 3.25]) 0.087 or CD4 reconstitution (CD4 increase 11.4; 95% CI [-19.8, 42.7]) in univariate analyses; however, in our multivariate model, a statistically significant relationship between VF and at-risk drinking was observed (OR 2.28 [95% CI 1.01, 5.15]). Conclusions We found a high proportion of at-risk drinking in our military cohort, which was predictive of VF in multivariate analysis. Given alcohol's effect on myriad HIV and non-HIV outcomes, interventions to decrease the prevalence of at-risk drinking among HIV-infected individuals are warranted.

Alcohol Use and Human Immunodeficiency Virus (HIV) Infection: Current Knowledge, Implications, and Future Directions

“…Of the several prospective studies conducted in the prehighly active ART era (Chandiwana et al., ; Eskild and Petersen, ; Kaslow et al., ; Penkower et al., ; Tang et al., ; Veugelers et al., ; Webber et al., ), none found an association between alcohol consumption and the onset of the acquired immune deficiency syndrome (AIDS). In the highly active ART era, after controlling for ART use, 4 prospective studies found no association between heavy drinking and HIV disease progression, as measured by CD4 cell count or HIV viral load (Chander et al., ; Cook et al., ; Ghebremichael et al., ; Kowalski et al., ), and 1 identified an increased risk of virological failure associated with heavy alcohol use (Deiss et al., ). Two earlier prospective studies that separately examined HIV disease progression among those not on ART found that heavy alcohol consumption was associated with lower CD4 cell count (Samet et al., ) and shorter time to CD4 cell count <200 cells/mm 3 (Baum et al., ), but not differences in HIV viral load (Baum et al., ; Samet et al., ).…”

Level of Alcohol Use Associated with HIV Care Continuum Targets in a National U.S. Sample of Persons Living with HIV Receiving Healthcare

“…13 Alcohol use is associated with HIV care including: testing 14–16 and diagnosis; 17 care engagement, 18 quality, 19 and retention; 20–23 receipt and use of ART; 24,25 and potentially viral suppression. 26–28 Thus, alcohol use may represent a modifiable influence on HIV care continuum targets. 2928 …”

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

“…While a large literature has reported associations between alcohol use and HIV-relevant outcomes (Williams et al, 2016a), including HIV disease severity (Baum et al, 2010; Deiss et al, 2016; Samet et al, 2007), longitudinal studies are rare. Further longitudinal work is needed to understand which specific patterns of alcohol use increase risks and how changes in alcohol use may alter the course of HIV-related outcomes over time (Williams et al, 2016a).…”