Lifetime Drinking Trajectories Among Veterans in Treatment for HIV

Jacob, Theodore; Blonigen, Daniel M.; Upah, Roxanne; Justice, Amy C.

doi:10.1111/acer.12071

Cited by 14 publications

(18 citation statements)

References 43 publications

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“…Finally, the selection and post hoc classification of the final set of drinking trajectories were ultimately subjective processes. However, we relied on established recommendations for group-based trajectory modeling (Jones and Nagin, 2007), and our classifications were informed by previously identified trajectories of alcohol consumption over the lifecourse (Chassin et al, 2002; Cook et al, 2013; Jacob et al, 2013, 2009). …”

Section: Discussionmentioning

confidence: 99%

Drinking trajectories among HIV-infected men who have sex with men: A cohort study of United States veterans

Marshall¹,

Operario²,

Bryant³

et al. 2015

Drug and Alcohol Dependence

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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 1,065 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 <$6,000 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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Section: Discussionmentioning

confidence: 99%

Drinking trajectories among HIV-infected men who have sex with men: A cohort study of United States veterans

Marshall¹,

Operario²,

Bryant³

et al. 2015

Drug and Alcohol Dependence

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“…Also, differences in CD4 T cell counts were not observed. The daily alcohol delivery protocol used in this study models a chronic binge, the most frequent pattern of alcohol abuse in the general population, and one frequently observed in PLWHA (Jacob et al, 2013). Generalization of these findings is limited because of diverse dose- and time-dependent effects of patterns of alcohol consumption, and the use of different ART drug combinations amongst PLWHA.…”

Section: Discussionmentioning

confidence: 99%

Chronic Binge Alcohol Consumption Does Not Diminish Effectiveness of Continuous Antiretroviral Suppression of Viral Load in Simian Immunodeficiency Virus‐Infected Macaques

Molina

Amedee

Veazey

et al. 2014

Alcoholism Clin & Exp Res

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Background Alcohol use disorders (AUD) are a frequent comorbidity in a large percentage of people living with HIV/AIDS (PLWHA). PLWHA with comorbid AUDs are consistently found to perform poorly at most levels of the HIV treatment cascade, resulting in a higher likelihood of virologic non-suppression. This has been partly attributed to lower rates of persistence with and adherence to antiretroviral therapies (ART). Focus groups of in-care PLWHA identify the need to suspend ART on drinking days because of the potential for toxicity and/or lack of therapeutic effectiveness. The aim of this study was to examine whether chronic binge alcohol (CBA) consumption decreases the effectiveness of uninterrupted ART, specifically that of nucleoside reverse transcriptase inhibitors (NRTI) tenofovir and emtricitabine in suppressing viral replication, or results in drug toxicity in simian immunodeficiency virus (SIV) infected rhesus macaques. Methods Daily CBA or isocaloric sucrose (SUC) administration was initiated three months prior to intrarectal SIVmac251 inoculation and continued throughout the study period. ART was initiated 2.5 months after SIV infection and continued through the study period. Results CBA administration did not prevent or delay the ART-mediated reduction in viral load. Following ART, circulating levels of total protein and creatinine were significantly higher than baseline values in both sucrose- and alcohol-treated animals, but still within a normal range. No evidence of ART toxicity was observed in either CBA- or SUC-administered macaques. Conclusions These findings indicate that CBA does not attenuate effectiveness of NRTI suppression of viral load, nor does it appear to interact with NRTI to produce toxicity during the initial 2 months of treatment. We conclude that while efforts to reduce AUD in PLWHA should be a priority, and that counseling on the importance of adherence to ART even on drinking days should also be promoted.

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“…While sociobehavioral, socioeconomic and access to health care differences may explain the differences between Australian and United States outcomes, until the VACS Index is validated in Australia the findings although provocative will remain speculative. Socioeconomic factors have been shown to influence clinical outcomes in contemporary HIV treated populations [16,43]. However, we were unable to account for socioeconomic status factors in our cohort as this data was not systematically collected.…”

Section: Discussionmentioning

confidence: 99%

“…There is widespread speculation as to the cause(s) of ‘accelerated biological ageing’ in individuals with HIV receiving cART. Putative causes include direct HIV effects [12,13], HIV-treatment associated effects [14,15] and behavioral or psychosocial effects [16]. The negative impact of the 'accelerated biological ageing' is speculated to be of such magnitude that many have called for a review of clinical practice and social policy in order to reduce the detrimental effects of 'accelerated biological ageing' in individuals with HIV who are on cART [17].…”

Section: Introductionmentioning

confidence: 99%

Co-Morbidity, Ageing and Predicted Mortality in Antiretroviral Treated Australian Men: A Quantitative Analysis

2013

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BackgroundLife expectancy has increased in HIV-positive individuals receiving combination antiretroviral therapy (cART); however, they still experience increased mortality due to ageing-associated comorbidities compared with HIV-negative individuals.MethodsA retrospective study of 314 Queensland HIV-infected males on cART was conducted. The negative impact of ageing was assessed by estimating the probability of 5-year mortality; comparisons were made between an HIV-specific predictive tool (VACS index) and the Australian Bureau of Statistics (ABS) life-tables to examine potential differences attributed to HIV. The negative impact of ageing was also assessed by the prevalence of comorbidities. Associations between comorbidity and estimates of predicted mortality by regression analysis were assessed.ResultsThe mean predicted 5-year mortality rate was 6% using the VACS index compared with 2.1% using the ABS life-table (p<0.001). The proportion of patients at predicted high risk of mortality (>9%) using the VACS index or ABS life-table were 17% and 1.8% respectively. Comorbidities were also more prevalent in this cohort compared with rates of comorbidities in age-matched Australian men from the general population. Metabolic disease (38.2%) was the most prevalent comorbidity followed by renal (33.1%) and cardiovascular disease (23.9%). Multivariate analysis demonstrated that patients with a history of cardiovascular disease had a higher predicted risk of mortality (OR=1.69;95%CI:1.17-2.45) whereas ex-smokers had a lower predicted risk of mortality (OR=0.61;95%CI:0.41-0.92).ConclusionsUsing the VACS Index there is an increased predicted risk of mortality in cART-treated HIV infected Australian men compared with age-matched men using the ABS data. This increased predicted mortality risk is associated with cardiovascular disease and the number of comorbidities per subject; which suggests that the VACS Index may discriminate between high and low predicted mortality risks in this population. However, until the VACS Index is validated in Australia this data may suggest the VACS Index overestimates predicted mortality risk in this country.

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Lifetime Drinking Trajectories Among Veterans in Treatment for HIV

Cited by 14 publications

References 43 publications

Drinking trajectories among HIV-infected men who have sex with men: A cohort study of United States veterans

Drinking trajectories among HIV-infected men who have sex with men: A cohort study of United States veterans

Chronic Binge Alcohol Consumption Does Not Diminish Effectiveness of Continuous Antiretroviral Suppression of Viral Load in Simian Immunodeficiency Virus‐Infected Macaques

Co-Morbidity, Ageing and Predicted Mortality in Antiretroviral Treated Australian Men: A Quantitative Analysis

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