Alcohol consumption patterns and HIV viral suppression among persons receiving HIV care in Florida: an observational study

R L Cook, Z Zhou, N E Kelso-Chichetto, J Janelle, J P Morano, C Somboonwit, W Carter, G E Ibanez, N Ennis, C L Cook, R A Cohen, B Brumback, K Bryant, R L Cook, Z Zhou, N E Kelso-Chichetto, J Janelle, J P Morano, C Somboonwit, W Carter, G E Ibanez, N Ennis, C L Cook, R A Cohen, B Brumback, K Bryant

Abstract

Background: Alcohol consumption has been associated with poor antiretroviral therapy (ART) adherence but less is known about its relationship to HIV viral suppression, or whether certain drinking patterns have a stronger association than others. The objectives of this study were to determine the association of different patterns of alcohol consumption to HIV viral suppression and ART adherence, and to determine whether any associations of alcohol with HIV viral suppression were mediated by poor ART adherence.

Methods: This observational study used baseline data from 619 HIV+ participants, recruited across 8 clinical and community settings across Florida as part of the Florida Cohort from 2014 to 2016. Alcohol consumption was measured by self-report, and grouped into four categories: heavy drinking (>7/week for women or >14 drinks/week for men); binge, but not heavy drinking (≥4 or >5 drinks/occasion for women and men, respectively), low level drinking (neither heavy nor binge), and abstinence. Serum HIV RNA measurements were obtained from statewide HIV surveillance data, and durable viral suppression was defined as achieving HIV viral suppression (<200 copies/ml) at every assessment in the past 12 months.

Results: The majority of the 619 participants were male (63%) and aged 45 or greater (65%). The proportion of participants with heavy, binge, low-level drinking and abstinence was 9, 25, 37 and 30%, respectively. Optimal ART adherence (≥95%) was reported by 68%, and 60% achieved durable viral suppression. In multivariable analysis controlling for demographic factors, drug use, and homelessness, heavy drinking (compared to abstinence) was associated with increased odds of failing to achieve durable viral suppression (OR 2.16, 95% CI 1.08-4.32) whereas binge drinking alone was not significantly associated with this outcome (OR 1.04, 95% CI 0.64-1.70). Both heavy drinking and binge drinking were significantly associated with suboptimal ART adherence. Mediation analyses suggested that only a small proportion of the relationship between heavy drinking and suboptimal viral suppression was due to poor ART adherence.

Conclusions: Exceeding weekly recommended levels of alcohol consumption (heavy drinking) was significantly associated with poor HIV viral suppression and ART non-adherence, while binge drinking was associated with suboptimal ART adherence in this sample. Clinicians should attempt to address heavy drinking in their patients with HIV.

Keywords: ART adherence; Alcohol consumption; Binge drinking; HIV; Viral suppression.

Figures

Fig. 1
Fig. 1
Proportion of 579 persons with HIV who are receiving ART that report optimal (≥95%) adherence to antiretroviral treatment in the previous month, according to alcohol consumption classification. Binge drinking defined as exceeding daily (but not weekly) drinking recommendations, and heavy drinking defined as exceeding weekly drinking recommendations. Florida Cohort, 2014–2016
Fig. 2
Fig. 2
Proportion of 619 persons with HIV with durable HIV viral suppression (HIV viral load undetectable or

References

    1. Skarbinski J, Rosenberg E, Paz-Bailey G, Hall HI, Rose CE, Viall AH, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588–596. doi: 10.1001/jamainternmed.2014.8180.
    1. Langford SE, Ananworanich J, Cooper DA. Predictors of disease progression in HIV infection: a review. AIDS Res Ther. 2007;14(4):11. doi: 10.1186/1742-6405-4-11.
    1. FACT SHEET: The national HIV/AIDS strategy: updated to 2020. . 2015 (cited 2015 Sept 30). . Accessed June 2017.
    1. Monroe AK, Lau B, Mugavero MJ, Mathews WC, Mayer KH, Napravnik S, et al. Heavy alcohol use is associated with worse retention in HIV care. J Acquir Immune Defic Syndr. 2016;73(4):419–425. doi: 10.1097/QAI.0000000000001083.
    1. Williams EC, Hahn JA, Saitz R, Bryant K, Lira MC, Samet JH. Alcohol use and human immunodeficiency virus (HIV) infection: current knowledge, implications, and future directions. Alcohol Clin Exp Res. 2016;40(10):2056–2072. doi: 10.1111/acer.13204.
    1. Azar MM, Springer SA, Meyer JP, Altice FL. A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug Alcohol Depend. 2010;112(3):178–193. doi: 10.1016/j.drugalcdep.2010.06.014.
    1. Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr. 2009;52(2):180–202. doi: 10.1097/QAI.0b013e3181b18b6e.
    1. Vagenas P, Azar MM, Copenhaver MM, Springer SA, Molina PE, Altice FL. The impact of alcohol use and related disorders on the HIV continuum of care: a systematic review: alcohol and the HIV continuum of care. Curr HIV/AIDS Rep. 2015;12(4):421–436. doi: 10.1007/s11904-015-0285-5.
    1. Barai N, Monroe A, Lesko C, Lau B, Hutton H, Yang C, et al. The association between changes in alcohol use and changes in antiretroviral therapy adherence and viral suppression among women living with HIV. AIDS Behav. 2017;21(7):1836–1845. doi: 10.1007/s10461-016-1580-x.
    1. Deiss RG, Mesner O, Agan BK, Ganesan A, Okulicz JF, Bavaro M, et al. Characterizing the association between alcohol and HIV virologic failure in a military cohort on antiretroviral therapy. Alcohol Clin Exp Res. 2016;40(3):529–535. doi: 10.1111/acer.12975.
    1. Sacamano PL, Farley JE. Behavioral and other characteristics associated with HIV viral load in an outpatient clinic. PLoS ONE. 2016;11(11):e0166016. doi: 10.1371/journal.pone.0166016.
    1. Conen A, Wang Q, Glass TR, Fux CA, Thurnheer MC, Orasch C, et al. Association of alcohol consumption and HIV surrogate markers in participants of the swiss HIV cohort study. J Acquir Immune Defic Syndr. 2013;64(5):472–478. doi: 10.1097/QAI.0b013e3182a61ea9.
    1. Sullivan KA, Messer LC, Quinlivan EB. Substance abuse, violence, and HIV/AIDS syndemic effects on viral suppression among HIV positive women of color. AIDS Patient Care STDS. 2015;29(Suppl 1):S42–S48. doi: 10.1089/apc.2014.0278.
    1. Cook RL, Clark DB. Is there an association between alcohol consumption and sexually transmitted diseases? A systematic review. Sex Transm Dis. 2005;32(3):156–164. doi: 10.1097/01.olq.0000151418.03899.97.
    1. Kim TW, Kertesz SG, Horton NJ, Tibbetts N, Samet JH. Episodic homelessness and health care utilization in a prospective cohort of HIV-infected persons with alcohol problems. BMC Health Serv Res. 2006;27(6):19. doi: 10.1186/1472-6963-6-19.
    1. Gordon AJ, McGinnis KA, Conigliaro J, Rodriguez-Barradas MC, Rabeneck L, Justice AC, et al. Associations between alcohol use and homelessness with healthcare utilization among human immunodeficiency virus-infected veterans. Med Care. 2006;44(8 Suppl 2):S37–S43. doi: 10.1097/01.mlr.0000223705.00175.3d.
    1. Garey L, Bakhshaie J, Sharp C, Neighbors C, Zvolensky MJ, Gonzalez A. Anxiety, depression, and HIV symptoms among persons living with HIV/AIDS: the role of hazardous drinking. AIDS Care. 2015;27(1):80–85. doi: 10.1080/09540121.2014.956042.
    1. Paulus DJ, Jardin C, Bakhshaie J, Sharp C, Woods SP, Lemaire C, et al. Anxiety sensitivity and hazardous drinking among persons living with HIV/AIDS: an examination of the role of emotion dysregulation. Addict Behav. 2016;63:141–148. doi: 10.1016/j.addbeh.2016.07.013.
    1. Braithwaite RS, Fang Y, Tate J, Mentor SM, Bryant KJ, Fiellin DA, et al. Do alcohol misuse, smoking, and depression vary concordantly or sequentially? A longitudinal study of HIV-infected and matched uninfected veterans in care. AIDS Behav. 2016;20(3):566–572. doi: 10.1007/s10461-015-1117-8.
    1. Green TC, Kershaw T, Lin H, Heimer R, Goulet JL, Kraemer KL, et al. Patterns of drug use and abuse among aging adults with and without HIV: a latent class analysis of a US Veteran cohort. Drug Alcohol Depend. 2010;110(3):208–220. doi: 10.1016/j.drugalcdep.2010.02.020.
    1. Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007;31(7):1208–1217. doi: 10.1111/j.1530-0277.2007.00403.x.
    1. National Institute on Alcohol Abuse and Alcoholism. Helping patients who drink too much: a clinician’s guide. National Institute on Alcohol Abuse and Alcoholism (NIAAA). 2008 (cited 2016 July 24). .
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.
    1. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097. doi: 10.1001/archinte.166.10.1092.
    1. Mekuria LA, Prins JM, Yalew AW, Sprangers MAG, Nieuwkerk PT. Which adherence measure—self-report, clinician recorded or pharmacy refill—is best able to predict detectable viral load in a public ART programme without routine plasma viral load monitoring? Trop Med Int Health. 2016;21(7):856–869. doi: 10.1111/tmi.12709.
    1. Wilson IB, Lee Y, Michaud J, Fowler FJ, Rogers WH. Validation of a new three-item self-report measure for medication adherence. AIDS Behav. 2016;20(11):2700–2708. doi: 10.1007/s10461-016-1406-x.
    1. Wilson IB, Fowler FJ, Cosenza CA, Michaud J, Bentkover J, Rana A, et al. Cognitive and field testing of a new set of medication adherence self-report items for HIV care. AIDS Behav. 2014;18(12):2349–2358. doi: 10.1007/s10461-013-0610-1.
    1. Mannheimer S, Friedland G, Matts J, Child C, Chesney M. The consistency of adherence to antiretroviral therapy predicts biologic outcomes for human immunodeficiency virus-infected persons in clinical trials. Clin Infect Dis. 2002;34(8):1115–1121. doi: 10.1086/339074.
    1. Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21–30. doi: 10.7326/0003-4819-133-1-200007040-00004.
    1. Valeri L, Vanderweele TJ. Mediation analysis allowing for exposure-mediator interactions and causal interpretation: theoretical assumptions and implementation with SAS and SPSS macros. Psychol Methods. 2013;18(2):137–150. doi: 10.1037/a0031034.
    1. Bae JW, Guyer W, Grimm K, Altice FL. Medication persistence in the treatment of HIV infection: a review of the literature and implications for future clinical care and research. AIDS. 2011;25(3):279–290. doi: 10.1097/QAD.0b013e328340feb0.
    1. Viswanathan S, Justice AC, Alexander GC, Brown TT, Gandhi NR, McNicholl IR, et al. Adherence and HIV RNA suppression in the current era of highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2015;69(4):493–498. doi: 10.1097/QAI.0000000000000643.
    1. Cook RL, Zhou Z, Miguez MJ, Brumback B, Lewis J, Espinoza L, et al. Reducing alcohol consumption improved HIV viral suppression in women. Abstract presented at CROI, Seattle, WA; 2017.

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