Persistent Unhealthy Drinking Is Associated With More Advanced HIV Disease Severity

Unhealthy alcohol use is common among people living with HIV. Previous studies have found a deleterious impact of drinking on HIV disease progression, probably mediated through effects on treatment adherence and the immune system. However, many previous studies have been limited by a focus on drinking measures at a single time point. Researchers used data from 3539 participants in the Veterans Aging Cohort Study (VACS) between 2002 and 2010 to examine the relationship between alcohol use trajectories and HIV disease severity over time.

• Based on Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) scores, the authors identified 4 distinct alcohol use trajectories: “abstainers” (24%), “lower risk” (44%), “moderate risk” (24%), and “higher risk” (8%).
• Based on the VACS index—a composite measure that predicts mortality and other clinical outcomes—the cohort was divided into 4 disease trajectories: “low risk” (2%), “moderate” (46%), “high” (36%) and “extreme” (16%).
• In multivariable analysis, higher-risk AUDIT-C trajectory was significantly associated with higher-risk VACS index trajectory.

Comments: This study adds to previous research showing a deleterious association between unhealthy alcohol use and HIV outcomes. However, this study cannot tell us much about the reasons for this association and it remains to be seen whether interventions targeting alcohol use in this population can improve clinical outcomes.

Darius A. Rastegar, MD

Reference: Marshall BDL, Tate JP, McGinnis KA, et al. Long-term alcohol use patterns and HIV disease severity. AIDS. 2017;31:1313–1321.