Changing Patterns of Alcohol Use and Probability of Unsuppressed Viral Load Among Treated Patients with HIV Engaged in R
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ORIGINAL PAPER
Changing Patterns of Alcohol Use and Probability of Unsuppressed Viral Load Among Treated Patients with HIV Engaged in Routine Care in the United States Catherine R. Lesko1 · Robin M. Nance2 · Bryan Lau1 · Anthony T. Fojo3 · Heidi E. Hutton4 · Joseph A. C. Delaney5 · Heidi M. Crane2 · Karen L. Cropsey6 · Kenneth H. Mayer7 · Sonia Napravnik8 · Elvin Geng9 · W. Christopher Mathews10 · Mary E. McCaul3,4 · Geetanjali Chander3 on behalf of the CNICS Accepted: 12 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract We examined HIV viral load non-suppression ( ≥ 200 copies/mL) subsequent to person-periods (3–18 months) bookended by two self-reports of alcohol use on a standardized patient reported outcome assessment among adults in routine HIV care. We examined the relative risk (RR) of non-suppression associated with increases and decreases in alcohol use (relative to stable use), stratified by use at the start of the person-period. Increases in drinking from abstinence were associated with higher risk of viral non-suppression (low-risk without binge: RR 1.16, 95% CI 1.03, 1.32; low-risk with binge: RR 1.35, 95% CI 1.11, 1.63; high-risk: RR 1.89, 95% CI 1.16, 3.08). Decreases in drinking from high-risk drinking were weakly, and not statistically significantly associated with lower risk of viral non-suppression. Other changes in alcohol use were not associated with viral load non-suppression. Most changes in alcohol consumption among people using alcohol at baseline were not strongly associated with viral non-suppression. Keywords Alcohol drinking · Drinking behavior · HIV infections · Prospective studies · Patient reported outcome measures · Viral load
Introduction Over half (53–66%) of persons with HIV (PWH) engaged in clinical care report recent alcohol use, one in three report heavy episodic drinking (binge), and between one in four and one in twelve (8–29%) report hazardous alcohol use * Catherine R. Lesko [email protected] 1
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
2
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
3
Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
4
Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
5
College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
[1–5]. Most, but not all, prior studies have reported associations between hazardous or binge drinking and poor clinical outcomes including: lower probability of being retained in HIV care; higher probability of having missed visits; delayed initiation of antiretroviral therapy (ART), worse ART
6
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AB, USA
7
Fenway Health, Beth Israel Medical Center, Harvard Medical School, Boston, MA, USA
8
Division of Infectiou
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