Increasing Alcohol Consumption Linked to Worsening HIV Severity

By Will Boggs MD

May 11, 2019

NEW YORK (Reuters Health) - A pattern of increasing alcohol consumption is associated with worsening HIV disease severity, whereas stable consumption is associated with small improvements, according to a national study of VA patients with HIV.

"This study suggests that controlled alcohol use over time, especially non-use or very low-level use, is likely to help optimize health and longevity in people living with HIV," said Dr. Emily C. Williams from Veteran Affairs Puget Sound Health Care System, in Seattle.

"Because many of the factors that influence health among people living with HIV (e.g., presence of comorbid conditions) are not modifiable, alcohol use may be a key lever for optimizing health," she told Reuters Health by email.

Several studies have found that higher levels of alcohol use are associated with greater HIV disease severity and risk of death, but it remains unclear whether individual-level changes in alcohol use over time affect HIV outcomes.

Dr. Williams's team used data from the Veterans Aging Cohort Study (VACS) to evaluate the association between individual-level changes in alcohol use and subsequent changes in the VACS Index 2.0, a sensitive measure of HIV disease severity.

The VACS Index 2.0 scores range from 0 to 164, with higher scores reflecting higher disease severity and increasing risk of mortality.

Among more than 23,000 eligible people with HIV included in the study, 47% reported no and 40% lower-risk alcohol use, based on their initial AUDIT-C scores (which can range from 0 to 12).

Over time, 54% showed no change in AUDIT-C (i.e., stable alcohol consumption), 21% increased drinking and 24% decreased drinking. Most of those showing no change had no (74%) or low-level (23%) alcohol use at baseline, the researchers report in the Journal of Acquired Immune Deficiency Syndromes, online April 6.

Individuals with relatively stable alcohol use (AUDIT-C change of 1 point or less) showed VACS Index 2.0 improvements ranging from 0.36 to 0.60 points, while those showing maximum increased alcohol use had a 3.74-point worsening of VACS Index 2.0.

Maximum decreases in alcohol use were associated with minimal, nonsignificant changes in VACS Index 2.0.

"Though we have seen it in a couple of our other studies and hypothesized it would be so in the study, we remain surprised that decreases in alcohol use are generally not associated with improvements in HIV disease severity/risk of mortality," Dr. Williams said.

"However, these results are more likely due to measurement error than real biological processes," she said. "Specifically, it is hard to measure decreases in drinking because patients may be influenced by social desirability bias (e.g., they may be inclined to tell healthcare providers they have reduced their drinking when it might not be so) and our prior work has shown that clinicians sometimes do not administer or document the alcohol screen accurately. Additionally, the sickest people are more likely to have reduced alcohol use than the healthiest people."

"Despite groundbreaking innovations in prevention and treatment of HIV in the last three decades, the HIV epidemic is ongoing," Dr. Williams said. "Most new infections are being driven by social determinants of health (e.g., stigma and discrimination, social networks) and substance use. Alcohol use decreases the likelihood that people with HIV receive high-quality care for HIV (the optimal way to curb its spread because high quality care suppresses the virus) and increases risk of transmission."

"Because effective interventions are available to address alcohol use, healthcare could play a role in curbing the spread of HIV," she said. "All patients with HIV should be screened for unhealthy alcohol use, and those screening positive should be offered brief counseling interventions. For patients with the most severe unhealthy alcohol use - alcohol use disorders - specialty addictions treatment and/or pharmacotherapy are effective and recommended."


J Acquir Immune Defic Syndr 2019.