Alcohol use and the longitudinal HIV care continuum for people with HIV who enrolled in care between 2011 and 2019

Catherine R Lesko; Jeanine S Gnang; Anthony T Fojo; Heidi E Hutton; Mary E McCaul; Joseph A Delaney; Edward R Cachay; Kenneth H Mayer; Heidi M Crane; D Scott Batey; Sonia Napravnik; Katerina A Christopoulos; Bryan Lau; Geetanjali Chander

doi:10.1016/j.annepidem.2023.07.002

Alcohol use and the longitudinal HIV care continuum for people with HIV who enrolled in care between 2011 and 2019

Ann Epidemiol. 2023 Sep:85:6-12. doi: 10.1016/j.annepidem.2023.07.002. Epub 2023 Jul 12.

Authors

Affiliations

¹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: [email protected].
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
³ School of Medicine, Johns Hopkins University, Baltimore, MD.
⁴ College of Pharmacy, University of Manitoba, Winnipeg, Canada; Department of Epidemiology, University of Washington, Seattle, WA.
⁵ Department of Medicine, Division of Infectious Diseases, University of California San Diego, San Diego, CA.
⁶ School of Medicine, Harvard University, Cambridge, MA.
⁷ Department of Medicine, School of Medicine, University of Washington, Seattle, WA.
⁸ School of Social Work, Tulane University, New Orleans, LA.
⁹ School of Medicine, University of North Carolina, Chapel Hill, NC.
¹⁰ School of Medicine, University of California San Francisco, San Francisco, CA.
¹¹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; School of Medicine, Johns Hopkins University, Baltimore, MD.
¹² School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Medicine, School of Medicine, University of Washington, Seattle, WA.

Abstract

Purpose: We described the impact of alcohol use on longitudinal engagement in HIV care including loss to follow-up, durability of viral suppression, and death.

Methods: We followed a cohort of 1781 people with HIV from enrolled in care at one of seven US clinics, 2011-2019 through 102 months. We used a multistate, time-varying Markov process and restricted mean time to summarize engagement in HIV care over follow-up according to baseline self-reported alcohol use (none, moderate, or unhealthy).

Results: Our sample (86% male, 54% White) had median age of 35 years. Over 102 months, people with no, moderate, and unhealthy alcohol use averaged 62.3, 61.1, and 59.5 months virally suppressed, respectively. People who reported unhealthy or moderate alcohol use spent 5.1 (95% confidence intervals (CI): 0.8, 9.3) and 7.6 (95%CI: 3.1, 11.7) more months lost to care than nondrinkers. Compared to no use, unhealthy alcohol use was associated with 3.4 (95%CI: -5.6, -1.6) fewer months in care, not virally suppressed. There were no statistically significant differences after adjustment for demographic and clinical characteristics.

Conclusions: Moderate or unhealthy drinking at enrollment in HIV care was associated with poor retention in care. Alcohol use was not associated with time spent virally suppressed.

Keywords: Alcohol use; Competing risks; Descriptive; HIV care; Multistate model; Survival; Viral suppression.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Continuity of Patient Care
Female
HIV Infections* / complications
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Humans
Male
Viral Load

Abstract

Publication types

MeSH terms

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