Alcohol use and HIV disease management: The impact of individual and partner-level alcohol use among HIV-positive men who have sex with men
a Department of Medicine, Center for AIDS Prevention Studies , University of California, San Francisco (UCSF) , San Francisco , CA , USA. AIDS Care
(Impact Factor: 1.6).
11/2013; 26(6). DOI: 10.1080/09540121.2013.855302
Alcohol use among HIV-positive (HIV + ) individuals is associated with decreased adherence to antiretroviral therapy (ART) and consequently poorer HIV treatment outcomes. This study examined the independent association of individual and partner-level alcohol use with HIV disease management among men who have sex with men (MSM) in primary partnerships. In total, 356 HIV+ MSM and their male primary partners completed a baseline visit for a longitudinal study examining the role of couple-level factors in HIV treatment. The Alcohol Use Disorders Identification Test (AUDIT) was administered to assess the individual and the partner-level alcohol use. Primary outcome variables included self-reported ART adherence, ART adherence self-efficacy, and HIV viral load. Results demonstrated that abstainers, compared to hazardous drinkers, had higher self-efficacy to integrate and persevere in HIV treatment and a lower odds of having a detectable viral load. Participants with a partner-abstainer, versus a partner-hazardous drinker, had less self-efficacy to persevere in HIV treatment, a lower odds of 100% three-day adherence and a higher viral load. Together, these findings suggest that assessment and treatment of both the patient's and the patient's primary partner's pattern of alcohol consumption is warranted when attempting to optimize HIV care among MSM.
Available from: Brandon David Lewis Marshall
- "Heavy alcohol use (including " binge " drinking) has been documented as an independent risk factor for HIV seroconversion in some studies (Koblin et al., 2006, Sander et al., 2013), but not in others (Plankey et al., 2007). Additionally, a growing body of literature has established relationships between heavy alcohol use and poorer HIV treatment outcomes among MSM (e.g., lower adherence to antiretroviral therapy resulting in more rapid HIV disease progression) (Woolf-King et al., 2014, Michel et al., 2010). Despite these public health concerns, few longitudinal studies have been conducted to examine the typologies of alcohol use among MSM, and to elucidate how these patterns may change over the lifecourse (Woolf and Maisto, 2009). "
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Heavy episodic drinking (HED) is associated with sexual risk behavior and HIV seroconversion among men who have sex with men (MSM), yet few studies have examined heavy drinking typologies in this population.Methods
We analyzed data from 4,075 HIV-uninfected MSM (aged 16 to 88) participating in EXPLORE, a 48-month behavioral intervention trial, to determine the patterns and predictors of HED trajectories. HED was defined as the number of days in which ≥5 alcohol drinks were consumed in the past 6 months. Longitudinal group-based mixture models were used to identify HED trajectories, and multinomial logistic regression was used to determine correlates of membership in each group.ResultsWe identified 5 distinct HED trajectories: nonheavy drinkers (31.9%); infrequent heavy drinkers (i.e., <10 heavy drinking days per 6-month period, 54.3%); regular heavy drinkers (30 to 45 heavy drinking days per 6 months, 8.4%); drinkers who increased HED over time (average 33 days in the past 6 months to 77 days at end of follow-up, 3.6%); and very frequent heavy drinkers (>100 days per 6 months, 1.7%). Intervention arm did not predict drinking trajectory patterns. Younger age, self-identifying as white, lower educational attainment, depressive symptoms, and stimulant use were associated with reporting heavier drinking trajectories. Compared to nonheavy drinkers, participants who increased HED more often experienced a history of childhood sexual abuse (CSA). Over the study period, depressive symptomatology increased significantly among very frequent heavy drinkers.Conclusions
Socioeconomic factors, substance use, depression, and CSA were associated with heavier drinking patterns among MSM. Multicomponent interventions to reduce HED should seek to mitigate the adverse impacts of low educational attainment, depression, and early traumatic life events on the initiation, continuation, or escalation of frequent HED among MSM.
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Research conducted to date has focused primarily on identifying individual-level, psychological determinants of stimulant use and HIV disease management. The present cross-sectional study examined relationship factors as correlates of stimulant use and HIV disease management among men who have sex with men (MSM).
In total, 266 male couples completed a baseline assessment for a cohort study examining the role of relationship factors in HIV treatment. A computer-based assessment of relationship factors, self-reported alcohol and substance use, and self-reported anti-retroviral therapy (ART) adherence was administered. All HIV-positive participants also provided a blood sample to measure viral load.
After controlling for demographic characteristics and relationship factors, men in a primary relationship with a stimulant-using partner had more than six-fold greater odds of reporting any stimulant use in the past three months. Among HIV-positive participants on ART (n = 371), having a stimulant-using partner was independently associated with 67% lower odds of reporting perfect 30-day ART adherence and more than two-fold greater odds of displaying a detectable HIV viral load. In contrast, more partner-level alcohol use was independently associated with greater odds of reporting perfect 3-day ART adherence and lower odds of displaying a detectable HIV viral load.
Partner-level stimulant use is an important risk factor for individual-level stimulant use and difficulties with HIV disease management among MSM. To optimize the effectiveness of HIV treatment as prevention, clinical research is needed to develop couples–based interventions targeting stimulant use as a potential driver of detectable HIV viral load.
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ABSTRACT: Although high rates of alcohol consumption and related problems have been observed among HIV-infected men who have sex with men (MSM), little is known about the long-term patterns of and factors associated with hazardous alcohol use in this population. We sought to identify alcohol use trajectories and correlates of hazardous alcohol use among HIV-infected MSM.
Sexually active, HIV-infected MSM participating in the Veterans Aging Cohort Study were eligible for inclusion. Participants were recruited from VA infectious disease clinics in Atlanta, Baltimore, New York, Houston, Los Angeles, Pittsburgh, and Washington, DC. Data from annual self-reported assessments and group-based trajectory models were used to identify distinct alcohol use trajectories over an eight-year study period (2002-2010). We then used generalized estimate equations (GEE) to examine longitudinal correlates of hazardous alcohol use (defined as an AUDIT-C score ≥4).
Among 1065 participants, the mean age was 45.5 (SD=9.2) and 606 (58.2%) were African American. Baseline hazardous alcohol use was reported by 309 (29.3%). Group-based trajectory modeling revealed a distinct group (12.5% of the sample) with consistently hazardous alcohol use, characterized by a mean AUDIT-C score of >5 at every time point. In a GEE-based multivariable model, hazardous alcohol use was associated with earning <$6000 annually, having an alcohol-related diagnosis, using cannabis, and using cocaine.
More than 1 in 10 HIV-infected MSM US veterans reported consistent, long-term hazardous alcohol use. Financial insecurity and concurrent substance use were predictors of consistently hazardous alcohol use, and may be modifiable targets for intervention.
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