Association between alcohol consumption trajectories and clinical profiles among women and men living with HIV

<i>Background</i>: Alcohol use is common among persons living with HIV (PLWH). It is unclear how alcohol consumption changes over time and if these changes are associated with clinical profiles. <i>Objective</i>: We aimed to describe the association between longitudinal patterns of alcohol consumption and the clinical profiles of PLWH. <i>Methods</i>: Data from the Women’s Interagency HIV Study (<i>n</i> = 1123 women) and Multicenter AIDS Cohort Study (<i>n</i> = 597 men) from 2004 to 2013 were utilized. Group-based trajectory models were used to assess alcohol consumption patterns across 10 years. Generalized estimating equations were used to identify associations between clinical factors and alcohol consumption. All analyses were stratified by sex. <i>Results</i>: Four trajectories of alcohol use were identified in women and men (women: abstinent 38%, low: 25%, moderate: 30%, heavy: 7%; men: abstinent 16%, low: 69%, moderate: 9%, heavy: 5%). The Framingham Risk Score (women: adjusted odds ratio [AOR] 1.07, 95% confidence interval [CI] 1.04–1.09), years on ART (women: AOR 1.02, CI 1.00–1.05; men: AOR 1.05, CI 1.01–1.09), suboptimal ART adherence (men: AOR 1.23, CI 1.07–1.42), and unsuppressed viral load (women: AOR 1.82, CI 1.56–2.13; men: AOR 1.36, CI 1.17–1.58) were associated with increased odds for moderate drinking. The Framingham Risk Score (women: AOR 1.10, CI 1.07–1.14; men: AOR 1.12, CI 1.06–1.20), suboptimal adherence (women: AOR 1.25, CI 1.04–1.51), and unsuppressed viral load (women: AOR 1.78, CI 1.42–2.24) were associated with increased odds for heavy drinking. <i>Conclusions</i>: Clinicians should consider screening patients for alcohol consumption, particularly if patients have comorbid medical conditions, suboptimal antiretroviral adherence, and/or detectable viral load.

<i>研究背景</i>：酒精使用在人类免疫缺陷病毒感染者（People Living with HIV, PLWH）中十分普遍。目前尚不明确饮酒行为随时间的变化规律，以及此类变化是否与临床特征存在关联。<i>研究目的</i>：本研究旨在探讨饮酒行为的纵向变化模式与人类免疫缺陷病毒感染者临床特征之间的关联。<i>研究方法</i>：本研究纳入2004年至2013年间来自女性跨机构艾滋病研究（Women’s Interagency HIV Study, n=1123名女性）与多中心艾滋病队列研究（Multicenter AIDS Cohort Study, n=597名男性）的数据。研究采用基于分组的轨迹模型评估10年间的饮酒行为模式，并通过广义估计方程分析临床因素与饮酒行为之间的关联，所有分析均按性别进行分层。<i>研究结果</i>：研究在女性与男性群体中均识别出4类饮酒行为轨迹（女性：戒断饮酒38%、低量饮酒25%、中等量饮酒30%、大量饮酒7%；男性：戒断饮酒16%、低量饮酒69%、中等量饮酒9%、大量饮酒5%）。弗雷明汉风险评分（Framingham Risk Score，女性：校正比值比（adjusted odds ratio, AOR）=1.07，95%置信区间（95% confidence interval, CI）=1.04~1.09）、抗逆转录病毒治疗（Antiretroviral Therapy, ART）时长（女性：AOR=1.02，CI=1.00~1.05；男性：AOR=1.05，CI=1.01~1.09）、次优抗逆转录病毒治疗依从性（男性：AOR=1.23，CI=1.07~1.42）以及未被抑制的病毒载量（女性：AOR=1.82，CI=1.56~2.13；男性：AOR=1.36，CI=1.17~1.58）均与中等量饮酒的更高发生风险相关。此外，弗雷明汉风险评分（女性：AOR=1.10，CI=1.07~1.14；男性：AOR=1.12，CI=1.06~1.20）、次优治疗依从性（女性：AOR=1.25，CI=1.04~1.51）以及未被抑制的病毒载量（女性：AOR=1.78，CI=1.42~2.24）均与大量饮酒的更高发生风险相关。<i>研究结论</i>：临床医师应考虑对患者进行饮酒行为筛查，尤其针对合并基础疾病、抗逆转录病毒治疗依从性不佳及/或病毒载量可检测的患者。