Crane Heidi M, Nance Robin M, Merrill Joseph O, Hutton Heidi, Chander Geetanjali, McCaul Mary E, Mathews W Chris, Fredericksen Rob, Simoni Jane M, Mayer Kenneth, Mugavero Michael J, Willig James H, Burkholder Greer, Drozd Daniel R, Mimiaga Matthew, Lau Bryan, Kim H Nina, Cropsey Karen, Moore Richard D, Christopoulos Katerina, Geng Elvin, Eron Joseph J, Napravnik Sonia, Kitahata Mari M, Saag Michael S, Delaney Joseph Ac
a Department of Medicine , University of Washington , Seattle , WA , USA.
b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University , Baltimore , MD , USA.
AIDS Care. 2017 Feb;29(2):177-184. doi: 10.1080/09540121.2016.1204418. Epub 2016 Aug 2.
Studies of persons living with HIV (PLWH) have compared current non-drinkers to at-risk drinkers without differentiating whether current non-drinkers had a prior alcohol use disorder (AUD). The purpose of this study was to compare current non-drinkers with and without a prior AUD on demographic and clinical characteristics to understand the impact of combining them. We included data from six sites across the US from 1/2013 to 3/2015. Patients completed tablet-based clinical assessments at routine clinic appointments using the most recent assessment. Current non-drinkers were identified by AUDIT-C scores of 0. We identified a prior probable AUD by a prior AUD diagnosis in the electronic medical record (EMR) or a report of attendance at alcohol treatment in the clinical assessment. We used multivariate logistic regression to examine factors associated with prior AUD. Among 2235 PLWH who were current non-drinkers, 36% had a prior AUD with more patients with an AUD identified by the clinical assessment than the EMR. Higher proportions with a prior AUD were male, depressed, and reported current drug use compared to non-drinkers without a prior AUD. Former cocaine/crack (70% vs. 25%), methamphetamine/crystal (49% vs. 16%), and opioid/heroin use (35% vs. 7%) were more commonly reported by those with a prior AUD. In adjusted analyses, male sex, past methamphetamine/crystal use, past marijuana use, past opioid/heroin use, past and current cocaine/crack use, and cigarette use were associated with a prior AUD. In conclusion, this study found that among non-drinking PLWH in routine clinical care, 36% had a prior AUD. We found key differences between those with and without prior AUD in demographic and clinical characteristics, including drug use and depression. These results suggest that non-drinkers are heterogeneous and need further differentiation in studies and that prior alcohol misuse (including alcohol treatment) should be included in behavioural health assessments as part of clinical care.
对艾滋病毒感染者（PLWH）的研究将当前的不饮酒者与有酗酒风险的人进行了比较，但没有区分当前的不饮酒者之前是否患有酒精使用障碍（AUD）。本研究的目的是比较有和没有既往AUD的当前不饮酒者在人口统计学和临床特征方面的情况，以了解将他们合并在一起的影响。我们纳入了2013年1月至2015年3月期间美国六个地点的数据。患者在常规门诊预约时使用最新评估完成基于平板电脑的临床评估。通过AUDIT-C评分为0来确定当前的不饮酒者。我们通过电子病历（EMR）中先前的AUD诊断或临床评估中酒精治疗出勤报告来确定先前可能的AUD。我们使用多变量逻辑回归来检查与先前AUD相关的因素。在2235名当前不饮酒的PLWH中，36%有先前的AUD，通过临床评估确定有AUD的患者比通过EMR确定的更多。与没有先前AUD的不饮酒者相比，有先前AUD的男性、抑郁者以及报告当前使用毒品的比例更高。有先前AUD的人更常报告曾经使用可卡因/快克（70%对25%）、甲基苯丙胺/冰毒（49%对16%）和阿片类药物/海洛因（35%对7%）。在调整分析中，男性、过去使用甲基苯丙胺/冰毒、过去使用大麻、过去使用阿片类药物/海洛因、过去和当前使用可卡因/快克以及吸烟与先前的AUD相关。总之，本研究发现，在常规临床护理中的不饮酒PLWH中，36%有先前的AUD。我们发现有和没有先前AUD的人在人口统计学和临床特征方面存在关键差异，包括毒品使用和抑郁。这些结果表明，不饮酒者是异质性的，在研究中需要进一步区分，并且先前的酒精滥用（包括酒精治疗）应作为临床护理的一部分纳入行为健康评估。
