Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100231, Gainesville, FL, 32610, USA.
Department of Medicine, University of Florida, Gainesville, FL, USA.
Addict Sci Clin Pract. 2017 Sep 27;12(1):22. doi: 10.1186/s13722-017-0090-0.
BACKGROUND: Alcohol consumption has been associated with poor antiretroviral therapy (ART) adherence but less is known about its relationship to HIV viral suppression, or whether certain drinking patterns have a stronger association than others. The objectives of this study were to determine the association of different patterns of alcohol consumption to HIV viral suppression and ART adherence, and to determine whether any associations of alcohol with HIV viral suppression were mediated by poor ART adherence. METHODS: This observational study used baseline data from 619 HIV+ participants, recruited across 8 clinical and community settings across Florida as part of the Florida Cohort from 2014 to 2016. Alcohol consumption was measured by self-report, and grouped into four categories: heavy drinking (>7/week for women or >14 drinks/week for men); binge, but not heavy drinking (≥4 or >5 drinks/occasion for women and men, respectively), low level drinking (neither heavy nor binge), and abstinence. Serum HIV RNA measurements were obtained from statewide HIV surveillance data, and durable viral suppression was defined as achieving HIV viral suppression (<200 copies/ml) at every assessment in the past 12 months. RESULTS: The majority of the 619 participants were male (63%) and aged 45 or greater (65%). The proportion of participants with heavy, binge, low-level drinking and abstinence was 9, 25, 37 and 30%, respectively. Optimal ART adherence (≥95%) was reported by 68%, and 60% achieved durable viral suppression. In multivariable analysis controlling for demographic factors, drug use, and homelessness, heavy drinking (compared to abstinence) was associated with increased odds of failing to achieve durable viral suppression (OR 2.16, 95% CI 1.08-4.32) whereas binge drinking alone was not significantly associated with this outcome (OR 1.04, 95% CI 0.64-1.70). Both heavy drinking and binge drinking were significantly associated with suboptimal ART adherence. Mediation analyses suggested that only a small proportion of the relationship between heavy drinking and suboptimal viral suppression was due to poor ART adherence. CONCLUSIONS: Exceeding weekly recommended levels of alcohol consumption (heavy drinking) was significantly associated with poor HIV viral suppression and ART non-adherence, while binge drinking was associated with suboptimal ART adherence in this sample. Clinicians should attempt to address heavy drinking in their patients with HIV.
背景：饮酒与抗逆转录病毒疗法（ART）依从性差有关，但对其与 HIV 病毒抑制的关系知之甚少，也不知道是否某些饮酒模式比其他模式具有更强的相关性。本研究的目的是确定不同饮酒模式与 HIV 病毒抑制和 ART 依从性的关系，并确定与 HIV 病毒抑制相关的任何饮酒因素是否是由 ART 依从性差引起的。
方法：本观察性研究使用了 619 名 HIV 阳性参与者的基线数据，这些参与者是 2014 年至 2016 年期间作为佛罗里达州队列的一部分在佛罗里达州 8 个临床和社区环境中招募的。饮酒情况通过自我报告进行测量，并分为四类：重度饮酒（女性每周 >7 次或男性每周 >14 次）； binge 但非重度饮酒（女性和男性分别为 ≥4 次或 >5 次/次），低水平饮酒（既不重度也不 binge）和戒酒。血清 HIV RNA 测量值来自全州 HIV 监测数据，持久病毒抑制定义为在过去 12 个月的每次评估中均达到 HIV 病毒抑制（<200 拷贝/ml）。
结果：619 名参与者中大多数为男性（63%）和 45 岁或以上（65%）。重度、 binge、低水平饮酒和戒酒的参与者比例分别为 9%、25%、37%和 30%。报告最佳 ART 依从性（≥95%）的参与者占 68%，60%实现了持久的病毒抑制。在控制人口统计学因素、药物使用和无家可归的多变量分析中，与戒酒相比，重度饮酒（与戒酒相比）与未能实现持久病毒抑制的几率增加有关（OR 2.16，95% CI 1.08-4.32），而 binge 饮酒本身与该结果无显著相关性（OR 1.04，95% CI 0.64-1.70）。重度饮酒和 binge 饮酒均与 ART 依从性差有显著相关性。中介分析表明，重度饮酒与病毒抑制不佳之间的关系只有一小部分归因于 ART 依从性差。
结论：超过每周推荐的饮酒水平（重度饮酒）与 HIV 病毒抑制不良和 ART 不依从显著相关，而 binge 饮酒与该样本中 ART 依从性不佳相关。临床医生应尝试解决其 HIV 患者的重度饮酒问题。
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