Health Services Research & Development (HSR&D), Veteran Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care, Seattle, WA.
Department of Health Services, University of Washington, Seattle, WA.
J Acquir Immune Defic Syndr. 2019 Aug 1;81(4):448-455. doi: 10.1097/QAI.0000000000002049.
Alcohol use influences HIV disease severity through multiple mechanisms. Whether HIV disease severity is sensitive to changes in alcohol use among people with HIV (PWH) is understudied.
National Veterans Health Administration.
Pairs of AUDIT-C screens within 9-15 months (February 1, 2008-September 30, 2014) were identified among PWH from the Veterans Aging Cohort Study (VACS). Initial and follow-up VACS Index 2.0 pairs obtained 0-270 days after initial and follow-up AUDIT-Cs, respectively, determined change in VACS Index 2.0, a composite HIV severity measure. Change in VACS Index 2.0 was regressed on AUDIT-C change scores (-12 to +12) adjusted for demographics, initial VACS Index 2.0, and days between VACS Index measures.
Among 23,297 PWH (76,202 observations), most had no (51%) or low-level (38%) alcohol use initially. Most (54%) had no subsequent change; 21% increased and 24% decreased drinking. Initial VACS Index 2.0 scores ranged from 0 to 134, change scores ranged from -65 to +73, with average improvement of 0.76 points (SD 9.48). AUDIT-C change was associated with VACS Index 2.0 change (P < 0.001). Among those with stable alcohol use (AUDIT-C change ≤ │1│ point), VACS Index 2.0 improvements ranged 0.36-0.60 points. For those with maximum AUDIT-C increase (change from 0 to 12), VACS Index 2.0 worsened 3.74 points (95% CI: -4.71 to -2.78); for those with maximum AUDIT-C decrease (change from 12 to 0), VACS Index 2.0 changed minimally [-0.60 (95% CI: -1.43 to 0.23)].
In this national sample, improvement in HIV severity was generally greatest among those with stable alcohol use (primarily those with no use).
酒精使用通过多种机制影响 HIV 疾病的严重程度。HIV 感染者（PWH）的酒精使用情况是否会导致 HIV 疾病严重程度发生变化，这方面的研究还很少。
美国退伍军人健康管理局。
在退伍军人老龄化队列研究（VACS）中，确定了 2008 年 2 月 1 日至 2014 年 9 月 30 日期间，PWH 在 9-15 个月内（AUDIT-C 筛查）进行的两次 AUDIT-C 筛查。根据 AUDIT-C 筛查，分别在初次和随访后 0-270 天获得初始和随访的 VACS Index 2.0 配对，确定 VACS Index 2.0 的变化，这是一个综合的 HIV 严重程度指标。调整人口统计学、初始 VACS Index 2.0 和 VACS 指标之间的天数后，将 VACS Index 2.0 的变化与 AUDIT-C 变化分数（-12 到+12）进行回归。
在 23297 名 PWH（76202 次观察）中，大多数人最初没有（51%）或低度（38%）饮酒。大多数人（54%）没有后续变化；21%的人增加饮酒量，24%的人减少饮酒量。初始 VACS Index 2.0 评分范围为 0 至 134，变化评分范围为-65 至+73，平均改善 0.76 分（标准差 9.48）。AUDIT-C 变化与 VACS Index 2.0 变化相关（P<0.001）。在酒精使用稳定（AUDIT-C 变化≤1 分）的人群中，VACS Index 2.0 的改善范围为 0.36-0.60 分。对于 AUDIT-C 最大增加（从 0 到 12 的变化）的人群，VACS Index 2.0 恶化了 3.74 分（95%CI：-4.71 至-2.78）；对于 AUDIT-C 最大减少（从 12 到 0 的变化）的人群，VACS Index 2.0 变化很小[-0.60（95%CI：-1.43 至 0.23）]。
在这个全国性样本中，HIV 严重程度的改善通常在酒精使用稳定的人群中最大（主要是无饮酒者）。
