Fair Haven Community Health Care, New Haven, Connecticut, USA.
Yale School of Medicine, New Haven, Connecticut, USA.
Alcohol Clin Exp Res. 2022 Apr;46(4):600-613. doi: 10.1111/acer.14801. Epub 2022 Mar 16.
Heavy episodic drinking (HED) is a risk factor for opioid-related overdose and negatively impacts HIV disease progression. Among a national cohort of patients with HIV (PWH), we examined sociodemographic and clinical correlates of concomitant HED and self-reported opioid use.
We used data collected from 2002 through 2018 from the Veterans Aging Cohort Study, a prospective cohort including PWH in care at eight US Veterans Health Administration sites. HED was defined as consuming six or more drinks at least once in the year prior to survey collection. We examined the relationship between HED and self-reported opioid use and created a 4-level composite variable of HED and opioid use. We used multinomial logistic regression to estimate odds of reporting concomitant HED and self-reported opioid use.
Among 3702 PWH, 1458 (39.4%) reported HED during the study period and 350 (9.5%) reported opioid use. In the multinomial model, compared to reporting neither HED nor opioid use, lifetime housing instability (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.01 to 2.35), Veterans Aging Cohort Study Index 2.0 (a measure of disease severity; aOR 1.14, 95% CI 1.02 to 1.28), depressive symptoms (aOR 2.27, 95% CI 1.42 to 3.62), past-year cigarette smoking (aOR 3.06, 95% CI 1.53 to 6.14), cannabis use (aOR 1.69, 95% CI 1.09 to 2.62), and cocaine/stimulant use (aOR 11.54, 95% CI 7.40 to 17.99) were independently associated with greater odds of concomitant HED and self-reported opioid use. Compared to having attended no college, having some college or more (aOR 0.39, 95% CI 0.26 to 0.59) was associated with lower odds of concomitant HED and self-reported opioid use.
Among PWH, concomitant HED and self-reported opioid use are more common among individuals with depressive symptoms and substance use, structural vulnerabilities, and greater illness severity. Efforts to minimize opioid-related risk should address high-risk drinking as a modifiable risk factor for harm among these groups.
重度间断性饮酒（HED）是阿片类药物相关过量的危险因素，并对 HIV 疾病进展产生负面影响。在一个全国性的 HIV 患者队列中（PWH），我们研究了同时存在 HED 和自我报告阿片类药物使用的社会人口统计学和临床相关性。
我们使用了 2002 年至 2018 年期间从退伍军人老龄化队列研究中收集的数据，这是一个包括在美国退伍军人健康管理局 8 个地点接受护理的 PWH 的前瞻性队列。HED 定义为在调查收集前一年至少一次饮用六杯或更多饮料。我们检查了 HED 和自我报告阿片类药物使用之间的关系，并创建了 HED 和阿片类药物使用的 4 级复合变量。我们使用多项逻辑回归来估计报告同时存在 HED 和自我报告阿片类药物使用的可能性。
在 3702 名 PWH 中，1458 名（39.4%）在研究期间报告 HED，350 名（9.5%）报告阿片类药物使用。在多项模型中，与既不报告 HED 也不报告阿片类药物使用相比，终身住房不稳定（调整后的优势比 [aOR] 1.54，95%置信区间 [CI] 1.01 至 2.35）、退伍军人老龄化队列研究指数 2.0（衡量疾病严重程度的指标；aOR 1.14，95%CI 1.02 至 1.28）、抑郁症状（aOR 2.27，95%CI 1.42 至 3.62）、过去一年吸烟（aOR 3.06，95%CI 1.53 至 6.14）、大麻使用（aOR 1.69，95%CI 1.09 至 2.62）和可卡因/兴奋剂使用（aOR 11.54，95%CI 7.40 至 17.99）与同时存在 HED 和自我报告阿片类药物使用的可能性更高相关。与未上过大学相比，上过一些大学或更多（aOR 0.39，95%CI 0.26 至 0.59）与同时存在 HED 和自我报告阿片类药物使用的可能性更低相关。
在 PWH 中，同时存在 HED 和自我报告阿片类药物使用在有抑郁症状和物质使用、结构性脆弱性和更大疾病严重程度的个体中更为常见。为尽量减少阿片类药物相关风险，应将高危饮酒作为这些人群中危害的可改变风险因素。
