Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
Center for Health Services Research, Rutgers University, New Brunswick, NJ, USA.
Lancet HIV. 2023 Feb;10(2):e118-e125. doi: 10.1016/S2352-3018(22)00361-7.
Alcohol use, tobacco use, and other substance use often co-occur with depression, anxiety, and chronic pain, forming a constellation of alcohol, substance, and mood-related (CASM) conditions that disproportionately affects people with HIV in the USA. We used a microsimulation model to evaluate how alternative screening strategies accounting for CASM interdependence could affect life expectancy in people with HIV in the USA.
We augmented a microsimulation model previously validated to predict US adult life expectancy, including in people with HIV. Using data from the Veterans Aging Cohort Study, we incorporated CASM co-occurrence, inferred causal relationships between CASM conditions, and assessed the effects of CASM on HIV treatment and preventive care. We simulated an in-care HIV cohort exposed to alternative CASM screening and diagnostic assessment strategies, ranging from currently recommended screenings (alcohol, tobacco, and depression, with diagnostic assessments for conditions screening positive) to a series of integrated strategies (screening for alcohol, tobacco, or depression with additional diagnostic assessments if any screened positive) to a maximal saturation strategy (diagnostic assessments for all CASM conditions).
The saturation strategy increased life expectancy by 0·95 years (95% CI 0·93-0·98) compared with no screening. Recommended screenings provided much less benefit: 0·06 years (0·03-0·09) gained from alcohol screening, 0·08 years (0·06-0·11) from tobacco screening, 0·10 years (0·08-0·11) from depression screening, and 0·25 years (0·22-0·27) from all three screenings together. One integrated strategy (screening alcohol, tobacco, and depression with diagnostic assessment for all CASM conditions if any screened positive) produced near-maximal benefit (0·82 years [0·80-0·84]) without adding substantial screening burden, albeit requiring additional diagnostic assessments.
Primary care providers for people with HIV should consider comprehensive diagnostic assessment of CASM conditions if one or more conditions screen positive.
US National Institute on Alcohol Abuse and Alcoholism.
酒精使用、烟草使用和其他物质使用通常与抑郁、焦虑和慢性疼痛同时发生，形成一组与酒精、物质和情绪相关的（CASM）疾病，在美国不成比例地影响艾滋病毒感染者。我们使用微观模拟模型来评估考虑 CASM 相互依存关系的替代筛查策略如何影响美国艾滋病毒感染者的预期寿命。
我们对以前验证过的用于预测美国成年人预期寿命的微观模拟模型进行了扩充，包括艾滋病毒感染者。我们利用退伍军人老龄化队列研究的数据，纳入了 CASM 同时发生的情况，推断了 CASM 疾病之间的因果关系，并评估了 CASM 对艾滋病毒治疗和预防保健的影响。我们模拟了一个接受替代 CASM 筛查和诊断评估策略的在治艾滋病毒队列，这些策略的范围从目前推荐的筛查（酒精、烟草和抑郁，对筛查阳性的情况进行诊断评估）到一系列综合策略（筛查酒精、烟草或抑郁，如果任何一种筛查阳性则进行额外的诊断评估）到最大饱和策略（对所有 CASM 疾病进行诊断评估）。
与不筛查相比，饱和策略使预期寿命增加了 0.95 年（95%CI 0.93-0.98）。推荐的筛查获益甚微：酒精筛查增加 0.06 年（0.03-0.09），烟草筛查增加 0.08 年（0.06-0.11），抑郁筛查增加 0.10 年（0.08-0.11），三项筛查同时进行增加 0.25 年（0.22-0.27）。一种综合策略（如果任何一种筛查阳性，对酒精、烟草和抑郁进行筛查，并对所有 CASM 疾病进行诊断评估）产生了接近最大的效益（0.82 年[0.80-0.84]），而没有增加大量的筛查负担，尽管需要进行额外的诊断评估。
艾滋病毒感染者的初级保健提供者应考虑对 CASM 疾病进行全面的诊断评估，如果一种或多种疾病筛查阳性。
美国国家酒精滥用和酒精中毒研究所。
