Title

Association between changes in hazardous drinking and subsequent antiretroviral medication adherence, HIV viral control, and condomless sex

Presenter

Derek Satre

Authors

D. Satre^1,2, W. Leyden², C. Hare³, S. Catz⁴, M. Horberg⁵, E. Williams⁶, M. Silverberg²

Institutions

¹University of California, Psychiatry, San Francisco, United States, ²Kaiser Permanente, Division of Research, Oakland, United States, ³Kaiser Permanente, San Francisco, United States, ⁴University of California, Davis, United States, ⁵Kaiser Permanente Mid-Atlantic States, Rockville, United States, ⁶University of Washington, Seattle, United States

Background: Previous studies of people with HIV (PWH) have found that hazardous drinking is common, and associated with condomless sex, worse antiretroviral (ART) adherence, and worse viral control. Here, we examined the association between changes in hazardous drinking and these outcomes in a sample of PWH.
Methods: Participants included 614 PWH from an HIV clinic in San Francisco, randomized to three alcohol interventions. The sample was 16% Hispanic, 10% Black, 63% White, 7% other; 97% male; with mean age of 49 years. Data included follow-up interviews at 6, 12 and 24 months, with self-reported alcohol measures (any days drinking over 4/5 drinks for women/men respectively, in the prior 30 days), any condomless sex with a negative/unknown status partner, ART adherence >95%; and HIV viral suppression (HIV RNA < 75/mL). The primary exposure was change in alcohol use compared with baseline, categorized as an increase (any, and ≥3 days), decrease (any, and ≥3 days) or no change (reference). Odds ratios were obtained using GEE methods that accounted for repeated observations, adjusting for demographics.
Results: At 24 months, 40% reported a decrease in hazardous drinking frequency (20% ≥3 days), 9% reported an increase (4% ≥3 days), and 51% reported no change. In adjusted models, any increase in hazardous drinking was associated with lower rates of ART adherence >95% (OR = 0.67, 95% CI = 0.45, 0.99, p = 0.046), and greater odds of condomless sex (OR = 1.41, 95% CI = 1.0, 2.0, p = 0.053). Those who reported a greater decrease in drinking (reduced by ≥3 days), had better HIV viral suppression in bivariate analysis (p < 0.03), which was not significant in the adjusted analysis (OR = 0.65, 95% CI = 0.39, 1.11, p = 0.112).
Conclusions: In this sample of PWH enrolled in a primary-care based alcohol intervention study, an increase in hazardous drinking was associated with worse ART adherence and higher prevalence of sexual HIV transmission risk behavior. Increased hazardous drinking should be an indicator to providers that PWH are at risk for other problems such as worse HIV treatment adherence and condomless sex.