Alcohol and Mortality: Combining Self-Reported (AUDIT-C) and Biomarker Detected (PEth) Alcohol Measures Among HIV Infected and Uninfected. (1st February 2018)

• Record Type: Journal Article
• Authors: Eyawo, Oghenowede; McGinnis, Kathleen A.; Justice, Amy C.; Fiellin, David A.; Hahn, Judith A.; Williams, Emily C.; Gordon, Adam J.; Marshall, Brandon D. L.; Kraemer, Kevin L.; Crystal, Stephen; Gaither, Julie R.; Edelman, E. Jennifer; Bryant, Kendall J.; Tate, Janet P.
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 77:Number 2(2018)
• Publication Date: 2018-02-01
• Subjects: HIV -- HCV -- alcohol -- mortality -- AUDIT-C -- phosphatidylethanol; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000001588
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Background: Unhealthy alcohol use may be particularly detrimental among individuals living with HIV and/or hepatitis C virus (HCV), and is often under-reported. Direct biomarkers of alcohol exposure may facilitate improved detection of alcohol use. Methods: We evaluated the association of alcohol exposure determined by both self-report [Alcohol Use Disorders Identification Test-Consumption (AUDIT-C)] and a direct biomarker [phosphatidylethanol (PEth)], with mortality among HIV-infected and HIV-uninfected in the Veterans Aging Cohort Study-Biomarker Cohort. We considered PEth <8 ng/mL to represent no alcohol use. Alcohol exposure by AUDIT-C scores [0, 1–3/1–2 (men/women), 4–7/3–7 (men/women), 8–12] and PEth (<8, ≥8) was combined into categories to model the relationship of alcohol with mortality. Participants were followed from blood collection date for 5 years or until death within 5 years. Results: The sample included 2344 (1513 HIV+; 831 uninfected) individuals, 95% men. During a median follow-up of 5 years, 13% died. Overall, 36% were infected with HCV (40% HIV+/HCV+, 27% HIV−/HCV+). Overall, 43% (1015/2344) had AUDIT-C = 0 (abstinence). Of these, 15% (149/1015) had PEth ≥8 suggesting recent alcohol exposure. Among those with AUDIT-C = 0, HCV+ individuals were more likely to have PEth ≥8. After controlling for age, sex, race, HIV, HCV, and HIV viral suppression, those with AUDIT-C = 0 but PEth ≥8 had the highest risk of mortality (adjusted hazard ratio 2.15, 95% confidence interval: 1.40 to 3.29). Conclusions: PEth in addition to self-report may improve detection of alcohol use in clinical settings, particularly among those at increased risk of harm from alcohol use. Individuals infected with HCV were more likely to under-report alcohol use.