Alcohol Use and Antiretroviral Adherence Among Patients Living with HIV: Is Change in Alcohol Use Associated with Change in Adherence?

Emily C. Williams, Kathleen A. McGinnis, Anna D. Rubinsky, Theresa E. Matson, Jennifer F. Bobb, Gwen T. Lapham, E. Jennifer Edelman, Derek D. Satre, Sheryl L. Catz, Julie E. Richards, Kendall J. Bryant, Brandon D.L. Marshall, Kevin L. Kraemer, Stephen Crystal, Adam J. Gordon, Melissa Skanderson, David A. Fiellin, Amy C. Justice, Katharine A. Bradley

Publication Date: 09/09/2021

Alcohol use increases non-adherence to antiretroviral therapy (ART) among persons living with HIV (PLWH). Dynamic longitudinal associations are understudied. Veterans Aging Cohort Study (VACS) data 2/1/2008–7/31/16 were used to fit linear regression models estimating changes in adherence (% days with ART medication fill) associated with changes in alcohol use based on annual clinically-ascertained AUDIT-C screening scores (range − 12 to + 12, 0 = no change) adjusting for demographics and initial adherence. Among 21,275 PLWH (67,330 observations), most reported no (48%) or low-level (39%) alcohol use initially, with no (55%) or small (39% ≤ 3 points) annual change. Mean initial adherence was 86% (SD 21%), mean annual change was − 3.1% (SD 21%). An inverted V-shaped association was observed: both increases and decreases in AUDIT-C were associated with greater adherence decreases relative to stable scores [p < 0.001, F (4, 21,274)]. PLWH with dynamic alcohol use (potentially indicative of alcohol use disorder) should be considered for adherence interventions.