Table 3.
Impact of Alcohol Use Disorders on Health Outcomes: Study Characteristics
| Author, Publication year, Location | Study Design and Evaluation Period | Study Population, Sample Size | Measures of Health Outcomes and Time period of assessment | Alcohol Use Disorder Measure | Level of Health Outcomes | |
|---|---|---|---|---|---|---|
| CD4 count | HIV-1 RNA | |||||
| Chander, 2006, U.S | Prospective Observational Cohort (1998-2003) | 1171 HIV+ persons in urban areas | Viral suppression defined as: HIV-1 RNA ≤400 copies/mL Previous 6 months |
Hazardous drinking defined as: W: ≧7 drinks per week or 3 drinks per occasion M: ≧14 drinks per week or 4 drinks per occasion |
X | Decreased viral suppression with hazardous drinking AOR=0.76 (0.57-0.99) at 95% CI |
| Conen, 2009 Switzerland | Prospective Observational Cohort (2005-2007) | 4519 HIV+ persons on HAART | Detectable viral load defined as: HIV-1 RNA ≥ 400 copies/mL CD4 count <200 cells/mm3 Previous 6 months |
WHO International guide for alcohol consumption and related harm: Light, Moderate, Severe Drinking. | Increased likelihood of CD4 count <200/mm3 in severe drinkers compared to light drinkers AOR=0.81 (-0.30-2.02) at 95% Increased likelihood of CD4 count <200/mm3 in severe drinkers compared to moderate drinkers AOR=0.65(-0.80-2.11)at 95% CI |
Increased likelihood of detectable viral load in severe drinkers compared to light drinkers AOR= -0.10 (-0.32-0.12) at 95% CI Increased likelihood of detectable viral load in severe drinkers compared to moderate drinkers AOR= -0.17 (-0.44-0.09) at 95% CI |
| Conigliaro, 2003, U.S | Prospective Observational Cohort (1999-2000) | 881 HIV+ veterans | Detectable viral load defined as: HIV-1 RNA > 500 copies/mL CD4 count <200 cells/mm3 Previous year |
Hazardous drinking defined as: Score ≧8 using AUDIT or having ≥6 drinks on one occasion in the past month (binge drinking) Alcohol abuse or dependence by ICD-9 |
CD4 count ≤200/mm3 not associated with hazardous drinking P=0.6 CD4 count ≤200/mm3 not associated with alcohol abuse or dependence P=0.9 |
Increased likelihood of detectable viral load in hazardous drinkers compared to non-hazardous drinkers (64.8% vs. 48.2%; P<0.001) Detectable viral load not associated with alcohol abuse or dependence P=0.6 |
| Cook, 2009, U.S | Prospective Observational Cohort (1995-2006) | 2770 HIV+ women | CD4 count between 200-500 cells/mL CD4 count <200 cells/mL CD4 count >500 cells/mL Previous 6 months |
Hazardous drinking defined as: ≧7 drinks per week or 4 drinks per occasion |
Increased likelihood of CD4 counts between 200-500 cells/mL in hazardous drinkers AOR=1.10 (1.00-2.1) at 95% CI CD4 count <200 cells/mL and CD4 count >500 cells/mL not associated with hazardous drinking P>0.05 |
X |
| Henrich, 2008, U.S | Retrospective Cohort (2003-2004) | 239 HIV+ outpatients | Detectable viral load defined as: HIV-1 RNA > 500 copies/mL Mean CD4 count cells/mL change from baseline 18 months |
Alcohol Abuse defined using physician documented history of alcohol abuse | Mean change in CD4 count not associated with alcohol abuse P = 0.866 |
Detectable viral load not associated with alcohol abuse P = 0.629 |
| Palepu, Tyndall, 2003, Canada | Prospective Observational Cohort (1996-2001) | 234 HIV+ Injection drug users | Viral suppression defined as: Two consecutive HIV-1 RNA levels ≤ 500 copies/mL Previous 6 months |
Any self-reported alcohol use in prior 6 months | X | Decreased viral suppression with any alcohol use in prior 6 months AOR=0.31 (0.13-0.81) at 95% CI |
| Rosenbloom, 2007, U.S | Case Control cross sectional Study (2002-2005) | HIV+ men from HIV/AIDS and alcohol and substance abuse treatment centers HIV-Control (N=41) vs. HIV+ without alcohol dependence (N=44) vs. HIV- with Alcohol dependence (N=44) vs. HIV+ with Alcohol dependence (N=55) |
Log viral load (HIV-1 RNA copies/mL) change from baseline CD4 count cells/mL change from baseline Single time point |
Alcohol Dependence by SCID-IV | HIV+ with alcohol dependence not more likely to have decreased CD4 count P>0.05 | HIV+ with alcohol dependence not more likely to have increased log viral load P>0.05 |
| Samet, 2003, U.S | Cross Sectional Study (1997-2001) | 349 HIV+ persons with alcohol problems (205 on HAART) | Mean log10 HIV RNA copies/mL change from baseline Mean CD4 count cells/mL change from baseline Previous month |
Hazardous drinking (reported as At-risk drinking) defined as: W: ≧7 drinks per week or 3 drinks per occasion M: ≧14 drinks per week or 4 drinks |
No association for subjects on HAART, P<0.07 (possible trend) No association for those not on HAART P>0.05 |
Increased log HIV RNA associated with hazardous drinking in subjects on HAART, P<0.006 No association for those not on HAART P>0.05 |
| Samet, 2005, U.S | Randomized Controlled Trial (1997-2000): Multi-component behavioral intervention vs. Standard care for HIV infection |
151 HIV+ persons with alcohol problems | Detectable viral load defined as: HIV-1 RNA > 500 copies/mL Mean Log HIV RNA copies/mL change from baseline Mean CD4 cell count, cells/mm3 change from baseline At baseline, 6 months and 12 months |
Hazardous drinking defined as: W: ≧7 drinks per week or 3 drinks per occasion M: ≧14 drinks per week or 4 drinks per occasion |
Change in mean CD4 count not associated with hazardous drinking P>0.25 | Detectable viral load not associated with hazardous drinking P>0.25 Change in mean log10 HIV RNA not associated with hazardous drinking P>0.25 |
| Samet, 2007, U.S | Prospective Observational Cohort (1997-2003) | 595 HIV+ persons with alcohol problems (354 on HAART) | Mean log10 HIV RNA copies/mL change from baseline Median CD4 count cells/mL change from baseline Previous 6 months |
Hazardous drinking (reported as heavy alcohol consumption) defined as: W+M above 66: ≧7 drinks per week or 4 drinks per occasion M below 66: ≧14 drinks per week or 5 drinks per occasion |
Decreased CD4 count associated with hazardous drinking in subjects not on HAART P =0.03 Change in CD4 count not associated with hazardous drinking in subjects on HAART P=0.9 |
Change in mean log10 HIV RNA not associated with hazardous drinking in subjects on HAART (P= 0.10) or off HAART (P=0.92) |
W=women, M=men
X: Not reported
AOR: Adjusted Odds Ratio
ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification
SCID-IV: Structured Clinical Interview for DSM-IV