Alcohol and Mortality: Combining Self-Reported (AUDIT-C) and Biomarker Detected (PEth) Alcohol Measures Among HIV Infected and Uninfected.
- 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; VACS Project team
- Year
- 2018
- Journal
- Journal of acquired immune deficiency syndromes (1999)
- PMID
- 29112041
- DOI
- 10.1097/QAI.0000000000001588
- PMCID
- PMC5762259
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.
Figure 1a. Percent with PEth ≥8 by AUDIT-C, HIV and HCV Status Among the Full Sample (N = 2344)Figure 1b. Percent with PEth ≥8 by AUDIT-C, HIV and HCV StatusAmong the Restricted Sample (N = 682)* AUDIT-C summary score 1–3 for men and 1–2 for women** AUDIT-C summary score 4–7 for men and 3–7 for women
Figure 2a. Association of Alcohol Exposure with Five-Year Mortality Among HIV+ and Uninfected Individuals Among the Full Sample (N= 2344)Figure 2b. Association of Alcohol Exposure with Five-Year Mortality Among HIV+ and Uninfected Individuals Among the Restricted Sample (N = 682)Note: model adjusted for age, sex, race/ethnicity, HIV, HCV and HIV viral suppression. We used different AUDIT-C threshold to determine unhealthy alcohol use in men and women.* AUDIT-C summary score 1–3 for men and 1–2 for women** AUDIT-C summary score 4–7 for men and 3–7 for womenAUDIT-C, Alcohol Use Disorders Identification Test-ConsumptionPEth, Phosphatidylethanol
| Name | Type |
|---|---|
| abstinence | phenotype |
| African American | cohort |
| age | phenotype |
| alcohol | phenotype |
| Alcohol Exposure | phenotype |
| Alcohol Use | phenotype |
| All-cause five-year mortality local | phenotype |
| All-cause morbidity and mortality local | phenotype |
| all-cause mortality | phenotype |
| At-risk drinking local | cohort |
| AUDIT-C | phenotype |
| AUDIT-C survey local | drug |
| AUDIT-C trajectory models local | phenotype |
| binge drinking | phenotype |
| College education | phenotype |
| current smoking | phenotype |
| disease progression | phenotype |
| full sample | cohort |
| HCV local | cohort |
| HCV local | phenotype |
| HCV+ local | cohort |
| HCV- local | cohort |
| HCV-infected individuals local | cohort |
| HCV infection local | phenotype |
| HCV status local | phenotype |
| heavy drinking | phenotype |
| Hepatic disorders local | phenotype |
| Hepatitis C infection local | phenotype |
| High risk AUDIT-C local | phenotype |
| High risk drinking local | cohort |
| Hispanic/Other local | phenotype |
| HIV local | cohort |
| HIV+ local | cohort |
| HIV+ | drug |
| HIV- local | cohort |
| HIV+/HCV+ co-infected local | cohort |
| HIV/HCV co-infected individuals local | cohort |
| HIV+ individuals local | cohort |
| HIV+ individuals in Uganda local | cohort |
| HIV-infected local | cohort |
| HIV infection | phenotype |
| HIV medication adherence local | phenotype |
| HIV status local | phenotype |
| HIV-uninfected comparators local | cohort |
| HIV viral suppression local | phenotype |
| human alcoholics | phenotype |
| illicit drugs | phenotype |
| IV drug use local | phenotype |
| Liver-related morbidity local | phenotype |
| Lower risk drinking local | cohort |
| Lower risk drinking local | phenotype |
| Medicare Vital Status File local | cohort |
| men | cohort |
| mortality | phenotype |
| mortality risk local | phenotype |
| Negative PEth local | phenotype |
| participants | cohort |
| Past-year abstinence local | phenotype |
| patients | cohort |
| PEth local | other |
| PEth ≥ 50 ng/mL local | drug |
| PEth < 8 ng/mL local | drug |
| PEth ≥ 8 ng/mL local | drug |
| PEth ≥8 ng/mL local | drug |
| PEth assay local | drug |
| Phosphatidylcholine | drug |
| phosphatidylethanol | drug |
| Phosphatidylethanol species 16:0/18:1 local | drug |
| Phospholipase D | drug |
| Plasma HIV RNA local | drug |
| positive PEth local | phenotype |
| Positive PEth local | phenotype |
| race/ethnicity | phenotype |
| Recent alcohol consumption | phenotype |
| Restricted sample local | cohort |
| self-reported abstinence | phenotype |
| Self-reported abstinence local | cohort |
| Self-reported alcohol consumption | phenotype |
| sex | phenotype |
| smoking | phenotype |
| smoking status | phenotype |
| Social Security Death Master File local | cohort |
| Suppressed viral load local | phenotype |
| under-reporting alcohol exposure local | phenotype |
| Under-report of alcohol use local | phenotype |
| unhealthy alcohol use | phenotype |
| Unhealthy alcohol use local | drug |
| Uninfected local | cohort |
| Uninfected local | phenotype |
| Uninfected individuals local | cohort |
| Uninfected individuals local | phenotype |
| VACS-BC local | cohort |
| VACS-Biomarker Cohort local | cohort |
| VACS survey participants local | cohort |
| VACS surveys local | cohort |
| VA sites local | cohort |
| VA vital status file local | cohort |
| Veterans Aging Cohort Study | cohort |
| Viral suppression local | phenotype |
| White | phenotype |
| women | cohort |
| young people in San Francisco who inject drugs local | cohort |
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In this knowledge base
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