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

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.

• Authors: Oghenowede Eyawo, Kathleen A McGinnis, Amy C Justice, David A Fiellin, Judith A Hahn, Emily C Williams, Adam J Gordon, Brandon D L Marshall, Kevin L Kraemer, Stephen Crystal, Julie R Gaither, E Jennifer Edelman, Kendall J Bryant, Janet P Tate, VACS Project team
• Journal: Journal of acquired immune deficiency syndromes (1999) (J Acquir Immune Defic Syndr) Vol. 77 Issue 2 Pg. 135-143 (02 01 2018) ISSN: 1944-7884 [Electronic] United States
• PMID: 29112041 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Glycerophospholipids
• phosphatidylethanol

Topics

• Adult
• Aged
• Aged, 80 and over
• Alcoholism (diagnosis, mortality)
• Biomarkers (blood)
• Female
• Glycerophospholipids (blood)
• HIV Infections (complications)
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Self Report