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.

饮酒会增加 HIV 感染者 (PLWH) 对抗逆转录病毒治疗 (ART) 的不依从性。动态纵向关联研究不足。退伍军人老龄化队列研究 (VACS) 数据 2/1/2008–7/31/16 用于拟合线性回归模型，根据每年临床确定的与酒精使用变化相关的依从性变化（ART 药物填充天数百分比）估计AUDIT-C 筛查分数（范围 - 12 至 + 12，0 = 无变化）根据人口统计和初始依从性进行调整。在 21,275 名 PLWH（67,330 次观察）中，大多数报告最初没有（48%）或低水平（39%）饮酒，没有（55%）或很小（39% ≤ 3 分）年度变化。平均初始依从率为 86% (SD 21%)，平均年变化为 - 3.1% (SD 21%)。观察到倒 V 形关联：相对于稳定分数，AUDIT-C 的增加和减少都与更大的依从性降低有关 [p < 0.001, F (4, 21,274)]。应考虑对具有动态饮酒（可能表明酒精使用障碍）的 PLWH 进行依从性干预。