Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

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.

Resumen

El consumo de alcohol aumenta el no-cumplimiento a la terapia antirretroviral (TARV) entre las personas que viven con VIH. No se han estudiado lo suficiente las dinámicas asociaciones longitudinales. Los datos del Estudio de la Envejecimiento de Cohorte de Veteranos (EECV) (1/2/2008–31/7/2016) fueron usados para encajar modelos de regresión lineal estimando los cambios en cumplimiento (% de días con medicaciones TARV surtidas) asociados con los cambios en el consumo de alcohol basado en los resultados anuales de las evaluaciones AUDIT-C, determinadas clínicamente, (una gama de -12 a + 12, 0 = cero cambio) adaptándose a las estadísticas demográficas y cumplimiento inicial. Entre 21,275 personas que viven con VIH (67,330 observaciones), la mayoría reportó ningún (48%) o bajos niveles del (39%) consumo de alcohol inicialmente, con ningún (55%) o muy pequeño (39% ≤ 3 puntos) cambio anual. la media inicial de cumplimiento fue 86% (DE 21%). La media de cambio anual fue -3.1% (DE 21%). Se observó una asociación de forma V invertida: tanto los aumentos como las disminuciones en AUDIT-C fueron asociados con mayor disminuciones de cumplimiento en comparación con resultados estables (p < 0.001, F (4, 21,274)). Personas que viven con VIH con el consumo dinámico de alcohol (potencialmente indicativo de un trastorno por consumo de alcohol) deben ser considerados por intervenciones de cumplimiento.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Pau AK, George JM. Antiretroviral therapy: current drugs. Infect Dis Clin North Am. 2014;28(3):371–402.

    PubMed  PubMed Central  Google Scholar 

  2. Bangsberg DR. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clin Infect Dis. 2006;43(7):939–41.

    CAS  PubMed  Google Scholar 

  3. Kobin AB, Sheth NU. Levels of adherence required for virologic suppression among newer antiretroviral medications. Ann Pharmacother. 2011;45(3):372–9.

    CAS  PubMed  Google Scholar 

  4. Gordon LL, Gharibian D, Chong K, Chun H. Comparison of HIV Virologic Failure Rates Between Patients with Variable Adherence to Three Antiretroviral Regimen Types. Aids Patient Care STDS. 2015;29(7):384–8.

    PubMed  Google Scholar 

  5. Williams EC, Hahn JA, Saitz R, Bryant K, Lira MC, Samet JH. Alcohol use and Human Immunodeficiency Virus (HIV) Infection: current knowledge, implications, and future directions. Alcohol Clin Exp Res. 2016;4(10):2056–72.

    Google Scholar 

  6. Hahn JA, Samet JH. Alcohol and HIV disease progression: weighing the evidence. Curr HIV/AIDS Rep. 2010;7(4):226–33.

    PubMed  PubMed Central  Google Scholar 

  7. Scott-Sheldon LA, Carey KB, Kaiser TS, Knight JM, Carey MP. Alcohol Interventions for Greek Letter Organizations: a systematic review and meta-analysis, 1987 to 2014. Health Psychol. 2016;35(7):670.

    Google Scholar 

  8. Neblett RC, Hutton HE, Lau B, McCaul ME, Moore RD, Chander G. Alcohol consumption among HIV-infected women: impact on time to antiretroviral therapy and survival. J Womens Health. 2011;20(2):279–86.

    Google Scholar 

  9. Justice AC, McGinnis KA, Tate JP, Braithwaite RS, Bryant KJ, Cook RL, et al. Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men. Drug Alcohol Depend. 2016;161:95–103.

    PubMed  PubMed Central  Google Scholar 

  10. Ortego C, Huedo-Medina TB, Llorca J, Sevilla L, Santos P, Rodriguez E, et al. Adherence to highly active antiretroviral therapy (HAART): a meta-analysis. AIDS Behav. 2011;15(7):1381–96.

    PubMed  Google Scholar 

  11. Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr. 2009;52(2):180–202.

    PubMed  PubMed Central  Google Scholar 

  12. Grodensky CA, Golin CE, Ochtera RD, Turner BJ. Systematic review: effect of alcohol intake on adherence to outpatient medication regimens for chronic diseases. J Stud Alcohol Drugs. 2012;73(6):899–910.

    PubMed  Google Scholar 

  13. Williams EC, McGinnis KA, Bobb JF, Rubinsky AD, Lapham GT, Skanderson M, et al. Changes in alcohol use associated with changes in HIV disease severity over time: a national longitudinal study in the Veterans Aging Cohort. Drug Alcohol Depend. 2018;189:21–9.

    PubMed  PubMed Central  Google Scholar 

  14. Williams EC, McGinnis KA, Edelman EJ, Matson TE, Gordon A, Marshall BD, et al. Level of alcohol use associated with HIV care continuum targets in a National US sample of persons living with HIV receiving healthcare. AIDS Behav. 2019;23(1):140–51.

    PubMed  PubMed Central  Google Scholar 

  15. Fisher JD, Amico KR, Fisher WA, Harman JJ. The information-motivation-behavioral skills model of antiretroviral adherence and its applications. Curr HIV/AIDS Rep. 2008;5(4):193–203.

    PubMed  Google Scholar 

  16. Schensul SL, Ha T, Schensul JJ, Vaz M, Singh R, Burleson JA, et al. The role of alcohol on antiretroviral therapy adherence among persons living with HIV in Urban India. J Stud Alcohol Drugs. 2017;78(5):716–24.

    PubMed  PubMed Central  Google Scholar 

  17. Fatch R, Emenyonu NI, Muyindike W, Kekibiina A, Woolf-King S, Hahn JA. Alcohol interactive toxicity beliefs and ART non-adherence among HIV-infected current drinkers in Mbarara, Uganda. AIDS Behav. 2017;21(7):1812–24.

    PubMed  PubMed Central  Google Scholar 

  18. Kalichman SC, Amaral CM, White D, Swetsze C, Kalichman MO, Cherry C, et al. Alcohol and adherence to antiretroviral medications: interactive toxicity beliefs among people living with HIV. J Assoc Nurses AIDS Care. 2012;23(6):511–20.

    PubMed  PubMed Central  Google Scholar 

  19. Kalichman SC, Grebler T, Amaral CM, McNerey M, White D, Kalichman MO, et al. Intentional non-adherence to medications among HIV positive alcohol drinkers: prospective study of interactive toxicity beliefs. J Gen Intern Med. 2013;28(3):399–405.

    PubMed  Google Scholar 

  20. Pellowski JA, Kalichman SC, Kalichman MO, Cherry C. Alcohol-antiretroviral therapy interactive toxicity beliefs and daily medication adherence and alcohol use among people living with HIV. AIDS Care. 2016;28(8):963–70.

    PubMed  PubMed Central  Google Scholar 

  21. Lipira L, Williams EC, Huh D, Kemp CG, Nevin PE, Greene P, et al. HIV-related stigma and viral suppression among African-American women: exploring the mediating roles of depression and ART nonadherence. AIDS Behav. 2019;23(8):2025–36.

    PubMed  PubMed Central  Google Scholar 

  22. Kekwaletswe CT, Jordaan E, Nkosi S, Morojele NK. Social support and the mediating roles of alcohol use and adherence self-efficacy on antiretroviral therapy (ART) adherence among ART recipients in Gauteng, South Africa. AIDS Behav. 2017;21(7):1846–56.

    PubMed  Google Scholar 

  23. Braithwaite RS, McGinnis KA, Conigliaro J, Maisto SA, Crystal S, Day N, et al. A temporal and dose-response association between alcohol consumption and medication adherence among veterans in care. Alcohol Clin Exp Res. 2005;29(7):1190–7.

    PubMed  Google Scholar 

  24. Barai N, Monroe A, Lesko C, Lau B, Hutton H, Yang C, et al. The association between changes in alcohol use and changes in antiretroviral therapy adherence and viral suppression among women living with HIV. AIDS Behav. 2017;21(7):1836–45.

    PubMed  PubMed Central  Google Scholar 

  25. Satre DD, Sarovar V, Leyden W, Hare CB, Catz SL, Bryant KJ, et al. Changes in days of unhealthy alcohol use and antiretroviral therapy adherence, HIV RNA levels, and condomless sex: a secondary analysis of clinical trial data. AIDS Behav. 2019.

  26. Lucas GM, Gebo KA, Chaisson RE, Moore RD. Longitudinal assessment of the effects of drug and alcohol abuse on HIV-1 treatment outcomes in an urban clinic. AIDS. 2002;16(5):767–74.

    PubMed  Google Scholar 

  27. Fultz SL, Skanderson M, Mole LA, Gandhi N, Bryant K, Crystal S, et al. Development and verification of a "virtual" cohort using the National VA Health Information System. Med Care. 2006;44(8 Suppl 2):S25–30.

    PubMed  Google Scholar 

  28. Department of Veterans Affairs. HIV/Hepatitis C QUERI Strategic Plan. 2010. https://www.queri.research.va.gov/about/strategic_plans/hiv.pdf. Washington: U.S. Department of Veterans Affairs.

  29. Bradley KA, Williams EC, Achtmeyer CE, Volpp B, Collins BJ, Kivlahan DR. Implementation of evidence-based alcohol screening in the Veterans Health Administration. Am J Manag Care. 2006;12(10):597–606.

    PubMed  Google Scholar 

  30. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–95.

    CAS  PubMed  Google Scholar 

  31. Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL, et al. Two brief alcohol-screening tests from the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Arch Intern Med. 2003;163(7):821–9.

    PubMed  Google Scholar 

  32. Rubinsky AD, Dawson DA, Williams EC, Kivlahan DR, Bradley KA. AUDIT-C scores as a scaled marker of mean daily drinking, alcohol use disorder severity, and probability of alcohol dependence in a U.S. general population sample of drinkers. Alcohol Clin Exp Res. 2013;37(8):1380–90.

    PubMed  Google Scholar 

  33. Justice AC, Dombrowski E, Conigliaro J, Fultz SL, Gibson D, Madenwald T, et al. Veterans Aging Cohort Study (VACS): overview and description. Med Care. 2006;44(8 Suppl 2):S13–24.

    PubMed  PubMed Central  Google Scholar 

  34. Smith MW, Joseph GJ. Pharmacy data in the VA health care system. Med Care Res Rev. 2003;60(3 Suppl):92S–123S.

    PubMed  Google Scholar 

  35. Aspinall SL, Sales MM, Good CB, Calabrese V, Glassman PA, Burk M, et al. Pharmacy benefits management in the Veterans Health Administration revisited: a decade of advancements, 2004–2014. J Manag Care Spec Pharm. 2016;22(9):1058–63.

    PubMed  Google Scholar 

  36. Choo PW, Rand CS, Inui TS, Lee ML, Cain E, Cordeiro-Breault M, et al. Validation of patient reports, automated pharmacy records, and pill counts with electronic monitoring of adherence to antihypertensive therapy. Med Care. 1999;37(9):846–57.

    CAS  PubMed  Google Scholar 

  37. Ren XS, Kazis LE, Lee A, Zhang H, Miller DR. Identifying patient and physician characteristics that affect compliance with antihypertensive medications. J Clin Pharm Ther. 2002;27:47–56.

    CAS  PubMed  Google Scholar 

  38. Williams EC, McGinnis KA, Tate JP, Matson TE, Rubinsky AD, Bobb JF, et al. HIV disease severity is sensitive to temporal changes in alcohol use: a National Study of VA patients With HIV. J Acquir Immune Defic Syndr. 2019;81(4):448–55.

    PubMed  PubMed Central  Google Scholar 

  39. Bradley KA, McDonell MB, Bush K, Kivlahan DR, Diehr P, Fihn SD. The AUDIT alcohol consumption questions: reliability, validity, and responsiveness to change in older male primary care patients. Alcohol Clin Exp Res. 1998;22(8):1842–9.

    CAS  PubMed  Google Scholar 

  40. Frank D, DeBenedetti AF, Volk RJ, Williams EC, Kivlahan DR, Bradley KA. Effectiveness of the AUDIT-C as a screening test for alcohol misuse in three race/ethnic groups. J Gen Intern Med. 2008;23(6):781–7.

    PubMed  PubMed Central  Google Scholar 

  41. Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007;31(7):1208–17.

    PubMed  Google Scholar 

  42. Johnson JA, Lee A, Vinson D, Seale JP. Use of AUDIT-based measures to identify unhealthy alcohol use and alcohol dependence in primary care: a validation study. Alcohol Clin Exp Res. 2013;37(Suppl 1):E253–E259259.

    PubMed  Google Scholar 

  43. Steiner JF, Koepsell TD, Fihn SD, Inui TS. A general method of compliance assessment using centralized pharmacy records. Description and validation. Med Care. 1988;26(8):814–23.

    CAS  PubMed  Google Scholar 

  44. Braithwaite RS, Kozal MJ, Chang CC, Roberts MS, Fultz SL, Goetz MB, et al. Adherence, virological and immunological outcomes for HIV-infected veterans starting combination antiretroviral therapies. AIDS. 2007;21(12):1579–89.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Steiner JF, Prochazka AV. The assessment of refill compliance using pharmacy records: methods, validity, and applications. J Clin Epidemiol. 1997;50(1):105–16.

    CAS  PubMed  Google Scholar 

  46. Kinder LS, Bryson CL, Sun H, Williams EC, Bradley KA. Alcohol screening scores and all-cause mortality in male Veterans Affairs patients. J Stud Alcohol Drugs. 2009;70(2):253–60.

    PubMed  Google Scholar 

  47. Khamis H, Kepler M. Multivariate cubic spline smoothing in multiple prediction. Comput Methods Prog Biomed. 2002;67(2):131–6.

    Google Scholar 

  48. Holloway IW, Tan D, Dunlap SL, Palmer L, Beougher S, Cederbaum JA. Network support, technology use, depression, and ART adherence among HIV-positive MSM of color. AIDS Care. 2017;29(9):1153–61.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Blashill AJ, Gordon JR, Safren SA. Depression longitudinally mediates the association of appearance concerns to ART non-adherence in HIV-infected individuals with a history of injection drug use. J Behav Med. 2014;37(1):166–72.

    PubMed  Google Scholar 

  50. Sullivan LE, Goulet JL, Justice AC, Fiellin DA. Alcohol consumption and depressive symptoms over time: a longitudinal study of patients with and without HIV infection. Drug Alcohol Depend. 2011;117(2–3):158–63.

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22.

    Google Scholar 

  52. StataCorp. Stata statistical software: release 14. College Station: StataCorp LP; 2015.

    Google Scholar 

  53. Saha TD, Chou SP, Grant BF. Toward an alcohol use disorder continuum using item response theory: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med. 2006;36(7):931–41.

    PubMed  Google Scholar 

  54. Saha TD, Compton WM, Chou SP, Smith S, Ruan WJ, Huang B, et al. Analyses related to the development of DSM-5 criteria for substance use related disorders: 1. Toward amphetamine, cocaine and prescription drug use disorder continua using Item Response Theory. Drug Alcohol Depend. 2012;122(1–2):38–46.

    PubMed  Google Scholar 

  55. Saha TD, Stinson FS, Grant BF. The role of alcohol consumption in future classifications of alcohol use disorders. Drug Alcohol Depend. 2007;89(1):82–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. Rehm J, Baliunas D, Borges GL, Graham K, Irving H, Kehoe T, et al. The relation between different dimensions of alcohol consumption and burden of disease: an overview. Addiction. 2010;105(5):817–43.

    PubMed  PubMed Central  Google Scholar 

  57. Shaper AG, Wannamethee G, Walker M. Alcohol and mortality in British men: explaining the U shaped curve. Lancet. 1988;8623(2):1267–73.

    Google Scholar 

  58. Bradley KA, Lapham GT, Hawkins EJ, Achtmeyer CE, Williams EC, Thomas RM, et al. Quality concerns with routine alcohol screening in VA clinical settings. J Gen Intern Med. 2011;26(3):299–306.

    PubMed  Google Scholar 

  59. McGinnis KA, Tate JP, Williams EC, Skanderson M, Bryant KJ, Gordon AJ, et al. Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients. Drug Alcohol Depend. 2016;168:196–202.

    PubMed  PubMed Central  Google Scholar 

  60. Naar-King S, Parsons JT, Murphy D, Kolmodin K, Harris DR. A multisite randomized trial of a motivational intervention targeting multiple risks in youth living with HIV: initial effects on motivation, self-efficacy, and depression. J Adolesc Health. 2010;46(5):422–8.

    PubMed  PubMed Central  Google Scholar 

  61. Parsons JT, Golub SA, Rosof E, Holder C. Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers: a randomized controlled trial. J Acquir Immune Defic Syndr. 2007;46(4):443–50.

    PubMed  PubMed Central  Google Scholar 

  62. Parsons JT, Rosof E, Punzalan JC, Di Maria L. Integration of motivational interviewing and cognitive behavioral therapy to improve HIV medication adherence and reduce substance use among HIV-positive men and women: results of a pilot project. Aids Patient Care STDS. 2005;19(1):31–9.

    PubMed  Google Scholar 

  63. Matson TE, McGinnis KA, Rubinsky AD, Frost MC, Czarnogorski M, Bryant KJ, et al. Gender and alcohol use: influences on HIV care continuum in a national cohort of patients with HIV. AIDS. 2018;32(15):2247–53.

    PubMed  PubMed Central  Google Scholar 

  64. Williams EC, Achtmeyer CE, Thomas RM, Grossbard JR, Lapham GT, Chavez LJ, et al. Factors underlying quality problems with alcohol screening prompted by a clinical reminder in primary care: a multi-site qualitative study. J Gen Intern Med. 2015;30(8):1125–32.

    PubMed  PubMed Central  Google Scholar 

  65. Bradley KA, Chavez LJ, Lapham GT, Williams EC, Achtmeyer CE, Rubinsky AD, et al. When quality indicators undermine quality: bias in a quality indicator of follow-up for alcohol misuse. Psychiatr Serv. 2013;64(10):1018–25.

    PubMed  PubMed Central  Google Scholar 

  66. Hawkins EJ, Kivlahan DR, Williams EC, Wright SM, Craig T, Bradley KA. Examining quality issues in alcohol misuse screening. Subst Abus. 2007;28(3):53–655.

    PubMed  Google Scholar 

  67. Justice AC, Lasky E, McGinnis KA, Skanderson M, Conigliaro J, Fultz SL, et al. Medical disease and alcohol use among veterans with human immunodeficiency infection: a comparison of disease measurement strategies. Med Care. 2006;44(8 Suppl 2):S52–60.

    PubMed  Google Scholar 

  68. Moore RD, Bartlett JG. Dramatic decline in the HIV-1 RNA level over calendar time in a large urban HIV practice. Clin Infect Dis. 2011;53(6):600–4.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This research was funded by a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA; R21AA022866-01) and supported by the COMpAAAS/Veterans Aging Cohort Study (U24-AA020794, U01-AA020790, U01-AA020795, U01-AA020799; U10 AA013566). Dr. Williams was supported by a Career Development Award from VA Health Services Research & Development (CDt.A 12-276) at the time of this study. Drs. Bradley and Satre are supported by NIAAA K24 awards (AA022128 and AA025703, respectively). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. This work was supported in part with resources and the use of facilities at the VA Puget Sound Health Care System in Seattle, WA. However, the contents of this manuscript do not necessarily represent the views of the U.S. Department of Veterans Affairs or the United States Government.

Author information

Authors and Affiliations

  1. Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA

    Emily C. Williams, Anna D. Rubinsky, Theresa E. Matson, Gwen T. Lapham & Katharine A. Bradley

  2. Department of Health Services, University of Washington, Seattle, WA, USA

    Emily C. Williams, Theresa E. Matson, Julie E. Richards & Katharine A. Bradley

  3. Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA

    Kathleen A. McGinnis, Melissa Skanderson, David A. Fiellin & Amy C. Justice

  4. Kidney Health Research Collaborative, University of California, San Francisco and VA San Francisco Health Care System, San Francisco, CA, USA

    Anna D. Rubinsky

  5. Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA

    Theresa E. Matson, Jennifer F. Bobb, Gwen T. Lapham, Julie E. Richards & Katharine A. Bradley

  6. Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA, USA

    Sheryl L. Catz

  7. National Institute On Alcohol Abuse and Alcoholism, Bethesda, MD, USA

    Kendall J. Bryant

  8. Schools of Medicine and Public Health, Yale University, New Haven, CT, USA

    E. Jennifer Edelman, David A. Fiellin & Amy C. Justice

  9. Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA

    Derek D. Satre

  10. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Derek D. Satre

  11. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA

    Brandon D. L. Marshall

  12. Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Kevin L. Kraemer

  13. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Kevin L. Kraemer

  14. Health Services Research, Rutgers University, New Brunswick, NJ, USA

    Stephen Crystal

  15. Division of Epidemiology, Department of Internal Medicine, Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), University of Utah School of Medicine, Salt Lake City, UT, USA

    Adam J. Gordon

  16. Informatics, Decision-Enhancement, and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA

    Adam J. Gordon

  17. Center of Excellence in Substance Abuse Treatment and Education (CESATE) VA Puget Sound Healthcare System-Seattle Division, Seattle, WA, USA

    Katharine A. Bradley

  18. Department of Medicine, University of Washington, Seattle, WA, USA

    Katharine A. Bradley

Authors
  1. Emily C. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kathleen A. McGinnis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna D. Rubinsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Theresa E. Matson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jennifer F. Bobb
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gwen T. Lapham
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. Jennifer Edelman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Derek D. Satre
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sheryl L. Catz
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Julie E. Richards
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kendall J. Bryant
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Brandon D. L. Marshall
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kevin L. Kraemer
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Stephen Crystal
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Adam J. Gordon
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Melissa Skanderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. David A. Fiellin
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Amy C. Justice
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Katharine A. Bradley
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ECW and KAB served as principal investigators of the study and led its conception and development. ECW, KAB, JFB, KAM, ADR, GTL, and SLC designed the study and analytic plan. ECW, ADR, KAM, and TEM constructed initial drafts of the manuscript. ACJ, DAF, KAM, MS, and JFE all provided data and content knowledge as part of VACS. All authors read and approved the final manuscript. ECW oversaw and takes full responsibility for all aspects from design to results reporting.

Corresponding author

Correspondence to Emily C. Williams.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study, formal consent is not required. This study, including waivers of written consent and HIPAA authorization, was approved by the institutional review boards at VA Puget Sound and VA West Haven Healthcare Systems. All procedures were performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix 1

Appendix 1

See Fig. 3.

Fig. 3
figure 3

Adjusted* Association between Change in AUDIT-C and Change in Percent Days Adherent to Antiretroviral Treatment in a National Sample of Patients Living with HIV: Stratified by Initial AUDIT-C Risk Group (n = 67,330 observations)

Full size image

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Williams, E.C., McGinnis, K.A., Rubinsky, A.D. et al. Alcohol Use and Antiretroviral Adherence Among Patients Living with HIV: Is Change in Alcohol Use Associated with Change in Adherence?. AIDS Behav 25, 203–214 (2021). https://doi.org/10.1007/s10461-020-02950-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-020-02950-x

Keywords

Search

Navigation