Detecting alcohol problems in HIV-infected patients: use of the CAGE questionnaire.
The HIV epidemic has been consistently associated with injection drug use and crack cocaine, but alcohol problems in HIV-infected persons are less well described. Our objectives were 2-fold: (1) to assess the prevalence of alcohol problems in HIV-infected patients initiating medical care; and (2) to determine the positive predictive value of the CAGE questionnaire for alcohol abuse or dependence in HIV-infected patients. Between July 1997 and October 2000, we assessed a consecutive series of patients who were establishing primary care for HIV infection (clinic sample), using an established alcohol screening test, the CAGE questionnaire. In addition, we enrolled other HIV-infected patients, including some of the clinic sample, who had two or more positive responses to the CAGE questionnaire into a longitudinal cohort (cohort sample), performed a diagnostic interview for lifetime history of alcohol abuse and dependence, and determined the positive predictive value of CAGE for alcohol diagnoses. In the clinic sample (n = 664), 42% (276 of 664) had two or more positive responses to the four CAGE questions. In the cohort sample (n = 141), 95% (134 of 141) met DSM-IV criteria for diagnosis of lifetime alcohol abuse or dependence. For patients initiating HIV primary care, a history of alcohol problems is very common. The CAGE questionnaire identifies a lifetime history of alcohol abuse or dependence in HIV-infected patients. Routine screening for alcohol problems should be performed in all patients entering HIV medical care and the CAGE questions are useful in this setting.
Samet
Jeffrey H
JH
Department of Medicine, Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston University Schools of Medicine and Public Health, Boston, Massachusetts 02118, USA. jsamet@bu.edu
Phillips
Sharon J
SJ
Horton
Nicholas J
NJ
Traphagen
Elizabeth T
ET
Freedberg
Kenneth A
KA
D000328:Adult; D019973:Alcohol-Related Disorders / Q000150:complications* / Q000175:diagnosis* / Q000523:psychology; D000437:Alcoholism / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000523:psychology; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires