title: Drinking trajectories among HIV-infected men who have sex with men: a cohort study of United States veterans.
abstract: BACKGROUND
  Although high rates of alcohol consumption and related problems have been observed among HIV-infected men who have sex with men (MSM), little is known about the long-term patterns of and factors associated with hazardous alcohol use in this population. We sought to identify alcohol use trajectories and correlates of hazardous alcohol use among HIV-infected MSM.
  
  
  METHODS
  Sexually active, HIV-infected MSM participating in the Veterans Aging Cohort Study were eligible for inclusion. Participants were recruited from VA infectious disease clinics in Atlanta, Baltimore, New York, Houston, Los Angeles, Pittsburgh, and Washington, DC. Data from annual self-reported assessments and group-based trajectory models were used to identify distinct alcohol use trajectories over an eight-year study period (2002-2010). We then used generalized estimate equations (GEE) to examine longitudinal correlates of hazardous alcohol use (defined as an AUDIT-C score ≥4).
  
  
  RESULTS
  Among 1065 participants, the mean age was 45.5 (SD=9.2) and 606 (58.2%) were African American. Baseline hazardous alcohol use was reported by 309 (29.3%). Group-based trajectory modeling revealed a distinct group (12.5% of the sample) with consistently hazardous alcohol use, characterized by a mean AUDIT-C score of >5 at every time point. In a GEE-based multivariable model, hazardous alcohol use was associated with earning <$6000 annually, having an alcohol-related diagnosis, using cannabis, and using cocaine.
  
  
  CONCLUSIONS
  More than 1 in 10 HIV-infected MSM US veterans reported consistent, long-term hazardous alcohol use. Financial insecurity and concurrent substance use were predictors of consistently hazardous alcohol use, and may be modifiable targets for intervention.
authors.affiliation: Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912, USA. Electronic address: brandon_marshall@brown.edu.
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
authors.affiliation: Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI 02912, USA.
authors.forename: Don
authors.initials: D
authors.lastname: Operario
authors.affiliation: National Institute on Alcohol Abuse and Alcoholism, 6000 Executive Blvd, Rockville, MD 20852, USA.
authors.forename: Kendall J
authors.initials: KJ
authors.lastname: Bryant
authors.affiliation: Department of Epidemiology, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Cook
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, 367 Cedar Street, PO Box 20802, New Haven, CT 06520-8025, USA; Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT 06510-2483, USA.
authors.forename: E Jennifer
authors.initials: EJ
authors.lastname: Edelman
authors.affiliation: Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT 06510-2483, USA; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, CT 06520-8034, USA.
authors.forename: Julie R
authors.initials: JR
authors.lastname: Gaither
authors.affiliation: University of Pittsburgh School of Medicine (Mailcode 151-C-H), 7180 Highland Drive, Pittsburgh, PA 15206, USA; VA Pittsburgh Healthcare System, University Drive (151-C), Pittsburgh, PA 15240, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.affiliation: Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI 02912, USA; Center for Alcohol and Addiction Studies and the Alcohol Research Center on HIV (ARCH), Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI 02912, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Kahler
authors.affiliation: Department of Psychology, Syracuse University, 430 University Avenue, Syracuse, NY 13244, USA; VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Avenue, Syracuse, NY 13210, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Maisto
authors.affiliation: VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: McGinnis
authors.affiliation: Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI 02912, USA; Division of Infectious Diseases, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA.
authors.forename: Jacob J
authors.initials: JJ
authors.lastname: van den Berg
authors.affiliation: Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, 4301 West Markham #820, Little Rock, AR 72205, USA.
authors.forename: Nickolas D
authors.initials: ND
authors.lastname: Zaller
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, 367 Cedar Street, PO Box 20802, New Haven, CT 06520-8025, USA; Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT 06510-2483, USA; VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, 367 Cedar Street, PO Box 20802, New Haven, CT 06520-8025, USA; Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT 06510-2483, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology / Q000639:trends*; D015331:Cohort Studies; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D018451:Homosexuality, Male / Q000523:psychology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology
keywords: Alcohol; HIV infection; Men who have sex with men; Trajectories; Trends; Veterans