title: Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men.
abstract: BACKGROUND
  HIV infected (HIV+) individuals may be more susceptible to alcohol-related harm than uninfected individuals.
  
  
  METHODS
  We analyzed data on HIV+ and uninfected individuals in the Veterans Aging Cohort Study (VACS) with an Alcohol Use Disorders Identification Test-Consumption AUDIT-C score from 2008 to 2012. We used Cox proportional hazards models to examine the association between alcohol exposure and mortality through July, 2014; and linear regression models to assess the association between alcohol exposure and physiologic injury based on VACS Index Scores. Models were adjusted for age, race/ethnicity, smoking, and hepatitis C infection.
  
  
  RESULTS
  The sample included 18,145 HIV+ and 42,228 uninfected individuals. Among HIV+ individuals, 76% had undetectable HIV-1 RNA (<500 copies/ml). The threshold for an association of alcohol use with mortality and physiologic injury differed by HIV status. Among HIV+ individuals, AUDIT-C score ≥4 (hazard ratio [HR] 1.25, 95% CI 1.09-1.44) and ≥30 drinks per month (HR, 1.30, 95% CI 1.14-1.50) were associated with increased risk of mortality. Among uninfected individuals, AUDIT-C score ≥5 (HR, 1.19, 95% CI 1.07-1.32) and ≥70 drinks per month (HR 1.13, 95% CI 1.00-1.28) were associated with increased risk. Similarly, AUDIT-C threshold scores of 5-7 were associated with physiologic injury among HIV+ individuals (beta 0.47, 95% CI 0.22, 0.73) and a score of 8 or more was associated with injury in uninfected (beta 0.29, 95% CI 0.16, 0.42) individuals.
  
  
  CONCLUSIONS
  Despite antiretroviral therapy, HIV+ individuals experienced increased mortality and physiologic injury at lower levels of alcohol use compared with uninfected individuals. Alcohol consumption limits should be lower among HIV+ individuals.
authors: Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, CT 06510, USA. Electronic address: amy.Justice2@va.gov.
authors: Amy C
authors: AC
authors: Justice
authors: VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA.
authors: Kathleen A
authors: KA
authors: McGinnis
authors: Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, CT 06510, USA.
authors: Janet P
authors: JP
authors: Tate
authors: Department of Population Health New York University School of Medicine, 227 East 30th Street, New York, NY 10016, USA.
authors: R Scott
authors: RS
authors: Braithwaite
authors: National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, MSC 9304, Bethesda, MD 20892-9304, USA.
authors: Kendall J
authors: KJ
authors: Bryant
authors: Department of Epidemiology, University of Florida, PO Box 100231, Gainesville, FL, USA.
authors: Robert L
authors: RL
authors: Cook
authors: Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, CT 06510, USA.
authors: E Jennifer
authors: EJ
authors: Edelman
authors: Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, CT 06510, USA.
authors: Lynn E
authors: LE
authors: Fiellin
authors: Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA; Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, 2525 West End Avenue, Nashville, TN, USA.
authors: Matthew S
authors: MS
authors: Freiberg
authors: VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Suite 600, 230 McKee Place, Pittsburgh, PA 15213, USA.
authors: Adam J
authors: AJ
authors: Gordon
authors: VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Suite 600, 230 McKee Place, Pittsburgh, PA 15213, USA.
authors: Kevin L
authors: KL
authors: Kraemer
authors: Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912, USA.
authors: Brandon D L
authors: BD
authors: Marshall
authors: University of Washington School of Public Health, 325 Ninth Avenue, Box 359762, Seattle, WA, USA.
authors: Emily C
authors: EC
authors: Williams
authors: Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, 950 Campbell Ave, West Haven, CT 06516, USA; Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, CT 06510, USA.
authors: David A
authors: DA
authors: Fiellin
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000401:mortality*; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D016016:Proportional Hazards Models; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology*
keywords: AUDIT-C; Alcohol; HIV; Morbidity; Mortality; VACS Index; Veteran