title: Characterizing the Association Between Alcohol and HIV Virologic Failure in a Military Cohort on Antiretroviral Therapy.
abstract: BACKGROUND
  The effects of at-risk drinking on HIV infection remain controversial. We investigated the impact of self-reported alcohol consumption on surrogate markers of HIV progression among individuals initiated on highly active antiretroviral therapy (HAART).
  
  
  METHODS
  We analyzed individuals who were surveyed on alcohol use within a year of HAART initiation between 2006 and 2014. At-risk drinking was defined as consumption of at least 3 or 4 drinks/d, or 7 and 14 drinks/wk among women and men, respectively. We performed time-updated generalized estimating equation logistic regression to determine the effect of at-risk drinking on virologic failure (VF) and mixed-effects linear regression on CD4 count reconstitution, controlling for potential confounders.
  
  
  RESULTS
  Of 801 individuals initiated on HAART, 752 individuals with alcohol survey data were included in the analysis. Of these, 45% (n = 336) met criteria for at-risk drinking at HAART initiation on at least 1 survey. The rates of VF were 4.30 per 100 person-years (95% CI [2.86, 6.21]) for at-risk drinkers and 2.45 per 100 person-years (95% CI [1.57, 3.65]) for individuals without at-risk drinking. At-risk drinking was not significantly associated with VF (OR 1.73, 95% CI [0.92, 3.25]) (p = 0.087) or CD4 reconstitution (CD4 increase 11.4; 95% CI [-19.8, 42.7]) in univariate analyses; however, in our multivariate model, a statistically significant relationship between VF and at-risk drinking was observed (OR 2.28, 95% CI [ 1.01, 5.15]).
  
  
  CONCLUSIONS
  We found a high proportion of at-risk drinking in our military cohort, which was predictive of VF in multivariate analysis. Given alcohol's effect on myriad HIV and non-HIV outcomes, interventions to decrease the prevalence of at-risk drinking among HIV-infected individuals are warranted.
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.|Division of Infectious Diseases, Naval Medical Center of San Diego, San Diego, California.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Deiss
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.
authors.forename: Octavio
authors.initials: O
authors.lastname: Mesner
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Agan
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.|Division of Infectious Diseases, Walter Reed Medical Center, Bethesda, Maryland.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Ganesan
authors.affiliation: Infectious Disease Service, San Antonio Military Medical Center, San Antonio, Texas.
authors.forename: Jason F
authors.initials: JF
authors.lastname: Okulicz
authors.affiliation: Division of Infectious Diseases, Naval Medical Center of San Diego, San Diego, California.
authors.forename: Mary
authors.initials: M
authors.lastname: Bavaro
authors.affiliation: Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.|Division of Infectious Diseases, Naval Medical Center Portsmouth, Portsmouth, Virginia.
authors.forename: Tahaniyat
authors.initials: T
authors.lastname: Lalani
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.|Infectious Disease Service, San Antonio Military Medical Center, San Antonio, Texas.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: O'Bryan
authors.affiliation: Biostatistics Center, Department of Epidemiology and Biostatistics, The George Washington University, Washington, District of Columbia.
authors.forename: Ionut
authors.initials: I
authors.lastname: Bebu
authors.affiliation: Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.|Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland.
authors.forename: Grace E
authors.initials: GE
authors.lastname: Macalino
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D015497:HIV-1; D006801:Humans; D008297:Male; D008889:Military Personnel; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: Alcohol; HIV; Highly Active Antiretroviral Therapy; Military; Virologic Failure