title: Not all non-drinkers with HIV are equal: demographic and clinical comparisons among current non-drinkers with and without a history of prior alcohol use disorders.
abstract: Studies of persons living with HIV (PLWH) have compared current non-drinkers to at-risk drinkers without differentiating whether current non-drinkers had a prior alcohol use disorder (AUD). The purpose of this study was to compare current non-drinkers with and without a prior AUD on demographic and clinical characteristics to understand the impact of combining them. We included data from six sites across the US from 1/2013 to 3/2015. Patients completed tablet-based clinical assessments at routine clinic appointments using the most recent assessment. Current non-drinkers were identified by AUDIT-C scores of 0. We identified a prior probable AUD by a prior AUD diagnosis in the electronic medical record (EMR) or a report of attendance at alcohol treatment in the clinical assessment. We used multivariate logistic regression to examine factors associated with prior AUD. Among 2235 PLWH who were current non-drinkers, 36% had a prior AUD with more patients with an AUD identified by the clinical assessment than the EMR. Higher proportions with a prior AUD were male, depressed, and reported current drug use compared to non-drinkers without a prior AUD. Former cocaine/crack (70% vs. 25%), methamphetamine/crystal (49% vs. 16%), and opioid/heroin use (35% vs. 7%) were more commonly reported by those with a prior AUD. In adjusted analyses, male sex, past methamphetamine/crystal use, past marijuana use, past opioid/heroin use, past and current cocaine/crack use, and cigarette use were associated with a prior AUD. In conclusion, this study found that among non-drinking PLWH in routine clinical care, 36% had a prior AUD. We found key differences between those with and without prior AUD in demographic and clinical characteristics, including drug use and depression. These results suggest that non-drinkers are heterogeneous and need further differentiation in studies and that prior alcohol misuse (including alcohol treatment) should be included in behavioural health assessments as part of clinical care.
authors.affiliation: a Department of Medicine , University of Washington , Seattle , WA , USA.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
authors.affiliation: a Department of Medicine , University of Washington , Seattle , WA , USA.
authors.forename: Robin M
authors.initials: RM
authors.lastname: Nance
authors.affiliation: a Department of Medicine , University of Washington , Seattle , WA , USA.
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Merrill
authors.affiliation: b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University , Baltimore , MD , USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Hutton
authors.affiliation: c Department of Medicine , Johns Hopkins University , Baltimore , MD , USA.
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Chander
authors.affiliation: b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University , Baltimore , MD , USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: McCaul
authors.affiliation: d Department of Medicine , University of California , San Diego , CA , USA.
authors.forename: W Chris
authors.initials: WC
authors.lastname: Mathews
authors.affiliation: a Department of Medicine , University of Washington , Seattle , WA , USA.
authors.forename: Rob
authors.initials: R
authors.lastname: Fredericksen
authors.affiliation: e Department of Psychology , University of Washington , Seattle , WA , USA.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Simoni
authors.affiliation: f Fenway Institute and Department of Medicine , Harvard Medical School , Boston , MA , USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mayer
authors.affiliation: g Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.affiliation: g Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA.
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
authors.affiliation: g Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA.
authors.forename: Greer
authors.initials: G
authors.lastname: Burkholder
authors.affiliation: a Department of Medicine , University of Washington , Seattle , WA , USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Drozd
authors.affiliation: h Departments of Behavioral and Social Sciences , Brown University , Providence , RI , USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Mimiaga
authors.affiliation: i Department of Epidemiology , Johns Hopkins University , Baltimore , MD , USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Lau
authors.affiliation: a Department of Medicine , University of Washington , Seattle , WA , USA.
authors.forename: H Nina
authors.initials: HN
authors.lastname: Kim
authors.affiliation: j Department of Psychiatry , University of Alabama at Birmingham , Birmingham , AL , USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Cropsey
authors.affiliation: c Department of Medicine , Johns Hopkins University , Baltimore , MD , USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.affiliation: k Department of Medicine , University of California at San Francisco , San Francisco , CA , USA.
authors.forename: Katerina
authors.initials: K
authors.lastname: Christopoulos
authors.affiliation: k Department of Medicine , University of California at San Francisco , San Francisco , CA , USA.
authors.forename: Elvin
authors.initials: E
authors.lastname: Geng
authors.affiliation: l Department of Medicine , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
authors.affiliation: l Department of Medicine , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.affiliation: a Department of Medicine , University of Washington , Seattle , WA , USA.
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.affiliation: g Department of Medicine , University of Alabama at Birmingham , Birmingham , AL , USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.affiliation: m Department of Epidemiology , University of Washington , Seattle , WA , USA.
authors.forename: Joseph Ac
authors.initials: JA
authors.lastname: Delaney
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*; D019969:Amphetamine-Related Disorders / Q000453:epidemiology; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D003710:Demography; D057286:Electronic Health Records; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology; D012737:Sex Factors; D011795:Surveys and Questionnaires
keywords: HIV; adherence; alcohol use; alcohol use disorders; substance use