Prevalence and Factors Associated with Hazardous Alcohol Use Among Persons Living with HIV Across the US in the Current Era of Antiretroviral Treatment
Open accessAbstract
Hazardous alcohol use is associated with detrimental health outcomes among persons living with HIV (PLWH). We examined the prevalence and factors associated with hazardous alcohol use in the current era using several hazardous drinking definitions and binge drinking defined as ≥5 drinks for men versus ≥4 for women. We included 8567 PLWH from 7 U.S. sites from 2013 to 2015. Current hazardous alcohol use was reported by 27% and 34% reported binge drinking. In adjusted analyses, current and past cocaine/crack (odd ratio [OR] 4.1:3.3–5.1, p < 0.001 and OR 1.3:1.1–1.5, p < 0.001 respectively), marijuana (OR 2.5:2.2–2.9, p < 0.001 and OR 1.4:1.2–1.6, p < 0.001), and cigarette use (OR 1.4:1.2–1.6, p < 0.001 and OR 1.3:1.2–1.5, p < 0.001) were associated with increased hazardous alcohol use. The prevalence of hazardous alcohol use remains high in the current era, particularly among younger men. Routine screening and targeted interventions for hazardous alcohol use, potentially bundled with interventions for other drugs, remain a key aspect of HIV care.ResumenEl consumo riesgoso de alcohol se asocia a los resultados adversos de salud entre las personas que viven con VIH (PLWH, por sus siglas en inglés). Estudiamos la preponderancia y los factores asociados al consumo riesgoso en la época actual con el uso de distintas definiciones de beber alcohol en forma riesgosa y consumir alcohol en forma desmedida, que se define como el consumo de ≥ 5 tragos para hombres y ≥ 4 tragos para mujeres. Incluimos a 8567 PLWH de 7 lugares distintos de EE. UU entre 2013 y 2015. El 27% informó de consumo de alcohol en forma riesgosa y el 34% informó de consumo de alcohol en forma desmedida en la actualidad. En el análisis ajustado, el consumo actual y pasado de cocaína o crack (índice de probabilidad [OR, por sus siglas en inglés] 4,1:3,3-5,1, p < 0,001 y OR 1,3:1,1-1,5, p < 0,001, respectivamente), marihuana (OR 2,5:2,2-2,9, p < 0,001 y OR 1,4:1,2-1,6, p < 0,001) y consumo de cigarrillo (OR 1,4:1,2-1,6, p < 0,001 y OR 1,3:1,2-1,5, p < 0,001) se asoció al consumo de alcohol cada vez más riesgoso. La prevalencia del consumo de alcohol en forma riesgosa permanece alta en la actualidad, en especial entre los hombres más jóvenes. Los análisis de rutina y las intervenciones dirigidas a públicos específicos para abordar el consumo riesgoso de alcohol, posiblemente en conjunto con intervenciones para abordar el consumo de otras drogas, sigue siendo un aspecto clave del tratamiento contra el VIH.
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Unhealthy alcohol use is prevalent among people with HIV, with 27-40% reporting drinking at unhealthy levels.
“Unhealthy alcohol use is prevalent among people with HIV (PWH) and associated with significant health-related consequences.”
From A Randomized Feasibility/Acceptability Trial of Acceptance and Commitment Therapy for People with HIV Who Drink at Unhealthy Levels. (2026) · cites this paper as [3]
The Results section reports hazardous alcohol use in 27% of the people with HIV studied, supporting that it is prevalent. It does not report 40% for the overall group; the 38% figure applies only to participants reporting current illicit drug use. The Introduction also describes detrimental health outcomes associated with hazardous alcohol use. (LLM, conf=0.87)
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Duko, B., Ayalew, M., & Ayano, G. (2019) · Substance Abuse Treatment, Prevention, and Policy · doi:10.1186/s13011-019-0240-3 · Cited by 209 · see citing works
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“…on HIV care outcomes underscore the need to develop and evaluate interventions to reduce heavy drinking in PLWH. Men, and in particular men who have sex with men (MSM), have the highest rates of heavy drinking and alcohol use disorders among PLWH (Crane et al., 2017; Hartzler et al., 2017).”
Self-citationLipira, L., Rao, D., Nevin, P. E., Kemp, C. G., Cohn, S. E., Turan, J. M., Simoni, J. M., Andrasik, M. P., French, A. L., Unger, J. M., et al. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2019.107753 · Cited by 23 · see citing works
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Kahler, C. W., Surace, A., Liu, T., Pantalone, D. W., Mastroleo, N. R., Yan, Y., Wray, T. B., Mayer, K. H., & Monti, P. M. (2024) · AIDS and Behavior · doi:10.1007/s10461-024-04493-x · Cited by 4 · see citing works
“Sexual minority men (SMM), including gay, bisexual, and other men who have sex with men, constitute the majority of PWH in the United States [3] and report relatively high rates of alcohol misuse compared to other PWH [1].”
Self-citationWoolf-King, S. E., Dalton, M. R., Firkey, M., Sheinfil, A., Bucci, V., Estrada, B., Ramos, J., Hahn, J. A., Bricker, J., Gump, B., et al. (2026) · AIDS and Behavior · doi:10.1007/s10461-025-04990-7 · Cited by 1 · see citing works
- Authors
- Crane, H. M., McCaul, M. E., Chander, G., Hutton, H., Nance, R. M., Delaney, J. A. C., Merrill, J. O., Lau, B., Mayer, K. H., Mugavero, M. J., Mimiaga, M., Willig, J. H., Burkholder, G. A., Drozd, D. R., Fredericksen, R. J., Cropsey, K., Moore, R. D., Simoni, J. M., Christopher Mathews, W., Eron, J. J., Napravnik, S., Christopoulos, K., Geng, E., Saag, M. S., & Kitahata, M. M.
- Affiliations
- University of Washington (US)
- Johns Hopkins University (US)
- Harvard University (US)
- University of Alabama at Birmingham (US)
- University of North Carolina at Chapel Hill (US)
- University of California, San Francisco (US)
- Corresponding author
- Crane, Heidi M.
- ORCID
- Crane, Heidi M.
- McCaul, Mary E.
- Chander, Geetanjali
- Hutton, Heidi
- Nance, Robin M.
- Delaney, Joseph A. C.
- Merrill, Joseph O.
- Lau, Bryan
- Mayer, Kenneth H.
- Mugavero, Michael J.
- Mimiaga, Matthew
- Willig, James H.
- Burkholder, Greer A.
- Fredericksen, Rob J.
- Cropsey, Karen
- Moore, Richard D.
- Simoni, Jane M.
- Eron, Joseph J.
- Napravnik, Sonia
- Christopoulos, Katerina
- Geng, Elvin
- Saag, Michael S.
- Kitahata, Mari M.
- Venue
- AIDS and Behavior
- Published
- 2017-03-11
- Volume
- 21
- Issue
- 7
- Pages
- 1914-1925
- ISSN
- 1090-7165 (ISSN-L)
- 1573-3254
- PMC
- PMC5628735
- OpenAlex
- W2592327440
- Semantic Scholar
- 5f8867655fc6a4c6f6eab58e0819e8e367b0c133
- Cited by
- 125
- References
- 51
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 13 · 2023: 12 · 2022: 17 · 2021: 21 · 2020: 20 · 2019: 15 · 2018: 9 · 2017: 4 · 2013: 1
- FWCI
- 10.28
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- AIDS and Behavior (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- National Institute on Alcohol Abuse and Alcoholism (U24AA020801, U01AA020793, U01AA020802)
- National Institute of Allergy and Infectious Diseases (R24 AI067039, P30 AI027757, P30 AI50410, P30 AI027767, P30 AI094189)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- hazardous drinking, people living with HIV, binge drinking, prevalence, cannabis use, cigarette smoking, substance use comorbidity, HIV care, alcohol screening, young men
- MeSH terms
- Cigarette Smoking, Marijuana Use, Adult, Alcohol Drinking, Alcoholism, Female, Humans, Male, Middle Aged, Risk Factors, United States, HIV Infections, Prevalence, Odds Ratio, Crack Cocaine, Anti-HIV Agents, Cocaine-Related Disorders, Binge Drinking
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