Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men
Open accessAbstract
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 2008–2012. 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.
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Unhealthy alcohol use among people with HIV is associated with significant health-related consequences, including mortality, lack of viral suppression, less ART utilization, and sub-optimal adherence to ART.
“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 [6]
The Introduction says alcohol use is common among people with HIV and is associated with poor ART adherence. The Discussion reports that 30% of HIV-positive participants met its criteria for unhealthy alcohol use and links alcohol exposure to mortality and physiologic injury. These passages support the broad citing sentence, but the expanded claim's reduced ART utilization is not established; the Discussion links alcohol to viral load indirectly through nonadherence rather than directly demonstrating a lack of viral suppression. (LLM, conf=0.86)
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- Authors
- Justice, A. C., McGinnis, K. A., Tate, J. P., Braithwaite, R. S., Bryant, K. J., Cook, R. L., Edelman, E. J., Fiellin, L. E., Freiberg, M. S., Gordon, A. J., Kraemer, K. L., Marshall, B. D. L., Williams, E. C., & Fiellin, D. A.
- Affiliations
- Yale University (US)
- VA Pittsburgh Healthcare System (US)
- New York University (US)
- National Institute on Alcohol Abuse and Alcoholism (US)
- University of Florida (US)
- Vanderbilt University (US)
- University of Pittsburgh (US)
- Brown University (US)
- University of Washington (US)
- Corresponding author
- Justice, Amy C.
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2016-04
- Volume
- 161
- Pages
- 95-103
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC4792710
- OpenAlex
- W2271639429
- Semantic Scholar
- 2eac3056968a8c28cafbcfccb6aa5ba56b3eeeca
- Cited by
- 179
- References
- 58
- Citations by year
- 2026: 5 · 2025: 15 · 2024: 16 · 2023: 18 · 2022: 15 · 2021: 11 · 2020: 16 · 2019: 28 · 2018: 19 · 2017: 22 · 2016: 13
- FWCI
- 24.80
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (4u24aa022007-05)
- U.S. Public Health Service (U01-A1069918)
- National Institute on Alcohol Abuse and Alcoholism (U24-AA022007, U01AA020790, U24AA022001, U10AA013566, U24AA022002, U24AA020794, U24AA022000, U24AA02002, U13AA022864, U10- AA13566)
- National Institute on Aging (R01AG029154)
- National Heart, Lung, and Blood Institute (RC1HL100347, R01HL095136, RCI-HL100347, R01HL090342)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- HIV infection, alcohol consumption, alcohol-related harm, mortality, AUDIT-C, alcohol consumption thresholds, veterans, antiretroviral therapy, alcohol consumption limits
- MeSH terms
- Adult, Alcohol Drinking, Humans, Male, Middle Aged, United States, United States Department of Veterans Affairs, Veterans, Wounds and Injuries, Models, Statistical, HIV Infections, Proportional Hazards Models
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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