Session number: 1141
Abstract title: Hazardous Drinking and Alcohol Consumption among Veterans with HIV Infection
Author(s):
J Conigliaro - Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
A Justice - Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
A Gordon - Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
A Kilbourne - Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
K McGinnis - Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
for the Veterans Aging Cohort 3-Site Study -
Objectives: Alcohol use may play a pivotal, but unappreciated role in HIV disease. We sought to describe alcohol use, diagnosis of alcohol disorders, and provider awareness of alcohol problems among HIV infected veterans.
Methods: We surveyed 881 HIV infected veterans at 3 VA Hospitals. We assessed alcohol problems by asking providers whether the patient “drinks too much alcohol”, and by asking patients to describe their consumption using the Alcohol Use Disorders Identification Test (AUDIT) which includes questions regarding alcohol consumption and consequences of drinking. We extracted alcohol diagnoses from the VA electronic medical record up to three years before the survey. We calculated agreement and kappas between patient and provider report of alcohol use.
Results: Mean age was 49 years (42% > or = 50 years) and 99% were male. Overall, 55% were African American and 12% Latino. Forty percent were men who had sex with men, 26% were heterosexual and 38% reported intravenous drug use. Median CD4 cell count was 331 and median viral load was 714. Forty percent of patients reported current drinking. Mean AUDIT scores were 4.4 with 21% in the hazardous range (> or = 8). Thirty-five percent reported drinking 6 or more drinks on one occasion. Using ICD-9 diagnoses of alcohol use or abuse, 32% had at least one diagnosis. Yet providers reported that only 12.5% of patients currently drank too much. Kappa scores for patient assessments and provider report were fair (AUDIT and provider report =0.30; binge drinking and provider report = 0.23; AUDIT score of > or = 8 and provider report = 0.33). While older veterans (>50 years) were 19% less likely to report current use, providers were 56% less likely to think that older patients drank too much when compared to younger patients. Furthermore, ICD 9 diagnoses were 40% less common among older veterans.
Conclusions: Alcohol use and abuse among a cohort of HIV infected veterans may be under-appreciated by providers when compared to self report and diagnostic data. This may be especially true among older veterans.
Impact statement: An important intervention to reduce alcohol related comorbidity among HIV infected veterans might be to improve the providers’ ability to detect clinically important alcohol use in all age groups.