Treatment for alcohol use disorder among persons with and without HIV in a clinical care setting in the United States.
Alcohol use disorder
Depression
Gabapentin
HIV
Naltrexone
Pharmacotherapy
Psychotherapy
Unhealthy alcohol use
Journal
Drug and alcohol dependence
ISSN: 1879-0046
Titre abrégé: Drug Alcohol Depend
Pays: Ireland
ID NLM: 7513587
Informations de publication
Date de publication:
01 12 2021
01 12 2021
Historique:
received:
23
04
2021
revised:
10
09
2021
accepted:
23
09
2021
pubmed:
27
10
2021
medline:
11
1
2022
entrez:
26
10
2021
Statut:
ppublish
Résumé
Alcohol use disorders (AUD) can lead to poor health outcomes. Little is known about AUD treatment among persons with HIV (PWH). In an integrated health system in Northern California, 2014-2017, we compared AUD treatment rates between PWH with AUD and persons without HIV (PWoH) with AUD. Using Poisson regression with GEE, we estimated prevalence ratios (PRs) comparing the annual probability of receiving AUD treatment (behavioral intervention or dispensed medication), adjusted for sociodemographics, psychiatric comorbidities, insurance type, and calendar year. Among PWH, we examined independent AUD treatment predictors using PRs adjusted for calendar year only. PWH with AUD (N = 633; 93% men, median age 49) were likelier than PWoH with AUD (N = 7006; 95% men, median age 52) to have depression (38% vs. 21%) and a non-alcohol substance use disorder (SUD, 48% vs. 25%) (both P < 0.01). Annual probabilities of receiving AUD treatment were 45.4% for PWH and 34.4% for PWoH. After adjusting, there was no difference by HIV status (PR 1.02 [95% CI 0.94-1.11]; P = 0.61). Of treated PWH, 59% received only a behavioral intervention, 5% only a medication, and 36% both, vs. 67%, 4%, 30% for treated PWoH, respectively. Irrespective of HIV status, the most common medication was gabapentin. Among PWH, receiving AUD treatment was associated with having depression (PR 1.78 [1.51-2.10]; P < 0.01) and another SUD (PR 2.68 [2.20-3.27]; P < 0.01). PWH with AUD had higher AUD treatment rates than PWoH with AUD in unadjusted but not adjusted analyses, which may be explained by higher psychiatric comorbidity burden among PWH.
Sections du résumé
BACKGROUND
Alcohol use disorders (AUD) can lead to poor health outcomes. Little is known about AUD treatment among persons with HIV (PWH). In an integrated health system in Northern California, 2014-2017, we compared AUD treatment rates between PWH with AUD and persons without HIV (PWoH) with AUD.
METHODS
Using Poisson regression with GEE, we estimated prevalence ratios (PRs) comparing the annual probability of receiving AUD treatment (behavioral intervention or dispensed medication), adjusted for sociodemographics, psychiatric comorbidities, insurance type, and calendar year. Among PWH, we examined independent AUD treatment predictors using PRs adjusted for calendar year only.
RESULTS
PWH with AUD (N = 633; 93% men, median age 49) were likelier than PWoH with AUD (N = 7006; 95% men, median age 52) to have depression (38% vs. 21%) and a non-alcohol substance use disorder (SUD, 48% vs. 25%) (both P < 0.01). Annual probabilities of receiving AUD treatment were 45.4% for PWH and 34.4% for PWoH. After adjusting, there was no difference by HIV status (PR 1.02 [95% CI 0.94-1.11]; P = 0.61). Of treated PWH, 59% received only a behavioral intervention, 5% only a medication, and 36% both, vs. 67%, 4%, 30% for treated PWoH, respectively. Irrespective of HIV status, the most common medication was gabapentin. Among PWH, receiving AUD treatment was associated with having depression (PR 1.78 [1.51-2.10]; P < 0.01) and another SUD (PR 2.68 [2.20-3.27]; P < 0.01).
CONCLUSIONS
PWH with AUD had higher AUD treatment rates than PWoH with AUD in unadjusted but not adjusted analyses, which may be explained by higher psychiatric comorbidity burden among PWH.
Identifiants
pubmed: 34700145
pii: S0376-8716(21)00605-0
doi: 10.1016/j.drugalcdep.2021.109110
pmc: PMC8671330
mid: NIHMS1745384
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
109110Subventions
Organisme : NIAAA NIH HHS
ID : K24 AA025703
Pays : United States
Organisme : NIAAA NIH HHS
ID : R01 AA025902
Pays : United States
Organisme : NIDA NIH HHS
ID : T32 DA007250
Pays : United States
Organisme : NIAAA NIH HHS
ID : U01 AA026230
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier B.V. All rights reserved.
Références
AIDS Behav. 2020 Jun;24(6):1784-1792
pubmed: 31773444
J Subst Abuse Treat. 2018 Feb;85:34-37
pubmed: 28527854
Addiction. 2021 Oct;116(10):2617-2634
pubmed: 33245581
J Acquir Immune Defic Syndr. 2016 Dec 1;73(4):419-425
pubmed: 27243904
J Acquir Immune Defic Syndr. 2011 Mar 1;56 Suppl 1:S22-32
pubmed: 21317590
J Gen Intern Med. 2020 Nov;35(11):3262-3270
pubmed: 32754780
AIDS Behav. 2017 Apr;21(4):1138-1148
pubmed: 27738780
Addiction. 2021 Nov;116(11):3019-3026
pubmed: 33788332
JAMA Intern Med. 2014 Jan;174(1):70-7
pubmed: 24190578
Drug Alcohol Depend. 2019 Jan 1;194:288-295
pubmed: 30469100
Lancet HIV. 2019 Aug;6(8):e509-e517
pubmed: 31109915
Drug Alcohol Depend. 2016 Apr 1;161:95-103
pubmed: 26861883
J Subst Abuse Treat. 2020 Feb;109:14-22
pubmed: 31856946
AIDS Behav. 2017 Jul;21(7):1914-1925
pubmed: 28285434
Am J Epidemiol. 2019 Oct 1;188(10):1830-1837
pubmed: 31360995
J Gen Intern Med. 2019 Oct;34(10):2054-2061
pubmed: 31187344
Alcohol Clin Exp Res. 2020 Dec;44(12):2545-2554
pubmed: 33067802
Clin Infect Dis. 2016 Nov 1;63(9):1160-1167
pubmed: 27506682
J Subst Abuse Treat. 2020 Dec;119:108078
pubmed: 32736926
PLoS One. 2020 Mar 5;15(3):e0228433
pubmed: 32134956
J Subst Abuse Treat. 2019 Aug;103:23-32
pubmed: 31229189
PLoS Med. 2015 Dec 22;12(12):e1001924
pubmed: 26694529
Subst Abus. 2019;40(3):302-310
pubmed: 30908174
Addiction. 2013 Feb;108(2):275-93
pubmed: 23075288
AIDS Behav. 2019 Jun;23(6):1634-1646
pubmed: 30443807
Contemp Clin Trials. 2019 Sep;84:105833
pubmed: 31446142
AIDS Behav. 2019 Jan;23(1):211-221
pubmed: 30073637
J Subst Abuse Treat. 2020 Mar;110:18-27
pubmed: 31952624
J Subst Abuse Treat. 2020 Dec;119:108141
pubmed: 33138926
Am J Epidemiol. 2010 Dec 15;172(12):1364-72
pubmed: 21044992
Subst Abus. 2019;40(3):318-327
pubmed: 30676915
Addiction. 2021 Jan;116(1):159-169
pubmed: 32415721
Addict Sci Clin Pract. 2019 Jun 7;14(1):21
pubmed: 31174601
Psychiatr Serv. 2013 Aug 1;64(8):745-53
pubmed: 23584606
J Acquir Immune Defic Syndr. 2011 Mar 1;56 Suppl 1:S46-53
pubmed: 21317594
Alcohol Clin Exp Res. 2011 Feb;35(2):203-10
pubmed: 21058961
AIDS. 2016 Jan;30(2):273-91
pubmed: 26691548
AIDS. 2019 Apr 1;33(5):873-884
pubmed: 30882491
Alcohol Clin Exp Res. 2019 Mar;43(3):522-530
pubmed: 30620410
Psychiatr Serv. 2012 Jul;63(7):679-85
pubmed: 22549276
Addiction. 2019 Jan;114(1):127-136
pubmed: 30109752
J Gen Intern Med. 2021 Jul;36(7):1989-1996
pubmed: 33515195
Perm J. 2016 Fall;20(4):15-225
pubmed: 27548806
Addiction. 2017 Jun;112(6):1036-1044
pubmed: 28061017
Am J Psychiatry. 2018 Jan 1;175(1):86-90
pubmed: 29301420
J Acquir Immune Defic Syndr. 2010 Feb;53(2):247-53
pubmed: 20009766
Drug Alcohol Depend. 2020 Dec 1;217:108272
pubmed: 32971391
Drug Alcohol Depend. 2017 May 1;174:113-120
pubmed: 28324813
Drug Alcohol Depend. 2014 Jun 1;139:33-40
pubmed: 24745475
JAMA. 2018 Aug 28;320(8):815-824
pubmed: 30167705
Am J Psychiatry. 2014 Apr;171(4):445-52
pubmed: 24525690
Lung. 2016 Oct;194(5):755-62
pubmed: 27405853
JAMA. 2018 Nov 13;320(18):1899-1909
pubmed: 30422199
JAMA Psychiatry. 2015 Aug;72(8):757-66
pubmed: 26039070
J Urban Health. 2006 Nov;83(6):1041-62
pubmed: 17031568