"We know that alcohol and unprotected sex are common bedfellows. Alcohol use and abuse may be an important risk factor for HIV infection," said the study's principal investigator, Amy Justice, M.D., Ph.D., of the University of Pittsburgh and the Pittsburgh VA. "Overuse of alcohol likely aggravates common related medical and psychiatric diseases such as hepatitis C and depression. Alcohol use may also decrease the benefit of HIV treatment by causing people to miss taking their medication and increasing the risk of treatment toxicity."
An expansion of the ongoing Veterans Aging Cohort Study (VACS), the current study -- VACS 5 -- will identify the role of alcohol use and abuse in determining health and quality of life among aging veterans with and without HIV. VACS 5 also will examine the effect alcohol has on susceptibility to drug toxicity and the progression of related diseases.
The need for this study is discussed in a special supplement to the recently released December issue of the Journal of Clinical Epidemiology.
By involving veterans who are HIV-negative as the control group, the study will help to identify alcohol-related effects that are specific to aging people with HIV, and those that affect the aging regardless of their HIV status. The study's results will help physicians understand what level of alcohol consumption may be dangerous and will help them tailor treatment for all people who use alcohol.
Dr. Justice and co-principal investigator Joseph Conigliaro, M.D., M.P.H., also of the University of Pittsburgh and the Pittsburgh VA, will lead the study of 2,000 HIV-infected veterans and 2,000 non-HIV-infected, matched controls from VA facilities in Manhattan/Brooklyn, Bronx, Atlanta, Los Angeles and Houston. At these five clinical sites, researchers will examine the impact of alcohol use and abuse on related diseases, drug toxicity, death, quality of life, treatment success, use of health care services and prescription drug use and adherence.
The VA's national electronic medical records system, which includes laboratory and pharmacy data and can track patient status over time, offers unique advantages for such a long-term study.
"Because the VA pays for all currently approved antiretroviral medications and can track patients among several clinical sites, we expect to achieve excellent follow-up on these patients," says Dr. Conigliaro. "In addition, patients with HIV infection in the VA system are predominantly members of important and understudied minority groups."
The national VA hospital system is the largest single provider of HIV services in the United States, and in 2000 it treated some 18,000 HIV-infected veterans. The VA has a patient population that includes minorities, economically disadvantaged persons and IV drug users in numbers disproportionate to their prevalence in the general population. An earlier study, VACS 3, found that 40 percent of HIV-infected VA patients reported current drinking, 35 percent reported binge drinking and 21 percent had Alcohol Use Disorders Identification Test scores consistent with hazardous drinking.
At the University of Pittsburgh, Dr. Justice is a Robert Wood Johnson Generalist Faculty Scholar and associate professor in the School of Medicine, and associate professor of health services research at the Graduate School of Public Health. Dr. Conigliaro is associate professor in the School of Medicine. Both are staff physicians at the Pittsburgh VA Medical Center.