Association of under-reporting of alcohol use with HIV viral non-suppression and an all-cause mortality risk score among people with HIV on antiretroviral therapy.

BACKGROUND: Unhealthy alcohol use contributes to poor HIV-related outcomes. Alcohol under-reporting may be associated with HIV viral non-suppression and all-cause mortality risk, especially at the high end of the spectrum. We evaluated whether alcohol under-reporting was associated with these outcomes among PWH with unhealthy alcohol use who were receiving ART. METHODS: We pooled data from six studies of PWH in Uganda (ADEPT-T, DIPT, Extend), United States (MWCCS), and Russia (Russia ARCH 1, St Peter). We included PWH on ART who engaged in unhealthy drinking as determined by the alcohol biomarker phosphatidylethanol (PEth)≥50ng/mL. Self-reported alcohol use was assessed using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). We defined under-reporting of high-risk alcohol use as PEth≥200ng/mL and AUDIT-C score<6, and examined HIV viral non-suppression (≥200copies/mL or limit of assay detection) and an all-cause mortality risk score (Veterans Aging Cohort Study [VACS] Index 1.0) as outcomes. We explored level of -under-reporting of alcohol use using a continuous variable. RESULTS: In our sample of 1,435 PWH with unhealthy drinking, 24% under-reported high-risk alcohol use (prevalence range 1-34% across studies). We observed positive, non-significant associations between under-reporting of high-risk alcohol use and viral non-suppression and all-cause mortality risk score. An exploratory continuous under-reporting variable was significantly positively associated with all-cause mortality risk. CONCLUSIONS: Our findings indicate that under-reporting of high-risk alcohol use is common among PWH and suggest that under-reporting of alcohol use may mask other health issues, as reflected by increased mortality index scores. Low-cost methods to improve alcohol use are needed.