A prospective study of alcohol consumption and HIV acquisition among injection drug users


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Abstract

Objective:To estimate the effect of alcohol consumption on HIV acquisition while appropriately accounting for confounding by time-varying risk factors.Design:African–American injection drug users in the AIDS Link to Intravenous Experience cohort study. Participants were recruited and followed with semiannual visits in Baltimore, Maryland between 1988 and 2008.Methods:Marginal structural models were used to estimate the effect of alcohol consumption on HIV acquisition.Results:At entry, 28% of 1525 participants were women with a median (quartiles) age of 37 (32–42) years and 10 (10–12) years of formal education. During follow-up, 155 participants acquired HIV and alcohol consumption was 24, 24, 26, 17, and 9% for 0, 1–5, 6–20, 21–50, and 51–140 drinks per week over the prior 2 years, respectively. In analyses accounting for sociodemographic factors, drug use, and sexual activity, hazard ratios for participants reporting 1–5, 6–20, 21–50, and 51–140 drinks per week in the prior 2 years compared to participants who reported 0 drinks per week were 1.09 (0.60–1.98), 1.18 (0.66–2.09), 1.66 (0.94–2.93), and 2.12 (1.15–3.90), respectively. A trend test indicated a dose–response relationship between alcohol consumption and HIV acquisition (P value for trend = 9.7 × 10−4).Conclusion:A dose–response relationship between alcohol consumption and subsequent HIV acquisition is indicated, independent of measured known risk factors.

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