Alcohol use and viral suppression in HIV-positive Kenyan female sex workers on antiretroviral therapy.

BACKGROUND: Excessive alcohol intake has been associated with poor adherence to antiretroviral therapy (ART). The impact of alcohol on viral suppression is particularly important among groups at high risk of HIV transmission, such as female sex workers (FSWs). Few studies have directly evaluated the association between alcohol use and HIV viral load. We hypothesized that hazardous or harmful alcohol use is associated with detectable plasma viral load among HIV-positive FSWs. METHODS: A prospective cohort study was conducted among HIV-positive FSWs in Mombasa, Kenya. Hazardous or harmful alcohol use was assessed yearly and defined as an Alcohol Use Disorders Identification Test (AUDIT) score ≥7. Detectable viral load was assessed every six months and defined as ≥180 c/mL. Adherence measures were collected monthly and included late ART refill (>48 hours) and self-reported adherence, using both a validated self-rating scale of ability to take medication and visual analog scale (VAS) of ART use in the last month. Generalized estimating equations were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI). RESULTS: This analysis included 366 participants followed monthly between October 2012 and March 2018. At baseline, AUDIT scores indicated hazardous alcohol use (AUDIT 7-15) in 14.3%, harmful alcohol use (AUDIT 16-19) in 1.4%, and alcohol dependency (AUDIT ≥20) in 1.4% of participants. After adjusting for potential confounders, a combined exposure including hazardous, harmful, and dependent alcohol use was not associated with detectable viral load (aRR 1.10, 95%CI 0.63-1.92) or late ART refill (aRR 1.13, 95%CI 0.82-1.56), but was associated with lower self-rated ability to take medication (aRR 2.38, 95%CI 1.42-3.99) and a lower rate of self-reported perfect ART adherence by VAS (aRR 2.62, 95%CI 1.84-3.71). CONCLUSIONS: In this FSW cohort, while participants reporting hazardous, harmful, or dependent alcohol use were not more likely to have a detectable viral load, they were more likely to report lower ART adherence. These results suggest that interventions targeting alcohol use among this population of FSWs may not have a large impact on viral suppression.

Effect of Rational Emotive Health Therapy on Alcohol Use Among Community-dwelling, HIV-positive Patients.

BACKGROUND: Patients who have tested positive for the human immunodeficiency virus (HIV) and who also experience alcohol use disorder (AUD) symptoms have worse clinical outcomes when compared with those who do not have AUD symptoms. The objective of the present study was to determine the effect of rational emotive health therapy (REHT) on AUD among community-dwelling, HIV-positive patients in the Southeastern region of Nigeria. METHODS: The research design included a pretest/post-test control group with a total of 124 community-dwelling, HIV-positive patients with AUD symptoms participating in the study. The measures employed for data collection included Alcohol-related Irrational Beliefs Scale (AIBS) and Alcohol Use Disorder Scale (AUDS). Repeated measures analysis of variance was used for statistical analysis. RESULTS: The result obtained at the initial assessment indicated that AUD was severe. Furthermore, REHT intervention led to a significant reduction in AUD symptoms, as shown by a reduction in AUDS and AIBS scores with time in the treatment group compared to those in the waitlist control group after the intervention. Also, the effect of REHT was positively maintained in the treatment group participants at follow-up assessment. CONCLUSION: The presence of HIV symptoms alone does not cause HIV-positive patients to be dependent on alcohol; rather, irrational beliefs about the infection may contribute to unhealthy feelings and abuse of alcohol. Rational emotive health therapy is an effective approach that can be employed by therapists and health counselors in helping HIV-positive patients to think rationally about themselves and work to be able to overcome HIV-related, as well as alcohol-related, irrational beliefs.

Reasons for drinking as predictors of alcohol involvement one year later among HIV-infected individuals with and without hepatitis C.

INTRODUCTION: Heavy drinking can be harmful for individuals with HIV, particularly those coinfected with hepatitis C virus (HCV). HIV patients' reasons for drinking predict short-term alcohol involvement, but whether they predict longer-term involvement is unknown. Also, it remains unknown whether these motives are differentially predictive for HIV monoinfected and HIV/HCV coinfected patients. METHOD: HIV-infected heavy drinkers (n = 254) participated in a randomized trial of brief alcohol interventions, 236 (92.9%) of whom reported on baseline motives and alcohol involvement 12 months later (77.1% male, 94.9% minority, 30.6% with HCV). RESULTS: Greater endorsement of baseline drinking to cope with negative affect predicted greater alcohol dependence symptoms at 12 months (incident rate ratio [IRR] = 1.80, p < 0.05), while greater endorsement of baseline drinking due to social pressure predicted fewer drinks consumed at 12 months (IRR = 0.67, p < 0.05). Coping and social reasons were both predictive for HIV monoinfected patients, whereas only coping reasons were predictive for HIV/HCV coinfected patients. DISCUSSION: Drinking for coping and social reasons predict alcohol involvement 12 months later; however, social reasons may only be important for HIV monoinfected patients. Understanding patient reasons for drinking may help predict patient risk up to a year later. KEY MESSAGES Among HIV patients, drinking motives predict alcohol involvement 12 months later. For HIV monoinfected patients, drinking to cope and drinking for social reasons predict 12-month alcohol involvement. For HIV/Hepatitis C coinfected patients, coping (but not social) motives predict 12-month alcohol involvement.

DRD2 and DRD4 genes related to cognitive deficits in HIV-infected adults who abuse alcohol.

BACKGROUND: HIV-infected individuals continue to experience neurocognitive deterioration despite virologically successful treatments. The causes of neurocognitive impairment are still unclear. However, several factors have been suggested including the role of genetics. There is evidence suggesting that neurocognitive impairment is heritable and individual differences in cognition are strongly driven by genetic variations. The contribution of genetic variants affecting the metabolism and activity of dopamine may influence these individual differences. METHODS: The present study explored the relationship between two candidate genes (DRD4 and DRD2) and neurocognitive performance in HIV-infected adults. A total of 267 HIV-infected adults were genotyped for polymorphisms, DRD4 48 bp-variable number tandem repeat (VNTR), DRD2 rs6277 and ANKK1 rs1800497. The Short Category (SCT), Color Trail (CTT) and Rey-Osterrieth Complex Figure Tests (ROCT) were used to measure executive function and memory. RESULTS: Results showed significant associations with the SNP rs6277 and impaired executive function (odds ratio = 3.3, 95% CI 1.2-2.6; p = 0.004) and cognitive flexibility (odds ratio = 1.6, 95% CI 2.0-5.7; p = 0.001). The results were further stratified by race and sex and significant results were seen in males (odds ratio = 3.5, 95% CI 1.5-5.5; p = 0.008) and in African Americans (odds ratio = 3.1, 95% CI 2.3-3.5; p = 0.01). Also, DRD4 VNTR 7-allele was significantly associated with executive dysfunction. CONCLUSION: The study shows that genetically determined differences in the SNP rs6277 DRD2 gene and DRD4 48 bp VNTR may be risk factors for deficits in executive function and cognitive flexibility.

Characteristics and impact of methamphetamine use in patients with chronic hepatitis C.

OBJECTIVES: Methamphetamine (MA) use has increased in the United States in the last 20 years and is a risk factor for hepatitis C virus(HCV) infection. The purpose of this study was to determine the characteristics and HCV infection outcomes of patients with a history of MA use. METHODS: Subjects consisted of newly entered patients in the Veterans Affairs (VA) HCV registry at a single VA medical center from January 1, 2004, to June 30, 2004, and from January 1, 2007, to June 30, 2007. Univariate and multivariate analyses related to HCV infection antiviral treatment outcomes through 2010 was performed. RESULTS: A total of 198 consecutive eligible HCV registry patients were analyzed, and 40% had a history of MA use. Of patients with MA use history, 46% (36/79) had active use (within 6 months) at initial contact. Active MA users were significantly younger (mean age, 45.5 years), with more concomitant drug use (86%), compared with patients without MA use (mean age, 53.5 years; 42% minority; 29% other drug use). Overall, 71% of the 198 patients reported a history of problematic alcohol use, and 47% of those reported active abuse. Logistic regression analyses indicated that MA use did not significantly adversely affect antiviral treatment initiation, completion, or sustained virological response rates compared with that in patients without MA use. Active alcohol users had lower treatment initiation than patients without alcohol use. CONCLUSIONS: MA use is common in recent US veterans with HCV infection and occurs in younger patients with polysubstance use. Prior history or active MA use does not seem to adversely affect HCV infection clinic treatment compared with that in HCV-infected patients without MA use.

Viral hepatitis in alcohol-dependent inpatients: prevalence, risk factors, and treatment uptake.

OBJECTIVES: Most epidemiological literature on the prevalence of viral hepatitis in alcohol-dependent patients is based on older data. This study aimed to provide current estimates and an assessment of risk factors. We further investigated whether the initiation of antiviral hepatitis C virus (HCV) treatment is feasible after detoxification. METHODS: We assessed serological markers for hepatitis B virus (HBV) and HCV infection and liver enzyme levels (alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase) in a sample of 463 inpatients in a tertiary care hospital, fulfilling International Classification of Diseases, Tenth Revision criteria for alcohol dependence. A subsample of 141 patients was interviewed on addiction history and risk factors for HCV acquisition. All patients with an indication for antiviral treatment were followed up. RESULTS: Compared with that in the general population, we found an elevated anti-HCV prevalence in alcohol-dependent patients (5.2%; 95% confidence interval, 3.2%-7.2%), whereas anti-Hbc immunoglobulin G prevalence (8.3%; 95% confidence interval, 5.7%-10.8%) corresponded to normal rates. Liver enzyme levels significantly differed between patients with chronic, past/remitted, or no HCV infection. On an observational level, a history of injection drug use or nonprofessional tattooing emerged as potential risk factors. In 1 of 10 patients, antiviral therapy was initiated. This 1 patient achieved the end-of-treatment response after extended rapid virological response, despite continuous alcohol consumption. CONCLUSIONS: The elevated HCV infection rates in our sample and the higher levels of fibrosis biomarkers in those with positive polymerase chain reaction corroborate previous findings and emphasize the importance of HCV screening in this population, particularly if further risk factors like injection drug use are given. Factors influencing treatment reluctance and conditions that may enhance the feasibility of antiviral treatment in alcohol-dependent patients should be subject of further research.

Self-reported alcohol abuse in HIV-HCV co-infected patients: a better predictor of HIV virological rebound than physician's perceptions (HEPAVIH ARNS CO13 cohort).

AIMS: Studying alcohol abuse impact, as measured by physicians' perceptions and patients' self-reports, on HIV virological rebound among patients chronically co-infected with HIV and hepatitis C virus (HCV). DESIGN: Cohort study. SETTING: Seventeen French hospitals. PARTICIPANTS: Five hundred and twelve patients receiving antiretroviral therapy (ART) with an undetectable initial HIV viral load and at least two viral load measures during follow-up. MEASUREMENTS: Medical records and self-administered questionnaires. HIV virological rebound defined as HIV viral load above the limit of detection of the given hospital's laboratory test. Alcohol abuse defined as reporting to have drunk regularly at least 4 (for men) or 3 (for women) alcohol units per day during the previous 6 months. Correlates of time to HIV virological rebound identified using Cox proportional hazards models. FINDINGS: At enrolment, 9% of patients reported alcohol abuse. Physicians considered 14.8% of all participants as alcohol abusers. Self-reported alcohol abuse was associated independently with HIV virological rebound [hazard ratio (95% confidence interval): 2.04 (1.13-3.67); P = 0.02], after adjustment for CD4 count, time since ART initiation and hospital HIV caseload. No significant relationship was observed between physician-reported alcohol abuse and virological rebound (P = 0.87). CONCLUSIONS: In France, the assessment of alcohol abuse in patients co-infected with HIV and hepatitis C virus should be based on patients' self-reports, rather than physicians' perceptions. Baseline screening of self-reported alcohol abuse may help identify co-infected patients at risk of subsequent HIV virological rebound.

Sexually transmitted infections among HIV-infected heavy drinkers in St Petersburg, Russia.

The objective of this study was to estimate the prevalence and identify correlates of four sexually transmitted infections (STIs) among HIV-infected Russians reporting heavy alcohol use and recent unprotected sex, we conducted a cross-sectional analysis of baseline data from the HERMITAGE study. The primary outcome was any current STI, based on urine tests for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis and serological testing for infection with Treponema pallidum. Data on potential demographic and behavioural predictors of STI were obtained from surveys administered at study entry. Of 682 participants, 12.8% (95% confidence interval [CI] 10.3, 15.3) tested positive for at least one STI. In a multivariable model adjusted for gender, age and marital status, only sex trade involvement over the last three months was significantly associated with an increased odds of STI (adjusted odds ratio [AOR] 2.00, 95% CI 1.13, 3.55). Given that STIs were common in this HIV-infected cohort, and that few patient characteristics predicted STI, the current practice of screening HIV-infected Russians for syphilis alone merits re-evaluation.

Spontaneous clearance of hepatitis C infection after liver transplantation from IL28B rs12979860 CC donors.

Genetic polymorphisms adjacent to IL28B have been previously associated with spontaneous clearance of hepatitis C virus (HCV) and a higher rate of sustained virological response to interferon-based treatment in HCV genotype 1-infected patients. A recent study has shown that patients with the CC genotype of the rs12979860 single nucleotide polymorphism upstream from the IL28B gene are more likely to clear HCV spontaneously relative to the CT or TT genotype. In the liver transplant cohort, HCV recurs almost universally in patients with detectable HCV RNA at the time of transplantation. The spontaneous clearance of HCV infection after transplant is very rare. We report two cases of spontaneous clearance of HCV genotype 1 infection after liver transplantation from homozygous IL28B CC donors. This finding may be explained by alterations in the host immune responses to HCV after transplantation with a CC donor liver, which has potential implications for donor selection in HCV-positive recipients.

Disrupted anabolic and catabolic processes may contribute to alcohol-accentuated SAIDS-associated wasting.

BACKGROUND: Alcohol abuse is a comorbid factor in many human immunodeficiency virus (HIV)-infected patients. Previously, we demonstrated that chronic binge alcohol accentuates loss of body mass at terminal stage of simian immunodeficiency virus (SIV) infection. The purpose of this study was to investigate changes in pathways that may contribute to muscle wasting in chronic binge alcohol-fed SIV-infected macaques. METHODS: The impact of chronic binge alcohol during SIV infection on insulin signaling and the ubiquitin (Ub)-proteasome system-regulators of protein synthesis and degradation-was examined in SIV-infected macaques. RESULTS: SIV infection induced an inflammatory and pro-oxidative milieu in skeletal muscle, which was associated with decreased insulin-stimulated phosphatidylinositol 3-kinase (PI-3k) activity and upregulated gene expression of mTOR and atrogin-1, and protein expression of Ub-proteasome system 19S base. Chronic binge alcohol accentuated the skeletal muscle pro-oxidative milieu and 19S base expression. Additionally, chronic binge alcohol increased skeletal muscle protein expression of protein-tyrosine phosphatase 1B (a negative regulator of insulin signaling) and 19S proteasome regulator non-ATPase (Rpn) 6 subunit and Rpn12, and suppressed PI-3K activity. Animals that were alcohol-fed and SIV-infected for >15 months had increased Ub-proteasome system activity. CONCLUSIONS: These data suggest negative modulation of insulin signaling coupled with enhanced Ub-proteasome system activity may be central mechanisms underlying chronic binge alcohol-induced accentuation of SIV-associated muscle wasting.

Epidemiological survey of hepatitis C virus infection in a cohort of patients from a ser.T in naples, Italy.

Hepatitis C virus (HCV) has infected an estimated 170 million people worldwide, most of whom are chronically infected (60% to 80%). In Italy, the estimate of anti-HCV antibody (Ab) prevalence, in the general population of Northern Italy, is 3.2%; in Central and Southern Italy, it is 8.4% to 22.4%. Highest prevalence of infection (70% to 90%) is found among intravenous drug users. Our purpose is to monitor HCV infection among drug users treated in a Drug Addiction Centre (Ser.T) in Naples and to gain a better understanding of that relationship with the abused substance(s). Epidemiological data are shown for viral coinfections. Finally, the authors investigate access to specific HCV therapy in an Italian Ser.T. The study analyzed a group of 1753 consecutive subjects treated from 1988 to 2008 in the O.U. Ser.T D.S.31 (Gesù e Maria Hospital), ASL Napoli 1 Centre. HCV Abs were detected by enzyme immune assay method and confirmed by recombinant immunoblot assay III method. During the entire period, we performed real-time polymerase chain reaction at random for 312 patients. The incidence (per year) of HCV infection showed a rapid spread decrease from 49.5% in 2003 to 14.5% in 2008. The overall prevalence of HCV was 48.1%. We tested 312 randomly selected patients for viral replication. Our study showed active viral replication in 201 (64.4%) patients as follows: 97 of 201 (31.1%) resulted infected by genotype (gt) 1; 3 of 201 (1.0%) gt 2; 84 of 201 (26.9%) gt 3; and 4 of 201 (1.3%) gt 4. Coinfection data showed that HCV Ab prevalence was 58.5% (48 of 82) in hepatitis B virus chronically infected patients. Human immunodeficiency virus (HIV)/HCV coinfection resulted in 95.2% (80 of 84) HIV patients. The prevalence of HIV Abs in HCV-infected patients was 8.99% (80 of 889). Analysis of drug abuse showed high prevalence of opiate addicted, multiabusers, and with high-risk factors. Cocaine abuser prevalence was 14.4%, and incidence, during past 4 years of the study, rose to 42.6%. Alcohol abuser prevalence represented 5.8% of patients and incidence rose to 17.7% in final 4 years of the study. In those opiate addicted, HCV infection was 61.0% (805 of 1320). HCV infection in cocaine-addicted patients was 9.5% (24 of 253). In 78 delta-9-tetra-hydro-cannabinol addicted patients, 5.1% of tests were positive (4 of 78). In alcohol abusers, HCV infection was 9.8% (10 of 102). Access to HCV treatment in our cohort from 2000 to 2008 resulted low (15.4%). Enhancing the Ser.Ts efficiency can result in health and financial benefits.

[The diagnostics of arrhythmogenic right ventricular dysplasia by an endomiocardial biopsy and the role of viruses in the pathogenesis of disease].

The comparative histologic, morphometric and immunohistochemical investigation of a right ventricular myocardium from 3 groups of patients has been carried out. The first group has included 12 patients with an arrythmogenic right ventricular dysplasia (ARVD) confirmed by an endomyocardial biopsy. The second group has consisted of 7 healthy people died a violent death. The third group has included 7 patients with a chronic alcoholism died from an acute alcoholic intoxication. The patients with ARVD and a chronic alcoholism have had an evident adiposis, a moderate fibrosis, and muscle atrophy with only 65% of cardiac hystiocytes. The patients with a chronic alcoholism have had only dystonia of intramural arteries. The cardiac hystiocytes of patients with ARVD have infected by enteroviruses (100%), parvoviruses B19 (58%), adenoviruses (25%), and hepatitis virus C (16%). 83% of observations have had a mixed viral infections.

Alcohol consumption among patients with hepatitis B infection in northern Portugal considering gender and hepatitis B virus genotype differences.

Alcohol abuse is an important public health problem. In Portugal with a population of 10 millions of inhabitants, there are around 10% of alcoholics or excessive alcohol drinkers and 1% of chronically infected patients with hepatitis B virus (HBV). To examine the characteristics of patients with higher levels of alcohol consumption and to investigate the association between alcohol consumption and liver damage a total of 298 chronically infected individuals, with HBV genotyped and submitted to liver biopsy, were classified with Child's grading and separated by habits of alcohol intake, less and greater than 20g/day. No significant differences were observed about genotype but genotypes A and D were predominant in both of them. A higher percentage of males (P<.001) were observed in the group with alcohol intake above 20g/day, as well a lower proportion of patients with HBeAg negativity (P< or =.035). In this group, biochemistry parameters, such as alanine aminotransferase (P=.006), aspartate aminotransferase (P=.001), gamma-glutamyl transferase (P<.001) were elevated in a significantly higher proportion than in the other group. The analysis of hematological parameters showed significantly lower values of platelets (P=.042) and mean corpuscular volume (P<.001) and significantly higher values of prothrombin time (P<.001) in the group with higher levels of alcohol consumption. The characteristics of biopsy (P<.001) and Child-Phug's classification (P=.002) revealed more severe results in this group. Logistic regression showed a positive association between liver damage and alcohol intake, increasing with age. In female patients, a strong positive association between alcohol intake and liver damage was also found (odds ratio: 9.379; 95% confidence interval: 0.859-468.422; P = .037); however, the most severe cases were only observed in women older than 45 years. In patients with HBV infection, alcohol is associated with a more severe liver disease. No evidence was found concerning association with HBV genotype.

Alcohol's role in HIV transmission and disease progression.

Alcohol use has negative effects on HIV disease progression through several mechanisms, including transmission, viral replication, host immunity, and treatment efficacy. Research with animal models has explored the effect of alcohol intake on several aspects of simian immunodeficiency virus (SIV) disease progression. Data suggest that the increased SIV levels observed in alcohol-consuming animals may represent an increase in virus production as opposed to a decrease in host defense. Results also suggest that changes in nutritional balance and metabolism, as a possible consequence of a proinflammatory state, together with increased virus production in animals consuming alcohol, accelerate SIV and possibly HIV disease progression. Further studies using the animal model are necessary.

Focus on the heart: alcohol consumption, HIV infection, and cardiovascular disease.

With the advent of effective antiretroviral therapy, people infected with HIV have a longer life expectancy and, consequently, are likely to develop other chronic conditions also found in noninfected people, including cardiovascular disease (CVD). Alcohol consumption, which is common among HIV-infected people, may influence the risk of CVD. In noninfected adults, moderate alcohol consumption can reduce the risk of coronary heart disease (CHD), heart attacks, and the most common type of stroke, whereas heavy drinking increases the risk of these cardiovascular events. These relationships can be partially explained by alcohol's effects on various risk factors for CVD, including cholesterol and other lipid levels, diabetes, or blood pressure. In HIV-infected people, both the infection itself and its treatment using combination antiretroviral therapy may contribute to an increased risk of CVD by altering blood lipid levels, inducing inflammation, and impacting blood-clotting processes, all of which can enhance CVD risk. Coinfection with the hepatitis C virus also may exacerbate CVD risk. Excessive alcohol use can further enhance CVD risk in HIV-infected people through either of the mechanisms described above. In addition, excessive alcohol use (as well as HIV infection) promote microbial translocation, the leaking of bacteria or bacterial products from the intestine into the blood stream, where they can induce inflammatory and immune reactions that damage the cardiovascular system.

Prevalence of problem alcohol use among patients attending primary care for methadone treatment.

BACKGROUND: Problem alcohol use is associated with adverse health outcomes among current or former heroin users and primary care is providing methadone treatment for increasing numbers of this population. This study aimed to determine the prevalence of problem alcohol use among current or former heroin users attending primary care for methadone treatment and to describe the socio-demographic characteristics and health service utilisation characteristics associated with problem alcohol uses. METHODS: We conducted a cross sectional survey of patients sampled from a national database of patients attending general practice for methadone treatment. Participants were recruited by their general practitioner and data was collected using an interviewer-administered questionnaire, which included the Alcohol Use Disorders Identification Test ('AUDIT'), with a score of >7 considered abnormal (ie 'AUDIT positive cases') and socio-demographic, medical and substance use characteristics. RESULTS: We interviewed 196 patients (71% of those invited, 31% of those sampled, 11% of the national database). The median age was 32 years, 55% were hepatitis C positive, 79% had used illicit drugs in the previous month and 68% were male. Sixty-eight 'AUDIT positive' cases were identified (prevalence of 35%, 95% CI = 28-41%) and these were more likely to have attended a local Emergency Department in the previous year (p < 0.05) and less likely to have attended a hospital clinic in the previous year (p < 0.05). Twenty-seven (14%) scored 20 or higher indicating possible alcohol dependence. CONCLUSION: Problem alcohol use has a high prevalence among current or former heroin users attending primary care for methadone treatment and interventions that address this issue should be explored as a priority. Interventions that address problem alcohol use in this population should be considered as a priority, although the complex medical and psychological needs of this population may make this challenging.

HIV testing and treatment among at-risk drinking injection drug users.

OBJECTIVE: To test the hypothesis that at-risk drinking is associated with a smaller probability of prior HIV testing and access to antiretroviral treatment (ART) among injection drug users (IDUs) entering treatment for drug abuse. METHODS: HIV infected IDUs (N = 643) entering detoxification or methadone maintenance treatment in New York City between 1997 and 2002 comprised the participants. Multivariate logistic regression was used to assess whether receiving ART was associated with at-risk drinking. RESULTS: A significantly smaller proportion of at-risk drinkers, compared to nondrinkers and moderate drinkers, reported receiving ART. Multivariate logistic regression analyses showed a significant interaction between alcohol and cocaine use in relation to reported ART. At-risk drinkers who used crack cocaine were less likely to receive ART compared to nondrinkers who did not use crack cocaine. CONCLUSION: HIV treatment programs should address at-risk drinking through screening for alcohol use and educating staff to improve the lower rate of ART reported by at-risk drinking IDUs.

Hospitalized HIV-infected patients in the era of highly active antiretroviral therapy.

We interviewed 1038 HIV-positive inpatients in public hospitals in Miami, Florida, and Atlanta, Georgia, to examine patient factors associated with use of HIV care, use of antiretroviral therapy, and unprotected sexual intercourse. Multivariate analyses and multiple logistic regression models showed that use of crack cocaine and heavy drinking were associated with never having had an HIV-care provider, high-risk sexual behavior, and not receiving antiretroviral therapy. Inpatient interventions that link and retain HIV-positive persons in primary care services could prevent HIV transmission and unnecessary hospitalizations.