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.

Authors

Cristina Espinosa da Silva, Robin Fatchm, Nneka Emenyonu, Aaron Scheffler, Winnie R Muyindike, Julian Adong, Evgeny Krupitsky, Elena Blokhina, Kaku So-Armah, Brian Beesiga, Kara Marson, Frank J Palella, Gabriel Chamie, Isabel E Allen, Phyllis C Tien, Judith A Hahn, Multicenter AIDS Cohort Study (MACS) / Women’s Interagency HIV Study (WIHS) Combined Cohort Study (MWCCS), the Russia Alcohol Research Collaboration on HIV/AIDS (Russia ARCH I), the Studying Partial agonists for Ethanol and Tobacco Elimination in Russians with HIV (ST PETER HIV) RCT, the Alcohol Drinkers’ Exposure to Preventive Therapy for TB (ADEPT-T) Study, the Mobile Technology to Extend Clinic-Based Counseling for HIV+s in Uganda (Extend) RCT, the Drinkers’ Intervention to Prevent Tuberculosis (DIPT) RCT, and International URBAN Alcohol Research Collaboration on HIV/AIDS Center

Published in

Journal of acquired immune deficiency syndromes (1999). Aug 20, 2026. Epub Aug 20, 2026.

Abstract

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.
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.
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.
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.

PMID:
42624072
Bibliographic data and abstract were imported from PubMed on 21 Aug 2026.

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