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Comparing Alcohol Screening Measures Among HIV-Infected and -Uninfected Men

Authors

  • Kathleen A. McGinnis,

    Corresponding author
    • Center for Health Equity Research and Promotion , VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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  • Amy C. Justice,

    1. Division of General Internal Medicine , Yale University School of Medicine, New Haven, Connecticut
    2. Veterans Aging Cohort Study Coordinating Center , West Haven VA Healthcare System, West Haven, Connecticut
    3. Center for Interdisciplinary Research on AIDS , Yale University School of Public Health, New Haven, Connecticut
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  • Kevin L. Kraemer,

    1. Department of Medicine , Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Richard Saitz,

    1. Department of Medicine , Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
    2. Department of Epidemiology , Boston University School of Public Health, Boston, Massachusetts
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  • Kendall J. Bryant,

    1. National Institute on Alcohol Abuse and Alcoholism , Bethesda, Maryland
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  • David A. Fiellin

    1. Division of General Internal Medicine , Yale University School of Medicine, New Haven, Connecticut
    2. Veterans Aging Cohort Study Coordinating Center , West Haven VA Healthcare System, West Haven, Connecticut
    3. Center for Interdisciplinary Research on AIDS , Yale University School of Public Health, New Haven, Connecticut
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Reprint requests: Kathleen McGinnis, MS, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 7180 Highland Drive (151C-H), Pittsburgh, PA 15206-4900; Tel.: 412-215-9927; Fax: 412-365-5264; E-mail: kathleen.mcginnis3@va.govThe views are not those of the Department of Veterans Affairs or the United States Government.

Abstract

Background

Brief measures of unhealthy alcohol use have not been well validated among people with HIV. We compared the Alcohol Use Disorders Identification Test (AUDIT) to reference standards for unhealthy alcohol use based on 30-day Timeline Follow Back (TLFB) and Composite International Diagnostic Interview—Substance Abuse Module (CIDI-SAM), among 837 male HIV-infected and -uninfected patients in the Veterans Aging Cohort Study.

Methods

Three reference standards were (i) Risky drinking—based on TLFB >14 drinks over 7 consecutive days or >4 drinks on 1 day; (ii) Alcohol dependence—based on a CIDI-SAM diagnosis; and (iii) Unhealthy alcohol use—risky drinking or a CIDI-SAM diagnosis of abuse or dependence. Various cutoffs for the AUDIT, AUDIT-C, and heavy episodic drinking were compared with the reference standards.

Results

Mean age of patients was 52 years, 53% (444) were HIV-infected, and 53% (444) were African American. Among HIV-infected and -uninfected patients, the prevalence of risky drinking (14 vs. 12%, respectively), alcohol dependence (8 vs. 7%), and unhealthy alcohol use (22 vs. 20%) was similar. For risky drinking and alcohol dependence, multiple cutoffs of AUDIT, AUDIT-C, and heavy episodic drinking provided good sensitivity (≥80%) and specificity (≥90%). For unhealthy alcohol use, few cutoffs provided sensitivity ≥80%; however, many cutoffs provided good specificity. For all 3 alcohol screening measures, sensitivity improved when heavy episodic drinking was included with the cutoff. Sensitivity of measures for risky drinking and unhealthy alcohol use was lower in HIV-infected than in uninfected patients.

Conclusions

For identifying risky drinking, alcohol dependence, and unhealthy alcohol use, AUDIT-C performs as well as AUDIT and similarly in HIV-infected and -uninfected patients. Cutoffs should be based on the importance of specific operating characteristics for the intended research or clinical use. Incorporating heavy episodic drinking increased sensitivity for detecting alcohol dependence and unhealthy alcohol use.

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