Impact of alcohol use disorder severity on human immunodeficiency virus (HIV) viral suppression and CD4 count in three international cohorts of people with HIV

Background Alcohol use has been linked to worse human immunodeficiency virus (HIV) immunologic/virologic outcomes, yet few studies have explored the effects of alcohol use disorder (AUD). This study assessed whether AUD severity is associated with HIV viral suppression and CD4 count in the three cohorts of the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Consortium. Methods People with HIV (PWH) in Uganda (n = 301), Russia (n = 400), and Boston (n = 251), selected in‐part based on their alcohol use, were included in analyses. Logistic and linear regressions were used to assess the cross‐sectional associations between AUD severity (number of DSM‐5 diagnostic criteria) and (1) HIV viral suppression, and (2) CD4 count (cells/mm3) adjusting for covariates. Analyses were conducted separately by site. Results The proportion of females was 51% (Uganda), 34% (Russia), and 33% (Boston); mean age (SD) was 40.7 (9.6), 38.6 (6.3), and 52.1 (10.5), respectively. All participants in Uganda and all but 27% in Russia and 5% in Boston were on antiretroviral therapy. In Uganda, 32% met criteria for AUD, 92% in Russia, and 43% in Boston. The mean (SD) number of AUD criteria was 1.6 (2.4) in Uganda, 5.6 (3.3) in Russia, and 2.4 (3.1) in Boston. Most participants had HIV viral suppression (Uganda 92%, Russia 57%, Boston 87%); median (IQR) CD4 count was 673 (506, 866), 351 (201, 542), and 591 (387, 881), respectively. In adjusted models, there were no associations between AUD severity and HIV viral suppression: adjusted odds ratios (AOR) (95%CI) per 1 additional AUD criterion in Uganda was 1.08 (0.87, 1.33); Russia 0.98 (0.92, 1.04); and Boston 0.95 (0.84, 1.08) or CD4 count: mean difference (95%CI) per 1 additional criterion: 5.78 (−7.47, 19.03), −3.23 (−10.91, 4.44), and −8.18 (−24.72, 8.35), respectively. Conclusions In three cohorts of PWH, AUD severity was not associated with HIV viral suppression or CD4 count. PWH with AUD in the current era of antiretroviral therapy can achieve virologic control. In cohorts from three different continents, we assessed the association between AUD severity and HIV viral suppression and CD4 count. Our results suggest that quantifying AUD severity by number of DSM‐5 criteria is not associated with these outcomes. PWH with AUD in the current era of antiretroviral therapy can achieve virologic control. Given the high prevalence of AUD among PWH, further research is needed to better understand