Alcohol interventions for persons with HIV: Meta-analysis of randomized controlled trials using phosphatidylethanol...

Area of Science:

• Addiction Medicine
• Public Health
• Biomarkers in Clinical Trials

Background:

• Reducing alcohol use is crucial for people living with HIV (PWH).
• Previous trials relied on self-report, potentially limiting validity.
• This study evaluated alcohol intervention efficacy using a combined biomarker and self-report approach.

Purpose of the Study:

• To determine the efficacy of alcohol interventions for PWH.
• To compare the efficacy using combined phosphatidylethanol (PEth)/self-report versus individual measures.
• To assess the validity of PEth as a biomarker in intervention studies.

Main Methods:

• Systematic review of alcohol intervention randomized controlled trials (RCTs) up to April 2023.
• Individual participant data meta-analysis (IPD-MA) using two-step random effects modeling.
• Primary outcome: unhealthy alcohol use defined by PEth (≥50 ng/mL) or AUDIT-C scores (≥3 women, ≥4 men).

Main Results:

• 16 studies (N=3559) were included in the IPD-MA.
• Alcohol interventions significantly reduced unhealthy alcohol use (PEth/self-report: OR=0.69).
• Combined PEth/self-report showed moderate certainty of evidence with low heterogeneity; PEth alone had lower efficacy but less heterogeneity; self-report alone showed higher heterogeneity.

Conclusions:

• Alcohol interventions are effective for PWH.
• Combined PEth and self-report is a robust primary outcome measure.
• Effect sizes were small, highlighting the need for sensitive outcome measures in intervention research.