Changes in Alcohol Use are Associated With Changes in Depression Severity Among People With HIV

High-risk alcohol use is associated with depressive symptoms. It is unclear if changes in alcohol use are correspondingly associated with changes in depression severity among people with HIV (PWH).

Data were from clinical assessments of patient-reported outcomes (PROs) completed by PWH receiving primary care at 7 sites of the Center for AIDS Research Network of Integrated Clinical Systems. Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores, range (lower to higher risk): 0-12, and Patient Health Questionnaire-9 (PHQ-9) scores, range for depressive symptom burden: 0-27 (≥10 indicative of clinically relevant depression), from PROs were identified as observation pairs (PHQ-9 and AUDIT-C on the same day) occurring 1-2 years apart. We used linear regression with clustered standard errors to estimate the association between changes in AUDIT-C and changes in PHQ-9 stratified by baseline alcohol consumption.

A total of 7806 PWH contributed 13,302 observation pairs with a baseline mean age of 45.4 (SD: ±11.4); 15% were female and 55% identified with a non-White race/ethnicity. Each 1-point increase in AUDIT-C was associated with a 0.30-point (95% CI: 0.15-0.44), 0.26-point (95% CI: 0.14-0.37), and 0.20-point (95% CI: 0.10-0.30) increase in PHQ-9 for PWH with no alcohol use, low-to-moderate risk alcohol use, and high-risk alcohol use at baseline, respectively. Estimates were essentially stable after adjusting for sex, age, and race/ethnicity.

There is a modest, statistically significant association between change in AUDIT-C and change in PHQ-9. These findings highlight the importance of routinely monitoring alcohol use and depression in HIV primary care settings. Future studies exploring causal directions are warranted.