The National Institute on Alcohol Abuse and Alcoholism today announces a 5-year prospective study on the role of alcohol use and abuse in determining patient outcomes for aging veterans with and without HIV infection. The study is an expansion of the ongoing Veterans Aging Cohort Study (VACS), initiated in 1999 and supported by a number of NIH components including the National Institute on Aging (NIA), the National Institute of Mental Health (NIMH), and the Office of AIDS Research (OAR), as well as the Robert Wood Johnson Foundation. The NIAAA study, designated as VACS 5, will assess the role of alcohol use in the patients' quality of life and risk for morbidity and mortality, and the extent to which alcohol effects are influenced by HIV infection treatment.  Results will be used to develop tailored interventions for veterans and non-veterans who are infected with HIV and use alcohol.

NIAAA research support totaling more than $8 million over five years will go to the University of Pittsburgh and the Pittsburgh Veterans Administration Medical Center and five additional VA study sites. Principal investigator Amy Justice, M.D., Ph.D., and co- principal investigator Joseph Conigliaro, M.D., M.P.H., both of the University of Pittsburgh and the Pittsburgh VA, will lead the study of approximately 2,000 HIV-infected veterans and 2,000 HIV-uninfected matched controls from VA facilities in Manhattan/Brooklyn, New York; Bronx, New York; Atlanta, Georgia; Los Angeles, California; and Houston,Texas. Substantial funding for the NlAAA study is provided by the OAR and NIA.

Alcohol use and abuse contribute to unsafe behaviors that increase risk of HIV transmission. In addition, alcohol use may increase complications of HIV disease, including co-occurring illnesses such as tuberculosis, hepatitis C infection, and depression among people aging with HIV infection. This may be especially true among veterans, whose rates of alcohol use, abuse, and dependence are higher than in the general population. Between 10 and 36 percent of veterans treated in VA primary care settings meet clinical criteria for alcohol abuse or dependence, and many more are hazardous or "risky" drinkers. An earlier component of the VAC, the Veterans Aging Cohort 3 Site Study (VACS-3), found that 40 percent of HIV-infected veteran patients reported current drinking, 35 percent reported binge drinking and 21 percent had Alcohol Use Disorders Identification Test scores consistent with hazardous drinking.

The VACS 5 researchers will use clinical, laboratory and survey data to study a variety of health outcomes including the occurrence of multiple medical conditions, death, quality of life, treatment success, use of health care services, and prescription drug use and adherence. A "bank" of blood specimens will allow the evaluation of biologic markers and direct comparisons with patient health outcomes. Surveillance of patient clinical information will be conducted using the VA national electronic medical record system, which includes laboratory and pharmacy data. This unique system allows for the tracking and verification of VA patient status and outcomes over time.

As the largest single provider of HIV services in the United States, the VA has a patient population that includes minorities, economically disadvantaged persons, and intravenous drug users in numbers disproportionate to their prevalence in the general U.S. population. In 2000, approximately 18,000 HIV-infected veterans received care at more than 170 VA clinical sites. One-third of VA patients are 50 years of age and older, and two-thirds are of minority status.

Groundwork for VACS 5 was established through VACS 3, which was designed to study the association of age and patient provider relationship in determining outcomes of HIV infection. VACS 3 also established data collection procedures and population demographics, and served to validate data quality in the VA electronic medical record system. VACS 3 recently was completed at three large VA sites; its results and the scientific rationale for VACS 5 will be reported in a December 2001 supplement to the Journal of Clinical Epidemiology. A 6-month, 5-site VACS 5 feasibility study, now underway, will roll over into VACS 5 study.

Further information is available from Amy Justice, M.D., Ph.D. (412/688-6957) and Kendall Bryant, Ph.D., Coordinator, HIV/AIDS Research, Office of Collaborative Research, NIAAA (301/402-9389).

 

Updated:  March 2005