Unhealthy Alcohol Use is Associated with a Higher Prevalence of Dysglycemia in Persons Living with HIV
Authors: Primeaux Stefany , Ferguson Tekeda , Brashear Meghan , Yeh Alice , Levitt Danielle , Simon Liz , Molina Patricia 
Published: April 2020

Chronic alcohol consumption is the most common and costly form of substance abuse in the United States and is highly prevalent in persons living with HIV (PLWH). Combination antiretroviral therapy (ART) has significantly increased longevity in PLWH and over 50% of PLWH in the U.S.A. are 50 years of age or older. Aging, unhealthy alcohol use and increased survival of PLWH on ART are complicated by metabolic dysregulation. The goal of the current study was to test the hypothesis that unhealthy alcohol use in PLWH increases the prevalence of dysglycemia following an oral glucose tolerance test (OGTT). Participants with a fasting blood glucose (FBG) of 94–125mg/dL (n=105) were recruited from a cohort of in‐care PLWH (≥ 18 years) enrolled in the ongoing translational study, New Orleans Alcohol Use in HIV (NOAH) and from the Greater New Orleans area. Alcohol use was determined by the Alcohol Use Disorders Identification Test (AUDIT). An AUDIT score ≥ 5 was defined as unhealthy alcohol use (n=47) versus an AUDIT score of < 5 (n=52). Questionnaires (i.e. AUDIT and Timeline Followback) and Phosphatidylethanol (PEth) were used to further describe and confirm alcohol use. All participants underwent an OGTT, which included an assessment of plasma glucose 2 hours following consumption of a standard glucose solution (75g, Trutol). Circulating insulin, c‐peptide and adiponectin were measured. Anthropometric measurements included assessment of weight, Body Mass Index, and waist/hip ratio (WHR). Among participants with an impaired FBG, 44.8% exhibited unhealthy alcohol use. 2‐h plasma glucose values were positively correlated with AUDIT, PEth and 2‐h insulin levels and there was a moderate, but not statistically significant (p = 0.06) increase in 2‐h plasma glucose levels following OGTT in participants with unhealthy alcohol use. AUDIT was also positively correlated with Timeline Followback (grams of alcohol) and PEth values, supporting the use of AUDIT as a valid marker of alcohol use. WHR, which is indicative of abdominal obesity, and has been linked to a higher incidence of insulin resistance, was higher in participants with unhealthy alcohol use and was positively correlated with FBG. Based on the results from the OGTT, participants were divided into 3 categories, Normal (2‐h glucose <140mg/dL), Prediabetic (140–199mg/dL) and Diabetic (≥200mg/dL). Of the participants with Normal plasma glucose, 37.3% exhibited unhealthy alcohol use. Among Prediabetics, 70.6% exhibited unhealthy alcohol use and in Diabetics, 80% exhibited unhealthy alcohol use. Unhealthy alcohol use (AUDIT ≥5) was associated with a 4.13 odds ratio (1.54, 11.08) of being Prediabetic or Diabetic. Overall, these data support our hypothesis that in PLWH with impaired fasting glucose, unhealthy alcohol use is associated with dysglycemia following an OGTT. These results suggest that directed interventions that focus on glucose regulation and alcohol use, including aerobic exercise, could have a profound impact on ameliorating the risk of developing metabolic comorbidities in this population of at‐risk PLWH.

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NIH NIAAA UH2AA026198 to PEM