This Kirschstein NRSA Predoctoral Fellowship (PA-14-147) proposal aims to conduct a nested case- control analysis to assess the effect of alcohol consumption patterns on subclinical cardiovascular disease (CVD) among persons living with HIV (PLWH). This proposal responds to the National HIV/AIDS Strategy for the United States to increase access to care and improve health outcomes for PLWH[49], as well as the NIH objectives to advance discovery of therapeutic strategies to prevent HIV comorbidities across the lifespan and to determine the link between HIV and associated comorbidities[50]. The proposal also aims to address the NIAAA objective to understand how alcohol use influences mortality among PLWH[51] and research focus of the NHLBI on the contribution of HIV related risk factors on the development of CVD[52]. CVD is the most prevalent non-HIV related cause of death among those who are adherent to antiretroviral therapy[3]. PLWH have a higher prevalence and earlier onset of CVD compared to uninfected populations[4-11]. Identifying those with subclinical CVD and modifiable risk factors for early intervention is a top priority in he field. Literature of how alcohol consumption impacts the development of CVD among PLWH is limited to mostly cross-sectional studies of alcohol abuse or dependence among HIV infected men. Longitudinal data from 2,149 participants of the Women's Interagency HIV Study (n=1,321 women) and the Multicenter AIDS Cohort Study (n=828 men) will be used to assess the relationship between longitudinal patterns of alcohol consumption and subclinical CVD among men and women living with HIV. To achieve this, the first aim is to determine patterns of alcohol consumption among PLWH, and to identify the factors associated with specific patterns. The average number of drinks per week will be calculated by using self-reported alcohol use quantity and frequency. A group-based trajectory analysis will then be conducted to identify 5-year alcohol consumption patterns hypothesized a priori.
The second aim i s to evaluate the effect of alcohol consumption patterns on subclinical CVD among PLWH. Subclinical CVD was measured by carotid artery ultrasound at four time points, from 2004-2013. Cases with subclinical CVD will be matched on age and gender to at least 3 controls without subclinical CVD. The 5-years prior to the first detection of subclinical CVD will be used to calculate 5-year alcohol consumption patterns for both cases and matched controls. The results of this study will have public health impact on the identification of CVD risk among PLWH, and the [potential to highlight the importance] of tailored interventions that can better address alcohol use issues. A parallel benefit of this award is the training goals that are individually tailored to establish th foundation of a successful career in research. The training goals will focus on 1) enhancing conceptual and practical understand of how alcohol affects the development of CVD among PLWH, 2) gaining advanced skills in longitudinal data analysis, and 3) developing professional skills including grant writing and manuscript production.
Patterns of alcohol use over time may contribute to the increased burden of cardiovascular disease among persons living with HIV. The proposed research will examine the presence of specific longitudinal patterns of alcohol consumption and the impact of patterns on subclinical cardiovascular disease among persons living with HIV. Findings will provide important data for 1) better identification of cardiovascular risk among HIV-infected men and women within clinical settings, 2) recommendations for clinical prevention services of cardiovascular disease, and 3) the potential to highlight the importance of tailored interventions to better address alcohol use issues that are specific to persons living with HIV.
