Yale Bulletin and Calendar

October 6, 2006|Volume 35, Number 5

NIAAA award will support
study of alcohol use and HIV

The Veterans Aging Cohort Study (VACS) has received a five-year, $13 million continuation award from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to examine the impact of aging and alcohol use on those with and without chronic HIV infection.

"VACS is one of the largest ongoing observational studies of HIV and the only study to include a matched HIV-negative comparison group," says principal investigator Amy Justice, associate professor of internal medicine and of epidemiology and public health at the School of Medicine and at the VA Connecticut Healthcare System, West Haven campus. "As such, it is uniquely poised to examine the independent effects of alcohol use and abuse, aging, HIV infection and HIV treatment as well as the interaction between these factors."

Justice says HIV infection is now considered a complex chronic disease, characterized by multiple co-occurring health conditions. Those in treatment for HIV infection often have age- and treatment-associated conditions like hypertension, diabetes and lung disease.

"They are also more likely to have conditions associated with substance use, including depression and viral hepatitis," she notes. "We do not know whether there is a 'safe' level of alcohol consumption for those with complex chronic disease."

VACS concentrates on an extensive, in-depth cohort of veterans with and without HIV infection, who are in primary outpatient care at eight VA medical centers around the country. The researchers use electronic medical record data including clinical, laboratory and pharmacy data as well as patient surveys to study the patients' multiple medical conditions, quality of life, treatment success, use of health care services and death.

This in-depth cohort is complemented by a "virtual cohort" of over 33,000 HIV-positive veterans and 66,000 age-, race- and site-matched HIV-negative "control" patients whose records are compared for health services use, costs of care and survival rates. The Veterans Health Administration's information system allows efficient and accurate tracking of patient outcomes over time.

"This is an important building block in NIAAA's AIDS research portfolio," says Kendall Bryant, NIAAA coordinator of HIV/AIDS research. "This ongoing research also reflects many of NIH's new points of emphasis on developing integrative and multidisciplinary teams of researchers, effectively using large informative clinical datasets, and addressing the interface between clinical and laboratory-based research to inform clinicians in the long-term management of their patients."

Justice adds: "As HIV-infected patients are living longer, thanks to antiretroviral therapy, they are facing a host of co-existing diseases and conditions associated with aging, HIV risk behaviors and HIV treatment. Findings from the VACS study will help clinicians and HIV-infected patients understand how best to optimize their medical care."

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Correction