(PS1-39) Pain and Alcohol Use Among People Living with HIV: A Prospective Study

Background: Heavy alcohol use and pain are common among people living with HIV (PLWH). Research suggests that pain and heavy alcohol use may have reciprocal influences on one another, which may contribute to exacerbation of these conditions over time. However, evidence for an association between pain and heavy drinking among PLWH has been equivocal. This study examines the prospective association between pain and continuous measures of drinking behavior 6-months later among a cohort of PLWH and explores the role of depressive symptoms and social support as potential moderators of these association.

Methods:   Participants were recruited from community health centers and urban academic, hospital-based, HIV primary care facilities as part of the Boston ARCH cohort (Kim et, 2018). Two-hundred and thirty-three participants completed measures at baseline and 6-month outcome. Heavy episodic drinking in the past month was assessed with the Addiction Severity Index while daily alcohol consumption was assessed with the Timeline Followback-14. Pain intensity and pain interference were assessed with the Brief Pain Inventory, social support was measured using the Medical Outcomes Study Social Support Survey, and depression was examined by the Center for Epidemiologic Studies Depression Scale-10. Pain Intensity (none/mild vs moderate/severe) and Pain Interference (none/mild vs moderate/severe) were modeled as dichotomous variables based on previous research. Negative binomial regression analyses were conducted to assess whether pain variables at baseline predicted alcohol use (heavy drinking days and number of drinks in the past two weeks) at 6 months, controlling for age, sex, unhoused status, past month drug use, and baseline drinking. We then examined social support and depression as moderators in subsequent negative binomial models.

Results:  The sample was primarily male (68.2%), Black, non-Hispanic (53.6%), with a mean age of 52 years old. Results showed that pain intensity was significantly associated with number of heavy drinking days, aIRR = 1.66 (CI 95: 1.17, 2.37) p < .01, and greater number of drinks aIRR = 1.55 (CI 95: 1.16, 2.08) p< .01, 6 months later, while pain interference was associated with more drinks aIRR = 1.41 (CI 95: 1.06, 1.89) p < .02, 6 months later, but not heavy drinking days aIRR = 1.28 (CI 95: 0.90, 1.83) p = 0.17. Neither social support, nor depression were significant moderators of the association between pain and 6-month alcohol use variables.

Conclusions: Results suggest that pain may influence alcohol use patterns over time among PLWH. Therefore, pain may be an important co-occurring condition to address in efforts to minimize unhealthy drinking among PLWH.