Evidence map›Paper›PMID 42751764›Full record

ArticleAlcohol, clinical & experimental research2026

Syndemic Classes of Unhealthy Alcohol Use Reveal Inequities in Alcohol-Related Consequences and HIV Care Outcomes.

Natalia Van Doren, Michael J Silverberg, Varada Sarovar, Tory Levine, Alexandra Lea, Stacy A Sterling, Vanessa A Palzes, Felicia W Chi, Andrea H Kline-Simon, Maha N Mian and 7 more

Abstract read
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In one paragraph

Article in Alcohol, clinical & experimental research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Natalia Van DorenDepartment of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA.ORCID https://orcid.org/0000-0001-6044-7208
Michael J SilverbergDivision of Research, Kaiser Permanente Northern California, Pleasanton, California, USA.ORCID https://orcid.org/0000-0001-9322-1395
Varada SarovarDivision of Research, Kaiser Permanente Northern California, Pleasanton, California, USA.
Tory LevineDivision of Research, Kaiser Permanente Northern California, Pleasanton, California, USA.
Alexandra LeaDivision of Research, Kaiser Permanente Northern California, Pleasanton, California, USA.ORCID https://orcid.org/0000-0001-6194-699X
Stacy A SterlingDepartment of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA.ORCID https://orcid.org/0000-0002-6987-8423
Vanessa A PalzesDivision of Research, Kaiser Permanente Northern California, Pleasanton, California, USA.ORCID https://orcid.org/0000-0002-3256-579X
Felicia W ChiDivision of Research, Kaiser Permanente Northern California, Pleasanton, California, USA.
Andrea H Kline-SimonDivision of Research, Kaiser Permanente Northern California, Pleasanton, California, USA.ORCID https://orcid.org/0000-0002-6303-7308
Maha N MianDepartment of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA.
Elena CyrusDepartment of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, Florida, USA.ORCID https://orcid.org/0000-0003-4449-1449
Lunthita M DuthelyDepartment of Obstetrics, Gynecology and Reproductive Sciences, and the Department of Public Health Sciences, University of Miami School of Medicine, Miami, Florida, USA.ORCID https://orcid.org/0000-0002-9003-3257
Typhanye DyerDepartment of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, USA.ORCID https://orcid.org/0000-0002-8493-5772
Angela M HeadsFaillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.ORCID https://orcid.org/0000-0002-3971-222X
Michael HorbergMid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Washington, DC, USA.
Janice Y TsohDepartment of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA.ORCID https://orcid.org/0000-0003-0989-7187
Derek D SatreDepartment of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA.ORCID https://orcid.org/0000-0002-4228-1504

Funding

Substance Use Disorders Treatment/Services Research Training ProgramT32DA007250 · NIDA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Derek D Satre, Janice Y Tsoh · 1991 to 2026
$7.4M
Mentoring alcohol use intervention research in HIV health care settingsK24AA025703 · NIAAA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Derek D Satre · 2018 to 2026
$1.8M
A Mobile Mindfulness-Based Intervention for Unhealthy Alcohol Use in People with AnxietyK23AA033108 · NIAAA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Natalia Van Doren · 2026 to 2026
$203k
NIAAA NIH HHS K23 AA033108NIAAA NIH HHS K23AA033108NIAAA NIH HHS K24 AA025703NIAAA NIH HHS K24AA025703NIDA NIH HHS T32 DA007250NIDA NIH HHS T32DA007250
6 · The paper itself

Abstract

backgroundUnhealthy alcohol use among people with HIV (PWH) often co-occurs with medical and mental health conditions and may negatively impact patient care. We examined syndemic classes of unhealthy alcohol use, substance use and comorbidities and their links to sociodemographic factors, alcohol treatment access, and HIV care outcomes.

methodsParticipants were 4574 adult PWH in Kaiser Permanente Northern California who reported alcohol use on routine primary care screening between 2013 and 2020 (index date). Latent class analysis identified subgroups based on alcohol use level and co-occurring conditions in the prior year, including smoking, alcohol and other substance use disorders, mental health diagnoses, chronic medical conditions, obesity, insufficient physical activity, and sexually transmitted infections. Age, race/ethnicity, sex, and HIV risk status were examined as predictors of class membership using latent class analysis (LCA) with covariates. HIV outcomes (viral suppression < 200 copies/mL, retention in care) and alcohol treatment in the year post-index (psychotherapy, medication) were compared across classes using Bolck, Croon, and Hagenaars (BCH) three-step procedure.

resultsFour classes were identified: Heavy Use/Complex Behavioral Multimorbidity, Moderate Use/High Cardiometabolic Burden, Low Use/High Medical Morbidity, and Moderate Use/Low Morbidity. Black and women PWH were more likely to belong to the Moderate Use/High Cardiometabolic Burden class, while men who have sex with men were less likely to belong to the Heavy Use/Complex Behavioral Multimorbidity class. Classes differed in care outcomes: the Low Use/High Medical Morbidity class had the highest HIV care retention and viral suppression; the Heavy Use/Complex Behavioral Multimorbidity class had the highest alcohol treatment receipt; and the Moderate Use/High Cardiometabolic Burden class had the lowest psychotherapy rates.

conclusionsSyndemic patterns of alcohol use and multimorbidity among PWH were associated with disparities in HIV outcomes and alcohol treatment. Findings highlight missed opportunities for integrated alcohol and cardiometabolic care and support targeted interventions to improve engagement.

Indexed as

AlcoholismHIV InfectionsSyndemicAdultCaliforniaComorbidityFemaleHumansLatent Class AnalysisMaleMiddle AgedTreatment Outcomecomorbiditydepressionhealth equityHIV treatmentlatent class analysissmokingunhealthy alcohol use

Identifiers

PMID42751764
PMCPMC13584650

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.