The BAHR Study

The International URBAN ARCH Center is excited to feature the Biomarkers for Alcohol/HIV Research (BAHR) study. The BAHR study was funded in May 2022 and is led by Dr. Judy Hahn, who is also the TRAC study project lead. This affiliated, NIAAA-funded study will leverage several research studies of persons with HIV (PWH) that measured phosphatidylethanol (PEth), a blood biomarker reflecting alcohol consumption over the past month, to investigate key questions about how alcohol use affects the health of persons with HIV and how to reduce alcohol use. In this issue of URBAN ARCH News, we will delve deeper into the BAHR study, highlighting the study team, research objectives, and progress so far.

The specific aims of the BAHR study are the following:

  1. Determine the relationship between PEth-measured alcohol use and HIV virologic failure and mortality risk among PWH who are on ART using data from six studies.
  2. Conduct individual participant data (IPD) meta-analyses of 15 alcohol/HIV intervention studies to examine evidence of the efficacy of the interventions to reduce PEth-measured alcohol use, and their further impact on virologic failure.
  3. Examine the predictive value of a combination of common laboratory tests as a low-cost alternative to PEth testing, leveraging the extensive testing being conducted in a 6000-person study.

Unlike a traditional research study which enrolls participants and collects data to answer research questions, the BAHR study will utilize data from existing studies to answer questions about the relationship of alcohol use to HIV virologic failure and mortality risk; the efficacy of alcohol intervention studies to reduce alcohol use and decrease virologic failure; information on the comparability of results using biomarkers versus self-report to measure alcohol use; and evidence on the predictive ability of a low-cost alcohol risk score for further testing and potential increased availability in low-resource and non-research settings.

Dr. Judy Hahn, the Principal Investigator of the BAHR study, was also interviewed for this issue’s spotlight interview, which you can read here. Judy has been working with biomarkers of alcohol use for nearly 20 years. “When you measure alcohol use by self-report, there’s all sorts of problems – but when you use a biomarker, you can overcome the problems of self-report and you also have more consistency of measures. We feel that when we’re trying to ask questions about alcohol use, we are going to get better answers, clearer answers, and maybe stronger answers when we use biomarkers,” she noted, speaking to the importance of alcohol biomarkers in the research field. She notes that biomarkers also have the potential to be used in clinical settings, commenting that, “just like measuring your blood pressure or getting your hemoglobin A1C, biomarkers can be an incredibly important tool in clinical care and in substance use treatment.”

Dr. Jeremy Kane is leading Aim 2 of the study. Jeremy is an Assistant Professor of Epidemiology at Columbia University Mailman School of Public Health, with research interests in global mental health, substance and alcohol use epidemiology, and adolescent health. His research investigates mental health and substance use problems among populations affected by violence and HIV in low- and middle-income countries.

Aim 3 is led by Dr. Cristina Espinosa da Silva, who is currently a postdoctoral fellow at the University of California, San Francisco. Cristina’s research interests lie in quantitative epidemiology studying HIV and other sexually transmitted infections (STIs), HIV/STI behavioral epidemiologic and intervention research, mental health, substance use disorders, as well as marginalized and underserved populations in resource-limited settings.

Other core collaborators, pictured left to right below, include Dr. Nneka Emenyonu (UCSF), Dr. Sarah Puryear (UCSF), Dr. Phyllis Tien (UCSF, San Francisco VA Health Care System), Dr. Aaron Scheffler (UCSF), Dr. Isabel Elaine Allen (UCSF), and Robin Fatch (UCSF).


Currently, the team has published a protocol paper for Aim 2 in BMJ Open. The paper can be accessed here. The team will also present an abstract at the Conference on Retroviruses and Opportunistic Infections (CROI), which will be held in Denver, CO from March 3-6, 2024. The team is looking forward to continuing to make progress on each of the aims and to translate these results into meaningful action items for the field of alcohol research.