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Many People with HIV Skip Antiretroviral Therapy When They Drink Alcohol

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About half of people who both take antiretroviral therapy (ART) and drink alcohol reported that they sometimes skip medication doses while drinking, according to a cohort study described in the October 12, 2012, advance online edition of the Journal of General Internal Medicine.

Seth Kalichman from the University of Connecticut and colleagues conducted a prospective cohort study to look at factors contributing to intentional medication non-adherence when drinking.

Alcohol use is a known barrier to antiretroviral therapy (ART) adherence, which is critical to successful treatment, the study authors noted as background. Poor adherence sometimes results from forgetfulness or cognitive impairment related to intoxication, but many people also believe it is harmful to mix alcohol and medications. While this is true for some types of drugs, commonly used antiretrovirals generally do not have adverse interactions with alcohol.

The study enrolled 178 people (80% men) who both take ART and drink alcohol. Researchers asked participants about their beliefs about the hazards of combining antiretroviral drugs with alcohol. For 12 months, they monitored alcohol consumption using electronic daily diaries, ART adherence by both self-report and unannounced pill counts, and HIV viral load based on medical charts.

Results

  • 90 of 178 participants -- just over 50% -- reported that they sometimes skipped or stopped ART when drinking.
  • About one-third of people who didn't entirely skip taking drugs said they delayed them until they thought alcohol was out of their system.
  • Over the year of observation, 43% of participants achieved less than 85% ART adherence.
  • Participants who said they thought mixing alcohol and medications was harmful were significantly more likely to miss ART on days when they drank.
  • People who skipped ART while drinking had significantly poorer overall adherence.
  • This group also was also less likely to have suppressed viral load and more likely to have CD4 T-cell counts < 200 cells/mm3.

Based on these findings, the researchers concluded, "Confirming earlier cross-sectional studies, the current findings from a prospective cohort show that a substantial number of people intentionally skip or stop their medications when drinking."

"Interventions are needed to correct alcohol-related interactive toxicity misinformation and promote adherence among alcohol drinkers," they recommended.

"Although ART and alcohol interactions can exacerbate hepatotoxicity in patients with HIV and liver disease, there are fewer known risks for alcohol interactions in patients with normal liver function," they explained in their discussion. "For many patients, the harms caused by ART non-adherence may outweigh those of ART and alcohol interactions." However, they noted, adverse interactions can occur if people also use recreational drugs when they drink.

"More than 80% of participants in this study reported that a provider had told them not to mix their ART with alcohol," they wrote. "Providers may assume patients will stop drinking to avoid mixing their medications, whereas patients may actually stop taking their medications when they are drinking."

11/9/12

Reference

SC Kalichman, T Grebler, CM Amaral, et al. Intentional Non-Adherence to Medications among HIV Positive Alcohol Drinkers: Prospective Study of Interactive Toxicity Beliefs. Journal of General Internal Medicine. October 12, 2012 (Epub ahead of print).