Past research has produced conflicting data on the role of alcohol consumption in the progression of HIV disease.

As reported in the December 1, 2006 Journal of Acquired Immune Deficiency Syndromes, researchers examined the independent effect of alcohol and the combined effects of alcohol and illicit drug use on antiretroviral therapy utilization, adherence, and virological suppression in an urban cohort of HIV positive individuals.

In this observational clinical cohort, alcohol use, active drug use, and adherence were prospectively assessed at 6-month intervals. The investigators classified "hazardous alcohol use" as more than 7 drinks per week or more than 3 drinks on one occasion for women, and more than 14 drinks per week or more than 4 drinks on one occasion for men. Active drug use was defined as any use within the previous 6 months. Outcomes included utilization of antiretroviral therapy, 2-week adherence, and virological suppression. Analyses were adjusted for age, sex, race, years on antiretroviral therapy, and clinic enrollment time.

Results

• Between 1998 and 2003, 1711 individuals participated in 5028 interviews.

• 1433 of these patients (accounting for 3761 interviews) were on antiretroviral therapy.

•The prevalence of any alcohol use at the first interview was 45%, with 10% classified as hazardous drinkers.

•One-third of the sample used illicit drugs.

• In multivariate analyses adjusting for age, sex, race, active drug use, years on antiretroviral therapy, and clinic enrollment time, hazardous alcohol use, compared with no alcohol use, was independently associated with:

- decreased antiretroviral therapy utilization (AOR 0.65; 95% CI 0.51 to 0.82);
- poorer 2-week adherence (AOR 0.46; 95% CI 0.34 to 0.63);
- reduced virological suppression (AOR 0.76; 95% CI 0.57 to 0.99)

• Concurrent injection drug use exacerbated these negative effects on antiretroviral therapy use, adherence, and virological suppression.

Conclusion

"Hazardous alcohol use alone and combined with injection drug use was associated with decreased antiretroviral therapy uptake, adherence, and viral suppression," the authors concluded. "Interventions targeting alcohol use may improve HIV outcomes in individuals with hazardous alcohol use."

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

12/12/06

Reference
G Chander, B Lau, R D Moore. Hazardous Alcohol Use: A Risk Factor for Non-Adherence and Lack of Suppression in HIV Infection. Journal of Acquired Immune Deficiency Syndromes 43(4): 411-417, December 1, 2006.