Alcohol and Antiretroviral Therapy - A Lethal Cocktail

Abstract

Background: Alcohol plays a role at the different points in the natural history of HIV/AIDS: This article focuses on the health implications of harmful alcohol consumption in the era of antiretroviral therapy. Aim:To explore the role of alcohol in HIV disease progression, in order to improve HIV patient management and overall better HIV prognosis. Methods:An examination of studies pertaining to the behavioral, biological and bio-chemical aspects of alcohol consumption on the pathogenesis of HIV.Findings: Alcohol consumption impacts on HIV progression resulting in increased morbidity and mortality. Alcohol consumption reduces compliance with ARV regimens, resulting in additional premature mortality. Both alcohol and HIV modulate innate and adaptive immunity and alcohol consumption for HIV-positive individuals increases the likelihood of viral replication and leads to increased susceptibility to contract opportunistic infections and other co-morbid conditions. The situation is further compounded by drugs used for the treatment of the opportunistic infections and other co-morbid conditions and their potential interactions with alcohol. The liver also metabolizes both alcohol and ARV drugs and alcohol-related liver toxicity results in compromised liver function with ARVs not working optimally and an increased risk of serious toxicity from antiretroviral therapy.Discussion: Very diverse measures of alcohol consumption have been used in studies on interactions between alcohol and HIV, making it difficult to compare studies and draw definitive conclusions. It is essential to acquire clear evidence-based guidelines on alcohol consumption for HIV-positive patients and their health-care providers. The variables alcohol, HIV and ART and their myriad interactions have not been clearly delineated. The multiple effects from HIV, alcohol and ART may compound each other, making it difficult to disentangle presenting adverse reactions and specifically the associations with alcohol. Furthermore findings in this arena are particularly relevant for prevention and treatment of HIV in countries such as South Africa that have high HIV and alcohol health burdens and have committed to an extended ARV rollout.

Heavy alcohol use in patients on highly active antiretroviral therapy: What responses are needed?

“…The high proportions of men and women who drink heavily is of grave concern given the associated risk for reduced ART adherence, [6] forward transmission of HIV, and other health problems. [7] Given the high levels of problematic drinking that were evident among patients on ART in Tshwane, we agree with recommendations made previously [2,5] that there should be more screening of patients attending HIV clinics for problematic alcohol use as a prelude to implementing brief interventions to reduce the negative impact of drinking on HIV treatment outcome, or where necessary referring HIV patients to more intensive treatment. However, the 2 -4 minutes typically taken to administer and score the AUDIT [4] is likely to serve as a barrier to its routine use in primary care settings, and as a result further research is also needed to assess the possibility of using briefer screening instruments in primary care settings.…”

“…This occurs as a result of the effect of alcohol on ART adherence and on the immune system, and its interaction with ART and medications used to treat opportunistic infections. [2] Yet little is known about the drinking behaviour of patients on ART in SA or how best to intervene.…”

Characteristics and drinking behaviour of patients on antiretroviral therapy who drink and attend HIV clinics in Tshwane, South Africa: Implications for intervention

“…ART medications may therefore not work optimally in heavy drinkers, and they are also at increased risk of toxicity from ART. [7,26] The finding that AUDIT total scores were negatively correlated with adherence and positively correlated with viral load was to be expected. [7,26] Eighty-six percent of study participants (86.6% of women and 85.6% of men) were virally suppressed.…”

“…Substance use, especially alcohol use, also influences PLWHA's adherence to ART. [7][8][9] Non-adherence to ART contributes to patients having a higher viral load. [10] SA has been identified as a country with one of the highest levels of heavy drinking globally.…”

“…HIV and alcohol consumption both modulate innate and adaptive immunity, and drinking by PLWHA increases the possibility of viral replication and the likelihood of contracting opportunistic infections and developing other co-morbid conditions. [7] In addition, the medications used to treat opportunistic infections and other comorbid conditions interact with alcohol. Both ART medications and alcohol are metabolised by the liver, and alcoholrelated liver toxicity results in compromised liver function.…”