Alcohol Interactive Toxicity Beliefs and ART Non-adherence Among HIV-Infected Current Drinkers in Mbarara, Uganda

Abstract

Interactive toxicity beliefs regarding mixing alcohol and antiretroviral therapy (ART) may influence ART adherence. HIV-infected patients in Uganda completed quarterly visits for one year, or one visit at 6 months, depending on study randomization. Past month ART non-adherence was less than daily or <100% on a visual analog scale. Participants were asked if people who take alcohol should stop taking their medications (belief) and whether they occasionally stopped taking their medications in anticipation of drinking (behavior). Visits with self-reported alcohol use and ART use for ≥30 days were included. We used logistic regression to examine correlates of the interactive toxicity belief and behavior, and to determine associations with ART non-adherence. 134 participants contributed 258 study visits. The toxicity belief was endorsed at 24%, the behavior at 15%, and any non-adherence at 35% of visits. In multivariable analysis, the odds of non-adherence were higher for those endorsing the toxicity behavior (adjusted odds ratio (AOR): 2.06; 95% confidence interval (CI): 0.97–4.36) but not the toxicity belief (AOR: 0.63; 95%CI: 0.32–1.26). Clear messaging about maintaining adherence, even if drinking, could benefit patients.

Alcohol Use, HIV Treatment Adherence, and Sexual Risk Among People with a History of Injecting Drug Use in Vietnam

“…This finding contributes to the debate regarding whether alcohol has an influence on HIV treatment. Previous studies have discussed possible mechanisms of how alcohol use could negatively affect HIV treatment adherence [9, 31]. One of the hypotheses was that PLH may choose to skip their ART regimens after drinking alcohol for fear of an alcohol-ART interactive toxicity [31, 32].…”

“…Previous studies have discussed possible mechanisms of how alcohol use could negatively affect HIV treatment adherence [9, 31]. One of the hypotheses was that PLH may choose to skip their ART regimens after drinking alcohol for fear of an alcohol-ART interactive toxicity [31, 32]. Another proposed explanation was that problematic alcohol use often co-occurs with psychiatric disorders that can subsequently impair the ability of PLH to take their daily medications [44].…”

“…The need to maintain a high level of adherence to ART has remained a challenge to achieve maximal treatment benefits [29, 30]. The fear of mixing alcohol with ART which could result in antiretroviral toxicity can lead to treatment interruptions in PLH [31]. The relationship between alcohol use and ART has attracted increased attention in recent years [32]; however, the findings related to the effects of alcohol consumption on ART outcomes have been mixed.…”

Evaluation of smartphone APP-based case-management services among antiretroviral treatment-naïve HIV-positive men who have sex with men: a randomized controlled trial protocol

“…Both instruments comprise four-point Likert scales with the responses based on occurrence of symptoms during the last week. In each scale, the sum of all items will be calculated and categorized into different levels of mental health disorder: normal (0-4), mild (5)(6)(7)(8)(9), moderate (10)(11)(12)(13)(14), and moderate to severe (≥15) [50,51].…”

“…However, the long-term success of such efforts to scale-up coverage of ART for PLWHA may be negatively affected by deficits in adherence to the spectrum of HIV care. ART requires adequate adherence (usually defined as intake of at least 95% of ART doses [7,8]) to yield satisfactory clinical outcomes, e.g., suppressing HIV viral replication [9], improving quality of life [10], and preventing transmission [11]. However, a recent meta-analysis indicated that only 77.6% (95% confidence interval [CI]: 71.6-83.1) of Chinese PLWHA on ART maintained adequate adherence [12].…”