Alcohol Use Accelerates HIV Disease Progression

Abstract

The effects of alcohol abuse on HIV disease progression have not been definitively established. A prospective, 30-month, longitudinal study of 231 HIV(+) adults included history of alcohol and illicit drug use, adherence to antiretroviral therapy (ART), CD4(+) cell count, and HIV viral load every 6 months. Frequent alcohol users (two or more drinks daily) were 2.91 times (95% CI: 1.23-6.85, p = 0.015) more likely to present a decline of CD4 to <or=200 cells/microl, independent of baseline CD4(+) cell count and HIV viral load, antiretroviral use over time, time since HIV diagnosis, age, and gender. Frequent alcohol users who were not on ART also increased their risk for CD4 cell decline to <or=200 cells/mm(3) (HR = 7.76: 95% CI: 1.2-49.2, p = 0.03). Combined frequent alcohol use with crack-cocaine showed a significant risk of CD4(+) cell decline (HR = 3.57: 95% CI: 1.24-10.31, p = 0.018). Frequent alcohol intake was associated with higher viral load over time (beta = 0.259, p = 0.038). This significance was maintained in those receiving ART (beta = 0.384, p = 0.0457), but not in those without ART. Frequent alcohol intake and the combination of frequent alcohol and crack-cocaine accelerate HIV disease progression. The effect of alcohol on CD4(+) cell decline appears to be independent of ART, through a direct action on CD4 cells, although alcohol and substance abuse may lead to unmeasured behaviors that promote HIV disease progression. The effect of alcohol abuse on viral load, however, appears to be through reduced adherence to ART.

Alcohol: is it detrimental to HIV infected individuals on antiretroviral therapy?

“…On comparing CD4 counts of alcoholic patients with CD4 counts of nonalcoholic patients who were HIV positive for similar duration; it was found that Alcoholic patients had lower CD4 counts; implying that alcoholism had Negative effect on CD4 counts and is risk factor for rapid HIV disease progression. 6 We found pulmonary tuberculosis to be more common opportunistic infection. 30 (20.68%) patients in our study patients (n=145) had tuberculosis.…”

Barriers to Nutrition Counseling with a Registered Dietitian (RD) and Its Association with Dietary Intake, Nutrition Status, Disease Outcomes and Substance Abuse in People Living with HIV (PLWH).

“…101 Those who consumed excess alcohol were more likely to report lack of attention to nutrition labels and reported skipping meals to purchase alcohol.…”

The Influence of Psychological Predictors and Cognitive Behavioral Stress Management Intervention on Antiretroviral Therapy (ART) Adherence Among HIV-Positive Female Haitian Alcohol Users

“…ART has played a significant role not only in reducing mortality and improving the quality of life of persons living with HIV, but also in helping them achieve long-term optimal health and almost certainly in reducing HIV incidence (UN Development Programme, 2013;Donnell et al, 2010;Palombi et al, 2012;Bangsberg, Moss, & Deeks, 2004;Carpenter since the 2010 earthquake (Wood et al, 2009;Malow et al, 2010;Moatti, 2002;Safren et al, 2001;Koenig et al, 2010). Research has identified multiple barriers to ART adherence and response, including poor social support Bryant, 2006), alcohol abuse Baum et al, 2010;Malow et al, 2013;Nachega et al, 2005), negative beliefs about medicine (DiMatteo, Lepper, & Croghan, 2000;Starace et al, 2002), depression and anxiety Starace et al, 2002;Weaver et al, 2005;Krain & Fitzgerald, 2005;Ghose et al, 2013), and stigma (Castro & Farmer, 2005;Dévieux et al, 2004;Vyavaharkar et al, 2007).…”

“…Depression and anxiety have been associated with non-adherence to ART (Bryant, 2006;Dévieux et al, 2009;Baum et al, 2010;Malow et al, 2013;Nachega et al, 2005;Li et al, 2011). A study examining behavioral and social factors that predict medication adherence found that poor ART adherence was significantly predicted by avoidant coping, which is predicted by both lack of social support and negative mood states (DiMatteo, Lepper, & Croghan, 2000).…”

“…Research has identified multiple barriers to ART adherence and response, including poor social support Malow et al, 2009;Bryant, 2006), alcohol abuse Baum et al, 2010;Malow et al, 2013;Nachega et al, 2005), negative beliefs about medicine (DiMatteo et al, 2000;Starace et al, 2002), depression and anxiety Malow et al, 2013;Weaver et al, 2005;Krain & Fitzgerald, 2005;Ghose et al, 2013) and stigma (Castro & Famer, 2005;Dévieux et al, 2004;Vyavaharkar et al, 2007).…”