Alcohol Use and HIV Pharmacotherapy

Abstract

Alcohol consumption by individuals infected with HIV is an important medical management issue with significant implications for the effectiveness of antiretroviral therapy as well as an important evolving field of HIV research. Alcohol consumption is a risk factor for poor medication adherence and can modify liver drug metabolism, both of which can lead to the emergence of drug-resistant virus. Research indicates that alcohol consumption greater than 50 g/day (four or five drinks) is a risk factor for liver disease progression among patients with HIV/HCV coinfection. In addition, alcohol-induced cirrhosis can result in changes in drug metabolism in the liver through compromised liver function. More research studies are needed to elucidate the biological and molecular basis of the clinical changes induced by alcohol consumption in HIV-infected individuals and on the relationship of these changes to the effectiveness of HIV pharmacotherapy. Specifically, research areas that are of particular importance are (1) determining alcohol consumption levels and patterns and its impact on antiretroviral medication adherence, efficacy, and physician prescribing practices; (2) identifying behavioral interventions to enhance adherence to HIV medications and reduce alcohol consumption; (3) clarifying the relationships and interactions among alcohol metabolism, HIV drug metabolism, and pharmacogenetics; (4) elucidating the extent of liver toxicity due to antiretroviral therapy and drug-drug interactions in individuals who consume alcohol; and (5) delineating the contribution of alcohol consumption to end-stage organ damage, particularly in HIV/HCV coinfection.

Problematic Alcohol Use Among Individuals with HIV: Relations with Everyday Memory Functioning and HIV Symptom Severity

“…More likely, and as articulated in previous work [35], the relations between memory functioning, HIV outcomes and alcohol use are reciprocal. Among HIVinfected individuals, problematic alcohol use is associated with worse HIV health outcomes [e.g., 2,5,7,8,[11][12][13][14][15][16][17][18][19] which ostensibly result in increased HIV symptom severity and lower overall quality of life. Adding to the clinical profile, HIV disease progression (i.e., heightened symptom burden) is commonly associated with neurocognitive impairment [24][25][26][27][28].…”

“…Importantly, both HIV and problematic alcohol use have significant implications for memory functioning, which is vital to successful adherence to complicated medication regimens and effectiveness of cognitive and behavioral interventions for HIV. Although previous research has shown that heavy alcohol use is associated with a host of negative HIV health outcomes, including poor medication adherence [2,7,8,[11][12][13][14][15][16], increased immune suppression [15,17,18], reduced effectiveness of therapeutic regimens [5], faster HIV disease progression [19], lower survival rates [20], and worse health-related quality of life [21], less is known about its impact on self-reported memory functioning and HIV symptom severity.…”

Transtorno Por Uso De Álcool E Hiv/Aids: Uma Revisão Da Literatura

“…As enzimas hepáticas que atuam na biotransformação do álcool também estão envolvidas na catálise das moléculas de ARVs (por exemplo, álcool desidrogenase, aldeído desidrogenase, xantina oxidase, epóxido hidrolase e isoenzimas do citocromo P450) 7,157 . Portanto, os pacientes HIV+ que apresentam TUA e que estão sob terapia com ARVs são predispostos a interações farmacológicas que podem diminuir ou aumentar de forma inadequada os efeitos das moléculas de ARVs.…”

Integrating HIV Prevention Activities into the HIV Medical Care Setting: A Report from the NYC HIV Centers Consortium

“…79 Although these findings are encouraging, it is widely reported that a history of injection drug use, alcohol use, and other substance use is associated with lower adherence to HAART 80,81 and that this group is therefore at increased risk for antiretroviral drug resistance. 82,83 There is preliminary evidence that individuals with resistance may be at increased risk for engaging in higher levels of risk behavior 15 and that the prevalence of ART resistance is high among some populations. 82 Resistance testing among those with treatment failure, therefore, may be important for groups such as drug users who may be at increased risk for transmitting drug-resistant HIV strains to sexual and needle-sharing partners and may actually benefit all individuals prior to HAART initiation.…”