Alcohol Use and Human Immunodeficiency Virus (HIV) Infection: Current Knowledge, Implications, and Future Directions

Abstract

Alcohol use is common among people living with human immunodeficiency virus (HIV). In this narrative review, we describe literature regarding alcohol’s impact on transmission, care, co-infections and comorbidities that are common among people living with HIV (PLWH), as well as literature regarding interventions to address alcohol use and its influences among PLWH. This narrative review identifies alcohol use as a risk factor for HIV transmission, as well as a factor impacting the clinical manifestations and management of HIV. Alcohol use appears to have additive and potentially synergistic effects on common HIV-related comorbidities. We find that interventions to modify drinking and improve HIV-related risks and outcomes have had limited success to date, and we recommend research in several areas. Consistent with Office of AIDS Research/National Institutes of Health priorities, we suggest research to better understand how and at what levels alcohol influences comorbid conditions among PLWH, to elucidate the mechanisms by which alcohol use is impacting comorbidities, and to understand whether decreases in alcohol use improve HIV-relevant outcomes. This should include studies regarding whether state-of-the-art medications used to treat common co-infections are safe for PLWH who drink alcohol. We recommend that future research among PLWH include validated self-report measures of alcohol use and/or biological measurements, ideally both. Additionally, subgroup variation in associations should be identified to ensure that the risks of particularly vulnerable populations are understood. This body of research should serve as a foundation for a next generation of intervention studies to address alcohol use from transmission to treatment of HIV. Intervention studies should inform implementation efforts to improve provision of alcohol-related interventions and treatments for PLWH in healthcare settings. By making further progress on understanding how alcohol use affects PLWH in the era of HIV as a chronic condition, this research should inform how we can mitigate transmission, achieve viral suppression, avoid exacerbating common comorbidities of HIV and alcohol use and make progress toward the 90-90-90 goals for engagement in the HIV treatment cascade.

Behavioral Interventions Targeting Alcohol Use Among People Living with HIV/AIDS: A Systematic Review and Meta-Analysis

“…This meta-analysis differs from prior reviews of the literature (6, 8, 9) in four ways. First, we included interventions that explicitly addressed (and measured) alcohol use (not broad substance use) alone or as part of a more comprehensive intervention to determine the efficacy of interventions that include an alcohol component.…”

“…A meta-analysis of studies conducted in Africa that examined the alcohol-HIV association (5) found drinker status to be associated with HIV infection such that drinkers were 70% more likely to be HIV-infected than non-drinkers and the risk of HIV was notably higher among problem drinkers than among non-problem drinkers. Furthermore, harmful alcohol use by PLWHA is of concern given that alcohol use is associated with the transmission of HIV, poor HIV management, and poor HIV treatment outcomes (6). Therefore, reducing alcohol consumption among PLWHA can help to reduce the transmission of HIV and promote medical adherence and subsequent viral suppression.…”

“…In contrast, a small, but growing body of research evaluating interventions targeting alcohol use alone or in the context of a broader HIV intervention (e.g., reducing sexual risk behaviors by addressing situations in which alcohol is consumed) has emerged over the past decade. Prior narrative reviews of interventions focused on alcohol use among PLWHA have found mixed results likely due to the nature of the intervention (i.e., single vs. multiple health behavior change target) (6, 8, 9). Researchers have advocated for a multiple behavioral change approach when intervening on behaviors that are related to one another such as alcohol and risky sexual behavior but there is limited evidence showing that multiple health behavior change interventions are superior to interventions addressing a single health behavior (10, 11).…”

The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder

“…Globally, AUD is associated with a substantial burden of disease in terms of years of life lost to premature mortality, disability-adjusted life years, and years lived with disability (Whiteford et al 2013). Additionally, problematic alcohol use has been linked to motor vehicle accidents (Kelly et al 2004); poor academic performance (Williams et al 2003;Wolaver 2002); increased risk of suicide (American Psychiatric Association 2016;Darvishi et al 2015); increased criminal activity, including intimate partner violence perpetration (Okuda et al 2015); increased risk for death by overdose (Jones et al 2014); and increased transmission risks for human immunodeficiency virus (HIV) and other sexually transmitted infections (Monroe et al 2016;Rashad and Kaestner 2004;Williams et al 2016). Additionally, many symptoms of AUD relate to the inability to regulate alcohol use, and relapse of AUD is common (Dawson et al 2007; Moos and Moos 2006;Tuithof et al 2014).…”

Relación entre la adherencia al tratamiento antirretroviral en pacientes VIH+ y el consumo de alcohol, asociado o no al uso de otras sustancias

“…Diversos autores han señala-do su elevada prevalencia (Parsons, Starks, Millar, Boonrai y Marcotte, 2014;Skalski, Sikkema, Heckman y Meade, 2013). Aunque las estimaciones varían entre el 8% y el 42% (Williams et al, 2016), se ha señalado que la prevalencia de consumo intensivo de alcohol (heavy drinking) (Cortés Tomás y Motos Sellés, 2016) en estos pacientes casi alcanza a duplicar la prevalencia en la población general (Galvan et al, 2002).…”