Alcohol use and immune reconstitution among HIV-infected patients on antiretroviral therapy in Nairobi, Kenya

Abstract

Studies on the effects of alcohol use on HIV disease progression have been contradictory, with at least one study finding a positive effect of low alcohol consumption on CD4 count. In addition, most such studies have taken place in the developed West. We investigated the association between alcohol use and immune reconstitution through CD4 count response among HIV-infected individuals on antiretroviral therapy (ART) at an urban sub-Saharan African clinic. This was a retrospective cohort study of treatment-naïve HIV-infected adults initiating ART in Nairobi, Kenya and followed for 12 months between January 2009 and December 2012. At enrollment, a standardized questionnaire was used to collect data on sociodemographic variables and alcohol consumption. CD4 count was measured every six months. Linear regression models assessed the association between CD4 count and alcohol consumption, categorized as abstinent, moderate, or hazardous. Overall, 854 participants were included, 522 of which were women, with 85 (25.6%) men and 50 (9.6%) women reporting any alcohol use, and 8 (2.4%) men and 7 (1.3%) women reporting hazardous drinking. At baseline, alcohol use was associated with higher education and socioeconomic status. Median CD4 count was higher among alcohol users compared to those who abstained at baseline and at 6 and 12 months post-ART initiation, although this was only significant at 6 months. There were no differences in adherence between abstainers and drinkers. While overall alcohol use was significantly associated with higher CD4 counts, moderate and hazardous use treated separately were not. We conclude that, while alcohol use was associated with higher CD4 counts at 12 months post-ART, the mechanism for this association is unclear but may reflect unmeasured socioeconomic or nutritional differences. Additional research is required on the specific drinking patterns of this population and the types of alcoholic beverages consumed to clarify this relationship.

Alcohol Use and HIV Disease Progression in an Antiretroviral Naive Cohort

“…The clinical significance of this is that unhealthy alcohol use does not appear to have a direct short-term impact on CD4 cell counts among persons with HIV who are not on ART. This is consistent with several prospective studies conducted in East Africa 18,19,21 and elsewhere, 14,17 but differs from some others. 15,16,20 The gender distribution (68% female) was representative of that of HIV in eastern and southern Africa.…”

“…Several studies among persons on ART have found no association between high levels of alcohol use (variously defined as heavy, hazardous, problem, or severe risk alcohol use) and CD4 cell count and/or HIV viral load after controlling for ART adherence. 14,15,17-19 Two recent studies conducted mediation analyses to separate out effects of alcohol use on CD4 cell counts due to reduced adherence versus other pathways. One found direct effects of heavy alcohol use on CD4 cell counts, 20 while the other found only indirect effects of alcohol use via adherence.…”

Integration of Alcohol Use Disorder Interventions in General Health Care Settings in Sub-Saharan Africa: A Scoping Review

“…This included routine screening or inquiring about alcohol use disorder ( n = 1), and screening and brief intervention (SBI) for AUD ( n = 1) ( Table 2 ). These studies aimed to assess routine screening for alcohol use for people living with HIV during enrollment in the HIV clinic ( 57 ) and implementation of an alcohol screening and brief intervention in 18 primary health care services ( 7 ). The study found nine clinics had good and nine had poor SBI implementation.…”

“…In this review, we found only two studies that described and reported on the integration status of AUD interventions in general health care settings in SSA (7,57). Importantly, we identified several studies detailing the mental health plans and programs based on integrated interventions for mental health services that include AUD (36)(37)(38).…”

Epidemiology of Non-communicable Diseases and Risk factors in South African Adolescents and Youth Living with HIV: Implications for Integrated Prevention

“…This is concerning because socioeconomic factors like food insecurity impact adherence to ART and retention in HIV care [146], which has implications for viral suppression and chronic disease pathways [64,147,148]. These factors also have an impact on mental health and may increase susceptibility to alcohol and substance use [149][150][151][152].…”