Does alcohol use have a causal effect on HIV incidence and disease progression? A review of the literature and a modeling strategy for quantifying the effect

Abstract

In the first part of this review, the nature of the associations between alcohol use and HIV/AIDS is discussed. Alcohol use has been found to be strongly associated with incidence and progression of HIV/AIDS, but the extent to which this association is causal has traditionally remained in question. Experiments where alcohol use has been manipulated as the independent variable have since helped establish a causal effect of alcohol use on the intention to engage in condomless sex. As the intention to engage in condomless sex is a surrogate measure of actual condom use behavior, which itself is linked to HIV incidence and re-infection, the causal chain has been corroborated. Moreover, there are biological pathways between alcohol use and the course of HIV/AIDS, only in part being mediated by adherence to antiretroviral medication. In the second part of the contribution, we provide suggestions on the quantification of the link between alcohol use and HIV incidence, using risk relations derived from experimental data. The biological links between alcohol use and course of HIV/AIDS are difficult to quantify given the current state of knowledge, except for an operationalization for the link via adherence to medication based on meta-analyses. The suggested quantifications are exemplified for South Africa.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-017-0121-9) contains supplementary material, which is available to authorized users.

The relationship between different dimensions of alcohol use and the burden of disease—an update

“…Systematic reviews and meta-analyses are now available to allow the quantification of the impact of alcohol use on HIV/AIDS. In the following, we try to summarize recent developments (following closely [98]; see also [99]), and suggest an operationalization to quantify the causal impact of alcohol use on HIV/AIDS. Alcohol use was found to be associated with HIV incidence and prevalence in systematic reviews and metaanalyses [100][101][102][103][104][105][106].…”

Acute Alcohol Consumption Directly Increases HIV Transmission Risk: A Randomized Controlled Experiment

“…20-26 It has been theorized that consuming alcohol limits cognitive processing capabilities; causing individuals to attend only to salient risk-impelling cues (e.g., feeling sexually aroused) while disregarding risk-inhibiting information (e.g., possible HIV transmission), which in turn increases the likelihood of engaging in sex without condoms. 27 Although results from meta-analyses and reviews are consistent with this theory, 28;29 the evidence has largely been based on cross-sectional studies, and findings from event-level analyses have been mixed.…”

Patterns of Alcohol Use Among Patients Living With HIV in Urban, Large Rural, and Small Rural Areas

“…Unhealthy alcohol use ranges from drinking above recommended limits to meeting diagnostic criteria for alcohol use disorder (AUD) and encompasses multiple patterns of drinking such as heavy episodic drinking and high average consumption level, which are negatively associated with a number of health outcomes . Unhealthy alcohol use is also strongly associated with increased HIV transmission and incidence . Given the dangers of any and unhealthy alcohol use for PLWH, understanding patterns of alcohol use may be important to providing effective interventions both to prevent and treat HIV.…”

“…We describe patterns of alcohol use across rurality among PLWH.Methods: Veterans Aging Cohort Study electronic health record data were used to identify patients with HIV (ICD-9 codes for HIV or AIDS) who completed AUDIT-C alcohol screening between February 1, 2008, and September 30, 2014. Regression models estimated and compared 4 alcohol use outcomes (any use [AUDIT-C > 0] and alcohol use disorder [AUD; ICD-9 codes for abuse or dependence] diagnoses among all PLWH, and AUDIT-C risk categories: lower-[1-3 men/1-2 women], moderate-[4-5 men/3-5 women], higher-6-7]), and severe-risk [8][9][10][11][12], and heavy episodic drinking (HED; ࣙ1 past-year occasion) among PLWH reporting use) across rurality (urban, large rural, small rural) and census-defined region.Findings: Among 32,699 PLWH (29,540 urban, 1,301 large rural, and 1,828 small rural), both any alcohol use and AUD were highest in urban areas, although this varied across region. Predicted prevalence of any alcohol use was 54.1% (53.5%-54.7%) in urban, 49.6% (46.9%-52.3%) in large rural, and 50.6% (48.3%-52.9%) in small rural areas (P < .01).…”

“…3,[6][7][8] Unhealthy alcohol use is also strongly associated with increased HIV transmission and incidence. [9][10][11] Given the dangers of any and unhealthy alcohol use for PLWH, understanding patterns of alcohol use may be important to providing effective interventions both to prevent and treat HIV.…”