Effects of sex and alcohol use on antiretroviral therapy outcomes in Botswana: a cohort study

Abstract

Aims We aimed to determine alcohol use’s effect on HIV treatment success and whether alcohol use mediates the relation between male sex and treatment failure. Design Longitudinal cohort. Setting Clinics in Botswana. Participants 938 HIV-infected treatment naïve adults initiating regimens containing efavirenz between June 2009 and February 2013, including 478 (51%) males, median age 38 years, and plasma HIV RNA 4·9 log10 copies/ml. Measurements Primary outcome was a composite of treatment failure over 6 months including death, loss to care, or plasma HIV RNA >25 copies/ml. Exposures included alcohol use and gender. Findings Failure in 339 (36%) participants included 40 (4%) deaths, 194 (21%) lost to care, and 105 (11%) with HIV RNA>25 copies/ml. Both hazardous alcohol use in the past year [aOR 1·4 (95% CI: 1·0, 1·9)] and male sex [aOR 2·1 (95% CI: 1·5, 2·9)] were associated with failure. Alcohol use was more common among men (51%) than women (19%), p<0·001. There was no difference in alcohol use’s effect on failure between sexes (p for interaction>0.5). Controlling for hazardous alcohol use did not change the relation between sex and failure. Conclusion Hazardous alcohol users had worse HIV treatment outcomes. Males were more commonly hazardous drinkers, but hazardous alcohol use had neither a mediating nor moderating effect on the relation between sex and failure. We found no evidence that alcohol reduction interventions for improving HIV outcomes should preferentially target males. Identification of other characteristics in males causing worse outcomes warrant investigation.

The longitudinal association between depression, anxiety symptoms and HIV outcomes, and the modifying effect of alcohol dependence among ART clients with hazardous alcohol use in Vietnam

“…PWH can use alcohol as a coping strategy, which may help improve mood to an extent [44]. However, since hazardous alcohol use independently decreased ART adherence [96,97], high levels of alcohol use such as alcohol dependence among PWH with anxiety symptoms may pose greater challenges than benefits to adherence.…”

Alcohol use and viral suppression in HIV-positive Kenyan female sex workers on antiretroviral therapy

“…Studies of general population clinic attendees in South Africa, Lesotho, and Morocco also found no association between alcohol use and detectable viral load [6][7][8][9]. In contrast, alcohol consumption was associated with detectable viral load among those on ART in a clinic-based cohort study in Botswana (aOR 1.7, 95%CI 1.0-3.0) [5] and a Ugandan cohort study (aOR 3.14, 95%CI 0.95-10.34) [11]. Similarly, a South African study reported that drinking >20 units of alcohol per week, compared to no alcohol use, was associated with detectable viral load (aOR 7.53, 95%CI 1.04-54.55) [10].…”

“…Studies in high-and low-income countries have demonstrated that alcohol use is associated with poor ART adherence [1][2][3][4]. Fewer studies have examined the association between alcohol use and viral suppression, particularly in low-income settings, and these provide conflicting results [5][6][7][8][9][10][11]. With modern ART regimens, adherence >80% is sufficient to maintain viral suppression [12].…”

Viral load outcomes in a cohort of alcohol-consuming people living with HIV receiving antiretroviral therapy in Mumbai, India

“…[35][36][37][38] The literature, however, is not conclusive about the effect of alcohol use on VL outcomes, nor is it conclusive on CD4 outcomes, a direct marker for immune function and predictor of VL. While some studies document a negative effect of alcohol on these two biological outcomes, 32,36,38,39 others have found no association. 34,[40][41][42] Given the well-documented association between adherence and VF, and that between alcohol use and non-adherence, it is possible that adherence falls along the causal pathway between alcohol use and VF.…”

“…4,6,16,27,28 Of these, the presence of alcohol and depression are consistently associated with poorer adherence across studies. 6,27,29 Alcohol use is common among PLHIV [30][31][32] and the deleterious effects of alcohol consumption on ART adherence and treatment interruptions (TIs) are well known. 6,33,34 High levels of alcohol consumption predict an increased risk of poorer mental health, liver dysfunction and all-cause mortality among PLHIV.…”