HIV treatment in drug abusers: impact of alcohol use

Míguez, María José; Shor‐Posner, Gail; Morales, Guillermo; Rodríguez, Allan; Burbano, Ximena

doi:10.1080/1355621031000069855

Cited by 108 publications

(95 citation statements)

References 9 publications

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“…Previous studies have shown that among HIV+ individuals with a history of alcohol problems and receiving antiretroviral therapy (ART), alcohol use was associated with lower CD4 counts and either higher or active undetectable HIV viral loads (Miguez et al, 2003;Samet, Horton, Traphagen, Lyon & Freedberg, 2003). In contrast, a recent prospective study found that among HIV+ individuals not receiving ART, heavy alcohol consumption was associated with lower CD4 counts, but no effect on HIV viral load was observed.…”

Section: Alcohol Use and Hiv Infection Disease Progression And Treatmentioning

confidence: 72%

“…Furthermore, evidence from clinical and laboratory studies has indicated that alcohol abuse may accelerate HIV disease progression (Bagby, Zhang, Purcell, Didier & Nelson, 2006;Hao rah et al, 2004;Miguez, Shor-Posner, Morales, Rodriguez & Burbano, 2003;Samet et al, 2007). In particular, proteasomes and immunoproteasomes, critical immune processes attenuated during progressive HIV-1 infection, are affected by alcohol abuse.…”

Section: Alcohol Use and Hiv Infection Disease Progression And Treatmentioning

confidence: 99%

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Descriptive systematic review of sub-Saharan African studies on the association between alcohol use and HIV infection

Pithey

Parry

2009

SAHARA-J: Journal of Social Aspects of HIV/AIDS

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The purpose of this review was to identify and assess studies that have quantified the association between alcohol consumption and HIV infection in sub-Saharan Africa. PubMed, CAB Abstracts and article references were searched to identify studies published in English between 2000 and 2008 that reported relative measures of the association between alcohol use and HIV prevalence and/or seroconversion rates. Twenty-one eligible studies were described in detail and information on study characteristics extracted. All of the identified studies were conducted either in east or southern Africa, and varied substantially regarding study population and alcohol use definitions. Overall, users of alcohol and especially problem drinkers were more likely to be HIV seropositive (HIV+) than non-users, frequency or quantity of alcohol use was positively associated with HIV prevalence, and the association varied by gender. The use of alcohol in sexual contexts was significantly associated with an increased risk of HIV acquisition and prevalence.The findings of this review of sub-Saharan African research strongly support an association between alcohol consumption and HIV infection. Although a causal relationship could not be established with certainty from the mainly cross-sectional studies, the negative consequences of such an association have profound implications for the burden of disease in this region. To confirm causality, future research should use prospective study designs, use clearly defined standardised measures of alcohol use (and problematic drinking) and an 'event-specific' approach to examine the situational links between alcohol use and HIV acquisition. Keywords: Alcohol, HIV, sexual risk, Africa.Anne Pithey is an independent researcher who has worked for the Alcohol and Drug Abuse Research Unit (ADARU) of the South African Medical Research Council (MRC) over a number of years. Her primary role has been to undertake systematic reviews of the literature and to assist with a variety of writing tasks. She holds an MSc (Med) from the University of Cape Town. Charles

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Section: Alcohol Use and Hiv Infection Disease Progression And Treatmentioning

confidence: 72%

Section: Alcohol Use and Hiv Infection Disease Progression And Treatmentioning

confidence: 99%

Descriptive systematic review of sub-Saharan African studies on the association between alcohol use and HIV infection

Pithey

Parry

2009

SAHARA-J: Journal of Social Aspects of HIV/AIDS

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“…Further, alcoholism comorbidity was an essential concomitant for observation of evidence for neuronal compromise (ie low NAA) and high-energy phosphate metabolism (ie low Cr) in parietal-occipital cortex in individuals with HIV infection. The exceedingly high prevalence of alcoholism in HIV-infected individuals and the interfering effect of alcohol consumption on HIV therapeutic efforts, both in terms of pharmacological response (Miguez et al, 2003) and therapy compliance (Cerwonka et al, 2000;Samet et al, 2004), underscore the relevance of rigorous study of the compounded diseases.…”

Section: Discussionmentioning

confidence: 99%

Cortical NAA Deficits in HIV Infection without Dementia: Influence of Alcoholism Comorbidity

Pfefferbaum

Adalsteinsson

Sullivan

2005

Neuropsychopharmacol

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Alcoholism comorbidity is highly prevalent in individuals infected with human immunodeficiency virus (HIV). Each condition is known to affect brain structure, function, and metabolism, but the combined effects on the brain have only recently been considered. Single-voxel, proton MR spectroscopy (MRS) has yielded sensitive measures of early brain deterioration in the progression of HIV, but has limited coverage of neocortex, whereas MRS imaging (MRSI) can simultaneously interrogate large regions of cortex. Included were 15 men with HIV þ alcoholism, nine men with HIV alone, eight men with alcoholism alone (abstinent for 3-17 months), and 23 controls. The two HIV groups were matched in T-cell count and were not demented; the two alcoholism groups were relatively matched in lifetime alcohol consumption. We used MRSI with a variable-density spiral sequence to quantify major proton metabolitesFN-acetylaspartate (NAA), creatine (Cr), and choline (Cho)Fin the superior parietal-occipital cortex. Metabolites were expressed in absolute units and as the NAA/Cr ratio. Significant group effects were present for NAA and Cr. Only the HIV þ alcoholism group was significantly affected, exhibiting a 0.8 SD deficit in NAA and a 1.0 SD deficit in Cr. The deficits were not related to highly active antiretroviral therapy (HAART) status. Neither HIV infection nor alcoholism independently resulted in parietal-occipital cortical metabolite abnormalities, yet each disease carried a liability that put affected individuals at a heightened risk of neuronal compromise when the diseases were compounded. Further, the use of absolute measures revealed deficits in NAA and Cr that would have gone undetected if these metabolites were expressed as a ratio.

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“…[1][2][3][4][5][6][7][8][9][10][11] Alcohol, cocaine, and heroin use have all been shown to significantly increase ART non-adherence in patients living with HIV (PLWH). [12][13][14] A meta-analysis of the association between alcohol use and ART adherence found that alcohol use is associated with a 40-50 % decrease in ART adherence.…”

Section: Introductionmentioning

confidence: 99%

“…11 While even Blight^alcohol use (less than once a week) is associated with increased viral loads, there is a dosedependent relationship between alcohol use and nonadherence. 4,11 Similarly, another study found that only 27 % of cocaine users were adherent to their ART regimen. 13 In a nationally representative survey of PLWH, 18 % of patients reported heavy drinking, 40 % reported illicit drug use other than marijuana, and 12 % screened positive for drug dependence.…”

Section: Introductionmentioning

confidence: 99%

Assessing Problematic Substance Use in HIV Care: Which Questions Elicit Accurate Patient Disclosures?

et al. 2016

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BACKGROUND: Substance use is associated with higher rates of antiretroviral non-adherence and poor HIV outcomes. This study examined how HIV care providers assess substance use, and which questions elicit accurate patient disclosures. METHODS: We conducted a conversation analysis of audio-recorded encounters between 56 providers and 162 patients living with HIV (PLWH) reporting active substance use in post-encounter interviews (cocaine or heroin use in the past 30 days, > 4 days intoxicated in past 30 days, or AUDIT score ≥ 8). We assessed the frequency of substance use discussion, characterized the types of questions used by providers, and determined the frequency of accurate patient disclosure by question type. RESULTS: In 55 reports of active substance use, providers already knew about the use (n = 16) or patients disclosed unpromptednn = 39). Among the remaining 155 instances of substance use in which providers had the opportunity to elicit disclosure, 78 reports (50 %) of substance use were not discussed. Of the remaining 77 reports in which the provider asked about substance use, 55 (71 %) patients disclosed and 22 (29 %) did not disclose. Questions were classified as: open-ended (n = 18, BHow's the drinking going?^); normalizing (n = 14, BWhen was the last time you used?^); closed-ended (n = 36, BHave you used any cocaine?^); leading towards non-use (n = 9, BHave you been clean?^). Accurate disclosure followed 100 % of open-ended and normalizing questions, 58 % of closed-ended questions, and 22 % of leading questions. After adjusting for drug type, closed-ended questions were 41 % less likely (p < 0.001), and 'leading' questions 78 % less likely (p = 0.016) than broad and normalizing questions to elicit disclosures. CONCLUSION: Providers in this sample missed almost half of the opportunities to identify and discuss substance use with PLWH. Providers can increase the probability of patient disclosure by using open-ended or normalizing questions that ask about the Blast time^that the patient used drugs or alcohol.

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HIV treatment in drug abusers: impact of alcohol use

Cited by 108 publications

References 9 publications

Descriptive systematic review of sub-Saharan African studies on the association between alcohol use and HIV infection

Descriptive systematic review of sub-Saharan African studies on the association between alcohol use and HIV infection

Cortical NAA Deficits in HIV Infection without Dementia: Influence of Alcoholism Comorbidity

Assessing Problematic Substance Use in HIV Care: Which Questions Elicit Accurate Patient Disclosures?

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