Association between HIV Treatment Status and Alcohol Metabolism
Alcohol and drug use are intimately associated with HIV transmission, and alcohol is known to increase HIV disease progression. This randomized double-blind placebo-controlled study of alcohol versus placebo administration in patients with untreated HIV disease investigated the role of HIV treatment status on alcohol pharmacokinetics. Fifteen patients with untreated HIV underwent 2 sets of alcohol or alcohol-placebo administration before and after initiation of antiretroviral therapy (ART). Pharmacokinetics were measured over 8 hours following administration. Choice of ART was at the discretion of the treating physician. Alcohol is metabolized through cytochrome P450 3A4; therefore, the authors studied HIV treatment regimens that included ritonavir (a CYP 3A4 inhibitor) or efavirenz (a CYP 3A4 inducer).
- Mean peak blood alcohol concentration (BAC) before ART initiation was 131 mg/dL (standard error [SE], 6.0). After 2–3 weeks of ART, mean peak BAC was 116 mg/dL (SE, 6.2), representing a 10–15% decrease.
- Alcohol area-under-the-curve was higher pre-ART initiation, with higher Cmax and Cmin; however, no difference was seen in alcohol elimination rates pre-initiation versus post-initiation.
- No differences in BAC were noted among patients receiving the ritonavir versus efavirenz regimen.