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Research Summary

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.


Although limited by small sample size, this study suggests untreated HIV is associated with higher BAC, and delayed alcohol pharmacokinetics may improve with ART. Larger studies powered to detect differences in alcohol metabolism should be performed to determine if patients with untreated HIV who ingest alcohol are at higher risk for alcohol-related adverse consequences. Jeanette M. Tetrault, MD


McCance-Katz EF, Lum PJ, Beatty G, et al. Untreated HIV infection is associated with higher blood alcohol levels. J Acquir Immune Defic Syndr. 2012;60(3):282–288.