Alcohol Worsens HIV Treatment Adherence

Adherence to highly active antiretroviral therapy (HAART)—a treatment that has substantially reduced morbidity and mortality, and improved the quality of life of people infected with HIV—appears to decrease with alcohol use. To determine whether there is an amount of alcohol that does not affect adherence to HAART, researchers analyzed interview data from a prospective cohort of patients with HIV and a history of alcohol problems. Key findings from analyses adjusted for potential confounders (e.g., sex, race/ethnicity, age) include the following:

• Among the 267 subjects with HIV who were taking HAART (mostly male and ethnic minorities), 40% were currently drinking alcohol, with 16% consuming amounts associated with alcohol-related consequences in the general population (risky amounts: >14 drinks per week or >4 drinks per day for men; >7 drinks per week or >3 drinks per day for women).
• Alcohol use was the most significant predictor of non-adherence (less than 100% of doses taken over the prior 3 days).
• Recent abstinence from alcohol was significantly associated with better adherence compared with both risky (odds ratio, OR, 3.6) and moderate (OR 3.0) amounts.

Comments:

Alcohol use appears to be associated with decreased adherence to HAART. Commonly accepted low-risk drinking thresholds for the general population are not appropriate for patients with HIV and a history of alcohol problems; whether they are appropriate for patients with HIV alone remains unknown.

Joseph Conigliaro, MD, MPH

Reference:

Samet JH, Horton NJ, Meli S, et al. Alcohol consumption and antiretroviral adherence among HIV-infected persons with alcohol problems. Alcohol Clin Exp Res. 2004;28(4):572–577.
(view abstract)