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)