Alcohol and HIV Disease Progression: Is Liquor Quicker (than Beer and Wine)?

Alcohol affects the course of HIV disease, but the mechanisms of this effect (i.e., individual susceptibility and the importance of the type of alcohol) are poorly understood. Miguez-Burbano and colleagues studied differences in antiretroviral (ART) effectiveness after 24 weeks of therapy as a function of alcohol type consumed, comparing only liquor (LI, n=55) with only beer or wine (BW, n=110). Outcome measures were CD4 cell count, thymus size (by MRI), naïve lymphocytes, and HIV viral load (HVL). Comparisons were controlled in multivariable analyses for potential confounders including gender, race/ethnicity, HIV status (per CDC criteria), drug use, and body mass index. Alcohol was consumed on a similar number of days by both groups but in higher quantity in the LI group, which also had a higher baseline HVL. The following differences were noted:

• CD4 increased in the BW group (+12 cells/mm3) compared with the LI group (-4 cells/mm3).

• thymus volume increased in the BW group compared with the LI group (p=0.05).

• an increase of at least 50 CD4 cells immediately after ART initiation (a good prognostic indicator) was more commonly achieved in the BW group (50%) than in the LI group (10%).

Comments:

According to the authors, these findings challenge the view that the effect of alcohol on HIV disease progression in individuals receiving ART is solely due to impact on medication adherence. Liquor is exposed as more destructive than beer or wine to the clinical course and specifically the immune system. Although the issues raised are provocative, it is not quite time to close down the liquor party but not the beer bash. Methodological issues in the paper, including the small sample size, the large number of variables for the analyses performed, the nonequivalent quantity of alcohol received, and HVL differences between the two groups, leave one desiring further reports.

Jeffrey H. Samet, MD, MA, MPH

Reference:

Míguez-Burbano MJ, Lewis JE, Fishman J, et al. The influence of different types of alcoholic beverages on disrupting highly active antiretroviral treatment (HAART) outcome. Alcohol Alcohol. 2009;44(4):366–371.