Is Strict Adherence to Antiretroviral Therapy Effective in the Setting of Daily Heavy Episodic Drinking?

Alcohol use is associated with antiretroviral therapy (ART) non-adherence in HIV-infected individuals. However, it is not known if alcohol use diminishes the effectiveness of ART in the context of strict ART adherence. Researchers randomized 24 age- and weight-matched rhesus macaques to daily intragastric infusions with 13–14 g ethanol/kg body weight/week or an isocaloric amount of sucrose. The animals were inoculated with simian immunodeficiency virus (SIV) 3 months after infusion initiation, randomized to nucleoside reverse-transcriptase inhibitor ART (tenofovir and emtricitabine) versus no ART 2.5 months after inoculation, and then followed for another 2.5 months (8 months total study period). SIV viral load and other labs were monitored approximately every 2 weeks.

• Compared with no ART, animals receiving ART had decreased plasma SIV viral load.
• There was no difference in viral load response to ART between animals in the alcohol and sucrose infusion groups (i.e., there was no interaction effect between ART and alcohol).
• There was no difference in ART toxic effects between the alcohol and sucrose groups.

Comments:

This animal study suggests that daily heavy alcohol use does not decrease the effectiveness of ART in the context of perfect ART adherence. However, even if the findings could be extrapolated directly to humans and over a longer timeframe, it is not clear they would change our clinical advice to HIV-infected patients. We would still strongly advise patients to take their ART as prescribed and recommend safer levels of alcohol use to aid ART adherence and decrease other adverse consequences. Further, these results suggest that patients who drink heavily should not avoid taking ART for fear of lack of efficacy or adverse effects.

Kevin L. Kraemer, MD, MSc

Reference:

Molina PE, Amedee AM, Veazey R, et al. Chronic binge alcohol consumption does not diminish effectiveness of continuous antiretroviral suppression of viral load in simian immunodeficiency virus-infected macaques. Alcohol Clin Exp Res. 2014;38(9):2335–2344.