By Mariana Plazas-Mayorca and Courtney McQueen
Published: Oct 27, 2010 9:00 am
A new review of several studies has found some evidence linking heavy alcohol use to accelerated HIV disease progression. In particular, alcohol use influences how reliably people take their medication, which can affect HIV progression. However, it is still unclear whether alcohol affects progression independently of antiretroviral adherence.
“There is strong evidence that alcohol consumption interferes with antiretroviral therapy adherence. The more a person drinks alcohol, the more medication he/she misses,” said Professors Judith Hahn and Jeffrey Samet, the authors of the review, in correspondence with The AIDS Beacon.
“Suboptimal adherence to these medications can cause HIV to become resistant and for the treatment regimen to fail,” they added.
However, whether alcohol affects disease progression independently of missed antiretroviral drug doses is more controversial.
Scientists have long speculated that alcohol and drug use affects the rate of HIV progression. Alcohol is known to have suppressive effects on the immune system, and illegal drug use (particularly stimulant use) has been linked to faster progression (see related AIDS Beacon news).
However, the role of alcohol in HIV progression has remained elusive.
“While many studies conducted in the early 1990s found no link between alcohol consumption and HIV disease progression, more recent studies have suggested that there is such a link,” said the authors.
To better understand the connection between alcohol and disease progression, the authors of the review examined a number of studies from before and after the advent of antiretroviral therapy, as well as animal studies where alcohol use was more controlled.
Results showed that prior to the advent of highly active antiretroviral therapy (HAART), studies found no relationship between heavy alcohol consumption and HIV disease progression.
However, more recent studies from the post-HAART era have been inconclusive. Three of the six studies from the post-HAART era included in the review demonstrated an association between heavy alcohol use and at least one measure of HIV disease progression, such as higher viral load (amount of HIV in the blood), lower CD4 (white blood cell) count, opportunistic infections, or death.
The other three studies found no association between alcohol consumption and HIV progression, aside from alcohol’s impact on treatment adherence.
Since studies of alcohol consumption in people can be complicated by other factors – heavy drinkers may be more likely to be depressed, for example, and depression can affect HIV progression – the review authors also examined studies of alcohol use in monkeys.
Monkeys can be infected with simian immunodeficiency virus (SIV), the monkey version of HIV. Since both their alcohol intake and antiretroviral adherence can be carefully controlled, these studies can potentially illuminate purely biological effects of alcohol consumption on disease progression, rather than effects of behavior, such as treatment adherence.
Results of these studies suggest that there might in fact be a biological basis for alcohol’s effects on HIV progression. For example, several studies found higher viral loads in monkeys that drank heavily, and one study found that monkeys with high alcohol consumption progressed faster than monkeys that did not drink alcohol.
The authors speculated on a variety of reasons why alcohol might affect HIV progression. Alcohol is known to have detrimental effects on the immune system, for example, and can also lead to vitamin and mineral deficiencies.
In addition, there is evidence that alcohol may interfere with the body’s metabolism of antiretroviral medications. As a result, chronic alcohol users might be at higher risk for ineffective therapy due to low concentrations of antiretrovirals in the blood.
Aside from these potential biological factors, heavy drinkers may be less likely to receive HIV care and more likely to take illegal drugs, which are known to increase disease progression. HIV-positive individuals who suffer from other conditions, such as hepatitis C, should be particularly cautious when consuming alcohol.
“Many persons living with HIV are also infected with hepatitis C virus (HCV), and for those patients, using alcohol can speed HCV disease progression,” said Professors Hahn and Samet.
The authors suggested that people with HIV be cautious about alcohol consumption.
“All persons who are living with HIV and who drink alcohol should discuss their alcohol consumption with their physicians,” said the authors. “There are several effective methods to reduce or quit alcohol consumption; counseling, medications, and mutual support groups (e.g., Alcoholics Anonymous) are options that can help.”
“Even if they do not stop drinking, their physicians should know so that they can monitor their liver function,” the authors added. “Physicians treating those with HIV should be aware of the potential effects of alcohol on HIV disease progression and routinely screen all of their patients for alcohol consumption.”
They concluded that the evidence linking alcohol abuse to HIV progression is suggestive but not conclusive, and that further study is needed to elucidate the link.
Brown University announced earlier this month that a new research institute, the Brown Alcohol Research Center on HIV, will be devoted to studying the health effects of drinking in people with HIV. The institute will conduct studies on the effects of alcohol and HIV on metabolism and brain function, and the interaction between alcohol, HIV, and HCV, among others.
For more information, please see the review article in Current HIV/AIDS Reports. For more information on the Brown Alcohol Research Center on HIV, please see the Brown University website.
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Also See: HIV, alcohol topic for Brown study
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