When alcohol consumption is a concern, it's better to prescribe antiretroviral therapy in HIV patients than to withhold it, according to a group of researchers at University Hospital of Berne in Switzerland.
Though several studies have demonstrated a significant association between alcohol consumption and the risk of being infected with HIV, it remains unclear whether this association is behavioral, biomedical, or both. Additionally, roughly 40 percent of HIV-infected people have histories of heavy drinking or alcoholism, and about 80 percent also drink socially after diagnosis, according to one study.
Of special concern to healthcare providers are that many patients’ beliefs about potential drug interactions between antiretroviral therapy (ART) and alcohol causes medication non-adherence. But until now, researchers have been unable to determine if alcohol consumption affects two key markers used to monitor immune competence and HIV replication levels: CD4 cell count and viral load.
A group of researchers at University Hospital of Berne in Switzerland enrolled 2,982 treatment-naïve patients between 2005 and 2012, while an additional 2,085 treatment-naïve patients served as the control group. Though the researchers found no evidence of alcohol consumption increasing treatment failure risk or affecting CD4 cell count, they did find that heavy drinkers were more likely to be non-adherent to ART compared to non-drinkers and light drinkers.
Patients were divided into three groups according to their self-reported drinking level: light health risk drinkers, moderate health risk drinkers, and severe health risk drinkers who consumed more than 40 grams of alcohol for women and more than 60 grams for men. The researchers examined the association between alcohol consumption and virological failure using viral load markers, and they also tracked unauthorized treatment interruptions lasting seven or more days and compared it to changes in CD4 cell count.
Slightly more than 50 percent of the study participants reported alcohol use in active treatment and control groups, while approximately 2 percent of participants were considered severe health risk drinkers.
Eight percent of patients starting HIV therapy experienced virological failure, though alcohol consumption did not change the risk of that occurring. Fifteen percent had HIV treatment interruptions of seven days or more, and those whose alcohol consumption represented a severe risk to health were twice as likely to interrupt ART as patients who did not drink or who were light drinkers. CD4 counts were similar between groups.
The authors concluded that it’s better to prescribe ART than to withhold it when alcohol is a concern, “as severe health risk drinkers were not shown to have a higher risk of virological failure.”