Heavy alcohol use is harmful for people with HIV who are not on antiretrovirals.

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Study shows link between alcohol consumption and HIV disease progression

(Boston) – Researchers from Boston University School of Medicine (BUSM) have found a link between alcohol consumption and HIV disease progression in HIV-infected persons. The study appears online in the August issue of the Journal of Acquired Immune Deficiency Syndromes.

Alcohol use is common among HIV-infected persons, and its impact on HIV disease progression has been examined in in-vitro, animal and human studies. Alcohol may adversely affect immunologic function in HIV-infected persons by various mechanisms, including increased HIV replication in lymphocytes.

Researchers assessed CD4 cell counts, HIV RNA levels [viral load], and alcohol consumption in 595 HIV-infected persons with alcohol problems. The relation of HIV disease progression to alcohol consumption was studied using longitudinal regression models controlling for known prognostic factors, including adherence and depressive symptoms, and stratified by antiretroviral therapy (ART) use. Among subjects who were not on ART, heavy alcohol consumption was associated with a lower CD4 cell count. Among subjects who were on ART, heavy alcohol consumption was not associated with a lower CD4 cell count or higher HIV viral load. “

Alcohol use in patients with a prevalent disease such as HIV, can have important public health consequences,” said lead author Jeffrey Samet, MD, MPH, a professor of medicine at BUSM and chief of General Internal Medicine at Boston Medical Center. “HIV-infected persons who drink alcohol heavily and are not on ART might decrease their risk of disease progression if they abstain from alcohol use.”

Researchers further noted that there is extensive evidence about the efficacy of a brief intervention for unhealthy alcohol use in nondependent drinkers in medical settings and of the efficacy of psychosocial and pharmacologic treatments for alcohol dependence. “Although limited evidence demonstrates the effectiveness of intervention for alcohol problems specifically in people with HIV, its implementation among HIV-infected populations seems to be a worthwhile goal,” according to senior author Richard Saitz, MD, MPH, professor of medicine at BUSM, director of the Clinical Addiction Research and Education Unit at Boston Medical Center, and associate director of the Boston University School of Public Health Youth Alcohol Prevention Center.

http://www.eurekalert.org/pub_releases/2007-08/bu-ssl082007.php#

Public release date: 20-Aug-2007
Contact: Michelle Roberts
michelle.roberts@bmc.org
617-638-8491
Boston University

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 Heavy drinkers living with HIV have lower CD4 counts
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Keith Alcorn, Friday, August 31, 2007
HIV-positive people not taking antiretroviral treatment who are heavy drinkers have lower CD4 counts than moderate drinkers or those who never drink. However, the same difference isn’t true for people taking antiretrovirals, and alcohol consumption doesn’t affect viral load, researchers from Boston report in the Journal of Acquired Immune Deficiency Syndromes.

The difference, of around 50 cells/mm3, may place some heavy drinkers at earlier risk of developing opportunistic illnesses, but the study was not designed to assess how quickly people developed clinical illnesses related to HIV infection.

Nevertheless, the findings imply that someone who consistently drinks heavily would be quicker to reach the point at which treatment is recommended than someone who is teetotal.

The study reviewed CD4 cell counts and viral load in 595 people with HIV in Boston, USA, recruited into cohort studies on alcohol and HIV disease progression between 1997 and 2006. Participants were recruited through hospitals and the community (including a homeless shelter and a methadone clinic) and were predominantly non-white (66%) and injecting drug users (54%).

Fifty-nine per cent were abstinent from alcohol at study entry, but 30% were classified as heavy users, having reported consumption of either 14 or more drinks a week in the past month, or five or more drinks on a single occasion for men, and seven or more drinks in a week, or four or more drinks on a single occasion for women and men aged 66 and over.

Heavy drinkers averaged seven drinks per day, although the median number of drinks per day among heavy drinkers was 2.6, with an interquartile range of 0.8 – 6.8. This implies that the sample included a small number of very heavy drinkers, and a large number who regularly drank at least two drinks per day, or who binge-drank on several occasions each week.

Once recruited to the study participants had CD4 count and viral load assessments every six months, together with an assessment of recent alcohol consumption. Participants were followed for a median of approximately four and a half years.

The study found that after controlling for age, race, HIV risk behaviour, homelessness, depression, adherence and duration in the study, heavy drinkers not taking antiretroviral therapy had CD4 cell counts that were, on average, 48.6 cells/mm3 lower than those of untreated HIV-positive people who did not drink. Moderate drinkers did not show any significant difference from abstinent people. Viral load was not significantly affected by alcohol consumption.

http://www.aidsmap.com/en/news/08740273-45A0-400B-9EB1-FEECB826AE3B.asp?type=preview

In people taking antiretroviral treatment there was no significant difference in CD4 cell count according to alcohol consumption. However, heavy drinkers were more likely to be non-adherent at baseline.

When they looked at the CD4 cell percentage, researchers found no difference between heavy drinkers and abstinent individuals, implying that the effect of alcohol is not specific to the CD4 cell population but instead reduces the lymphocyte population across the board.

In settings where high alcohol consumption is common, such as Russia or South Africa, the researchers say that the findings could have major public health consequences.

The CD4 cell difference between heavy drinkers and teetotal people – around 50 cells – is the equivalent of one years-worth of CD4 cell loss, if compared with calculations of CD4 cell loss in asymptomatic people with HIV in the UK.

The findings imply that people with HIV with levels of alcohol consumption that may appear modest by the standards of some countries or communities may already be closer to the threshold for starting treatment by the time they are diagnosed with HIV, and that if alcohol consumption increases after diagnosis and stays high, it will moderately affect disease progression.

Reference

Samet JH et al. Alcohol consumption and HIV disease progression. J Acquir Immune Defic Syndr (advance online publication), 2007.

UK CHIC Study Steering Committee. HIV diagnosis at CD4 count above 500 cells/mm3 and progression to below 350 cells/mm3 without antiretroviral therapy. J Acquir Immune Defic Syndr (advance online publication), 2007.