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Alcohol Does Not Worsen Disease Progression or Impair Treatment for People with HIV

People with HIV who consume alcohol did not see detrimental changes in their CD4 T-cell count or viral load when compared with non-drinkers, though those who drank heavily had more difficulty achieving good treatment adherence, researchers reported in the July 25, 2013, advance edition of the Journal of Acquired Immune Deficiency Syndromes.

Healthcare providers generally recommend moderate alcohol consumption or abstinence, but there is conflicting data about the effects of drinking on HIV disease progression and response to antiretroviral therapy (ART).

Anna Conen and fellow investigators with the Swiss HIV Cohort Study looked at the association between self-reported alcohol consumption and surrogate markers of HIV disease progression in both treated and untreated individuals.

This prospective cohort study included approximately 5000 participants in the Swiss HIV Cohort Study -- a long-term observational study of people with HIV throughout Switzerland -- who received care between 2005 and 2012. A majority were men, most were white, and men who have sex with men was the most common transmission risk category. 

The analysis included 2982 participants who started ART for the first time and 2085 people who did not start treatment. They were categorized as light, moderate, or severe drinkers in terms of health risk. Approximately 55% reported that they sometimes drank alcohol, but only 2% were classified as consuming enough to constitute a severe health risk (40 g for women or 60 g for men per week).

Results

• There was no observed association between changes in CD4 cell counts and alcohol consumption in either the treated or untreated groups.
• Among people who started ART, 8% experienced virological failure (either never achieving viral suppression or sustained viral rebound).
• There was also no association between treatment failure and alcohol consumption.
• 15% of people who started ART interrupted treatment without medical approval for at least 7 days.
• Treatment interruption was more common among heavy drinkers compared with light drinkers or non-drinkers (hazard ratio 2.24, or more than twice the risk).
• The link between ART interruption and heavy drinking remained significant even after adjusting for non-adherence.

"No effect of alcohol consumption on either virological failure or CD4 cell count in both groups of ART initiating and naive individuals was found," the researchers concluded. However, they added, "severe drinkers were more likely to interrupt ART."

"Efforts [related to] ART continuation should be especially implemented in individuals reporting high alcohol consumption," they recommended. But as heavy drinkers were not shown to have a higher risk of virological failure, "ART should not be withheld" from these individuals.

8/21/13

Reference

A Conen, Q Wang, CA Fux, et al. Association of alcohol consumption and HIV surrogate markers in participants of the Swiss HIV Cohort Study. Journal of Acquired Immune Deficiency Syndromes. July 25, 2013 (Epub ahead of print).