Recent estimates indicate that 61 percent of persons living with HIV (PLWH ) in the U.S. have consumed alcohol in the past year with 14.6 percent reporting drinking heavily. Two longitudinal studies have found that having of an alcohol use disorder or engaging in high levels of alcohol consumption predict increased risk of all-cause mortality in PLWH; in fact, the relative risk of mortality associated with heavy drinking appears to be especially high in PLWH compared to those without HIV. Understanding how alcohol use contributes to excess mortality in PLWH is an important topic for clinical research.
[Photo: Dr. Christopher W. Kahler]
Dr. Christopher W. Kahler, professor and chair in the department of behavioral and social sciences in the Brown University School of Public Health, and colleagues examined longitudinally the impact of past 30-day frequency of heavy drinking on HIV-related and non-HIV-related clinical outcomes and the extent to which these effects were due to reduced antiretroviral therapy (ART) adherence.
Data came from the Study to Understand the Natural History of HIV/AIDS in the Era of Effective Therapy. Between March 2004 and June 2006, 533 individuals receiving ART were recruited and followed every six months for six years. Using longitudinal mediation analysis, researchers estimated natural direct effects (NDE) of heavy drinking frequency on clinical outcomes and natural indirect effects (NIE) mediated via ART adherence.
The study found that heavy drinking in PLWH deleteriously affects multiple clinical biomarkers, including HIV VL, CD4+ T-cell counts, and estimated liver fibrosis. Reductions in heavy drinking are likely to benefit PLWH, both by reducing direct negative effects of heavy drinking on the body and by increasing adherence to ART. Prior research indicates that alcohol use leads to physical injury and increased mortality risk at lower levels in PLWH compared with those without HIV. Taken together, HIV clinicians may use these data in discussions with PLWH to encourage reduced heavy drinking. In particular, brief motivational interventions have been shown to reduce drinking in PLWH. These findings suggest that reducing the frequency of heavy drinking, even if it is not eliminated, may benefit overall health outcomes in PLWH in a dose-dependent manner. This study was published July in AIDS and Behavior.