November 20, 2013
Excessive alcohol consumption is an ongoing problem with young, Caucasian individuals living with HIV, whose situation may warrant targeted interventions to prevent negative impacts on adherence to highly active antiretroviral therapy (HAART), according to study results presented at IDWeek 2013, in San Francisco.
Previous studies have shown that the prevalence of alcohol use in the U.S. Department of Defense (DoD) is higher than in the general population. Since alcohol may have negative impacts on immunologic function as well as on adherence to HAART, Grace Macalino, Ph.D., and her group investigated the impact of alcohol use on CD4+ cell counts and viral loads in HIV-infected DoD beneficiaries on treatment.
The researchers analyzed data from the DoD HIV Natural History Study (NHS), which has collected self-reported alcohol use information since 2006. At-risk drinking was defined, for men, as more than four drinks in a 24-hour period or more than 14 drinks per week, and, for women, as more than three drinks in a 24-hour period or more than seven drinks per week. CD4+ cell count levels and viral load data were considered only for those who initiated HAART after 2006, with viral failure defined as two consecutive viral loads below 400 copies/mL after initiation.
The study followed 1,891 participants, 728 (38.5%) of whom reported at-risk drinking on their first questionnaire. At-risk drinkers, compared to not-at-risk drinkers, were more likely to be Caucasian (47% versus 37%) and younger (mean age of 27 versus 31), and less likely to have ever been on HAART (19% versus 8%). They mostly remained at-risk drinkers after the first year (67%), while those not at risk tended to remain not at risk (87%). The CD4+ cell count was higher in at-risk drinkers at HAART initiation (mean of 350 cells/mm3, 266-462 range), but no differences in viral load were detected between the two groups.
Statistical analyses revealed that at-risk drinking had no effect on CD4+ cell count, but was marginally significant for viral load failure (odds ratio [OR] 1.2), adjusting for age, years on HAART and beginning year of therapy. The researchers also found that Caucasian (OR 1.4, P < .005) and younger (OR 0.98, P < .01) at-risk drinkers were significantly more likely to report at-risk drinking in their next visit.
Given that more than a third of the study cohort reported at-risk drinking and remained at-risk, Macalino and her group conclude that targeted alcohol interventions should be directed toward Caucasians and younger individuals, even though, to date, at-risk drinking displays no adverse effect on CD4+ cell count and only a marginal effect on viral failure.
Fred Furtado is a science writer based in Rio de Janeiro, Brazil.
Follow Fred on Twitter: @Patchlord.