Jornal de AIDS e Pesquisa Clínica

Alcohol and Antiretroviral Therapy - A Lethal Cocktail

Abstract

Michelle Schneider, Manuela Neuman, Matthew Chersich and Charles Parry

Background: Alcohol plays a role at the different points in the natural history of HIV/AIDS: This article focuses on the health implications of harmful alcohol consumption in the era of antiretroviral therapy. Aim: To explore the role of alcohol in HIV disease progression, in order to improve HIV patient management and overall better HIV prognosis. Methods: An examination of studies pertaining to the behavioral, biological and bio-chemical aspects of alcohol consumption on the pathogenesis of HIV. Findings: Alcohol consumption impacts on HIV progression resulting in increased morbidity and mortality. Alcohol consumption reduces compliance with ARV regimens, resulting in additional premature mortality. Both alcohol and HIV modulate innate and adaptive immunity and alcohol consumption for HIV-positive individuals increases the likelihood of viral replication and leads to increased susceptibility to contract opportunistic infections and other co-morbid conditions. The situation is further compounded by drugs used for the treatment of the opportunistic infections and other co-morbid conditions and their potential interactions with alcohol. The liver also metabolizes both alcohol and ARV drugs and alcohol-related liver toxicity results in compromised liver function with ARVs not working optimally and an increased risk of serious toxicity from antiretroviral therapy. Discussion: Very diverse measures of alcohol consumption have been used in studies on interactions between alcohol and HIV, making it difficult to compare studies and draw definitive conclusions. It is essential to acquire clear evidence-based guidelines on alcohol consumption for HIV-positive patients and their health-care providers. The variables alcohol, HIV and ART and their myriad interactions have not been clearly delineated. The multiple effects from HIV, alcohol and ART may compound each other, making it difficult to disentangle presenting adverse reactions and specifically the associations with alcohol. Furthermore findings in this arena are particularly relevant for prevention and treatment of HIV in countries such as South Africa that have high HIV and alcohol health burdens and have committed to an extended ARV rollout.