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Alcohol Consumption and HIV Disease Progression

Samet, Jeffrey H MD, MA, MPH*†; Cheng, Debbie M ScD*‡; Libman, Howard MD§; Nunes, David P MD; Alperen, Julie K DrPh*; Saitz, Richard MD, MPH

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1st, 2007 - Volume 46 - Issue 2 - p 194-199
doi: 10.1097/QAI.0b013e318142aabb
Clinical Science

Objective: To assess the relation between alcohol consumption and laboratory markers of HIV disease progression.

Methods: We prospectively assessed CD4 cell counts, HIV RNA levels, and alcohol consumption for up to 7 years in 595 HIV-infected persons with alcohol problems recruited between 1997 and 2003. We investigated the relation of these markers of HIV disease progression to alcohol consumption using longitudinal regression models controlling for known prognostic factors, including adherence and depressive symptoms, and stratified by antiretroviral therapy (ART) use.

Results: Among subjects who were not on ART, heavy alcohol consumption was associated with a lower CD4 cell count (adjusted mean decrease of 48.6 cells/μL compared with abstinence; P = 0.03) but not with higher log10 HIV RNA. Among subjects who were on ART, heavy alcohol consumption was not associated with a lower CD4 cell count or higher log10 HIV RNA.

Conclusions: Heavy alcohol consumption has a negative impact on the CD4 cell count in HIV-infected persons not receiving ART. In addition to the known deleterious effects of alcohol on ART adherence, these findings suggest that avoiding heavy alcohol consumption in patients not on ART may have a beneficial effect on HIV disease progression.

From the *Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA; † Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, MA; ‡Department of Biostatistics, Boston University School of Public Health, Boston, MA; §Divisions of General Medicine and Primary Care and Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; ∥Section of Gastroenterology, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA; and the ¶Department of Epidemiology and Youth Alcohol Prevention Center, Boston University School of Public Health, Boston, MA.

Received for publication March 26, 2007; accepted June 14, 2007.

Support for this study came from the following grants from the National Institute of Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health: R01-AA13216 (Clinical Impact of HCV and Alcohol in HIV-Infected Persons), R01-AA11785 (Medication Adherence in Alcohol Abusing HIV Patients), R01-AA10870 (Enhanced Linkage of Alcohol Abusers to Primary Care), and K24-AA015674 (Impact of Alcohol Use on HIV Infection in US and Russia). This research was conducted in part at the General Clinical Research Center at Boston University School of Medicine (US Public Health Service [PHS] grant M01 RR00533) and at the Beth Israel Deaconess General Clinical Research Center (USPHS grant M01 RR01032).

Parts of these data were presented at the following scientific meetings: XV International AIDS Conference, Bangkok, Thailand, July 11-16, 2004; Research Society on Alcoholism National Meeting, Santa Barbara, CA, June 25-30, 2005; and the International Society for Biomedical Research on Alcoholism (ISBRA) International Congress, Sydney, Australia, September 10-13, 2006.

Correspondence to: Jeffrey H. Samet, MD, MA, MPH, Section of General Internal Medicine, Boston Medical Center, 91 East Concord Street, Suite 200, Boston, MA 02118 (e-mail: jsamet@bu.edu).

© 2007 Lippincott Williams & Wilkins, Inc.