Letters to the Editor
To the Editor:
Alcoholism is an important public health problem and, by itself, justifies policies that stimulate the reduction in the alcohol consumption.
The treatment of HIV infection with highly active antiretroviral therapy (HAART) has resulted in an important reduction of morbidity and mortality associated with HIV infection. For HAART to succeed, an almost perfect adherence to treatment is essential and can be compromised by a set of different factors, among the most important of which is the abuse of drugs and alcohol.1
Before the introduction of HAART, the Multicenter AIDS Cohort Study did not demonstrate a direct relation between alcoholism and the progression of HIV disease.2
Since then, several other studies tried to demonstrate this association, some of them taking into account the use of antiretrovirals and the classes used.
The interesting article by Samet et al3 presents a new approach to demonstrate that the relation exists; however, the evidence is not strong enough to completely support this point of view.
Adherence to treatment was evaluated through questions on the consistent use of antiretrovirals in the 3 days before the interview. Thus it cannot be representative of the real behavior and adherence in the periods between the interviews, which can compromise the validity of this information. Moreover, it seems that the viral load was not used at any time to indicate adherence and the consequent response to the therapeutic regimen. Participants sampled from a cohort of people classified as heavy drinkers can represent a source of bias. Alcoholism is a chronic disease, and during progression of HIV infection, the great majority of patients alternate different degrees of alcohol consumption. The current status of consumption cannot be the preponderant one. The comparison between the identified groups in the study, in a short time of 6 months, does not necessarily represent direct action of the alcohol consumption in this period.
Andre A. Costa Beber, MD
Marcia S. Zampese, MD
Nemora T. Barcellos, MD, PhD
Sandra C. Fuchs, MD, PhD
Medical Sciences Postgraduate Program School of Medicine Universidade Federal do Rio Grande do Sul Porto Alegre, Rio Grande do Sul, Brazil
1. Galvan FH, Bing EG, Fleishman JA, et al. The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: results from the HIV Cost and Services Utilization Study. J Stud Alcohol
2. Kaslow RA, Blackwelder WC, Ostrow DG, et al. No evidence for a role of alcohol or other psychoactive drugs in accelerating immunodeficiency in HIV-1-positive individuals. A report from the Multicenter AIDS Cohort Study. JAMA
3. Samet JH, Cheng DM, Libman H, et al. Alcohol consumption and HIV disease progression. J Acquir Immune Defic Syndr