Alcohol and HIV Disease Progression: Weighing the Evidence.

Alcohol and HIV Disease Progression: Weighing the Evidence.

Heavy alcohol use is commonplace among HIV-infected individuals; however, the extent that alcohol use adversely impacts HIV disease progression has not been fully elucidated. Fairly strong evidence suggests that heavy alcohol consumption results in behavioural and biological processes that likely increase HIV disease progression, and experimental evidence of the biological effect of heavy alcohol on simian immunodeficiency virus in macaques is quite suggestive. However, several observational studies of the effect of heavy alcohol consumption on HIV progression conducted in the 1990s found no association of heavy alcohol consumption with time to AIDS diagnosis, while some more recent studies showed associations of heavy alcohol consumption with declines of CD4 cell counts and nonsuppression of HIV viral load. The authors discuss several plausible biological and behavioural mechanisms by which alcohol may cause HIV disease progression, evidence from prospective observational human studies, and suggest future research to further illuminate this important issue.

What amount of alcohol intake is too much? The running joke answer is ‘More than what your physician drinks’. This review finds that, although there is strong biological plausibility that heavy alcohol intake might increase the rate of disease progression, it is difficult to demonstrate this in humans. In macaques, alcohol-exposed animals may consume fewer calories from food, have immune activation in the gut, and have higher viral loads at certain times but the association with increased progression of simian immunodeficiency virus infection has not been demonstrated. Heavy alcohol intake in human studies is defined as more than 4 drinks on any one occasion (3 for women) or more than 14 drinks a week (7 for women). Moderate drinking is anything between this level and abstinence. The strongest evidence linking alcohol intake and disease progression is the association between heavy alcohol intake and poor drug adherence. While you wait for scientists to disentangle any biological links between alcohol and disease progression, you can focus on the behavioural one – it would be smart to cut back on your drinking if you are having any trouble taking your medications regularly.