Alcohol and HIV: A Complex Relationship
People infected with HIV are nearly twice as likely to use alcohol than people in the general population. Moreover, up to 50 percent of adults with HIV infection have a history of alcohol problems. 3, 4 Understanding how alcohol influences HIV is vital, both in treating those infected with HIV and in stopping the spread of this disease.
The link between alcohol use and HIV is complex. Research shows that alcohol has numerous effects, both direct and indirect, on how this virus develops and how quickly it causes disease. Alcohol can increase how fast the virus grows, leading to higher amounts of virus( i. e., the viral load) in the body. Those high concentrations, in turn, can increase the spread of the disease. In one study, women receiving antiretroviral therapy( ART) * who drank moderately or heavily were more likely to have higher levels of the HIV virus, making it easier for them to spread the virus to others. 2
ART itself can be problematic in people who drink. A major cause of illness and death among HIV-infected patients
* Antiretroviral therapy( ART) is the use of medications for the treatment of infection by a specific type of virus, retrovirus, primarily HIV. Standard ART consists of at least three drugs for maximum suppression of the HIV virus and for stopping the progression of HIV to AIDS. http:// www. who. int / hiv / topics / treatment / en / index. html.
Framework for HIV / AIDS Risk
Individual
Interpersonal
Neighborhood
Societal
that has emerged since the advent of ART is liver disease. Antiretroviral medications not only are processed in the liver, they also have toxic effects on the organ, and some drug combinations can lead to severe toxicity in up to 30 percent of patients who use them. These patients are left with the grim choice of continuing ART to prevent the progression of the virus to AIDS— thereby risking further liver damage— or stopping ART to prevent liver damage and progressing to AIDS. Further, a large proportion of people with HIV also are infected with hepatitis C( HCV). Alcohol abuse and dependence significantly increase the risk of liver damage both in people with HIV alone and with HCV co-infection. 5
Research suggests too that alcohol may interfere directly with ART medications used for HIV, essentially blocking their effectiveness. 6 Moreover, patients who drink are nine times more likely to fail to comply with their medication regimens compared with sober patients. 7, 8 When HIV-infected drinkers fail to take their medications or do not take them correctly, it can lead to a higher viral load and an increasing likelihood that the virus will become resistant to the therapy.
Individual ' s personality, drinking patterns, drug use, and sexual behavior.
Friends, peers, social networks, and places where people interact.
Number of bars or alcohol outlets,“ broken windows,” and other neighborhood disadvantages.
Racism, stigma, segregation, formal and informal policy.
ART, alcohol consumption, and HIV infection can be harmful in other ways as well. HIV patients typically experience declines in organ function earlier in life than do uninfected people. And because people with HIV tend to drink heavily well into their middle and older years, these organs are even more at risk for injury. For example, both HIV infection and certain types of ART medications increase a person’ s risk for heart disease, because they change the balance of different fats— such as cholesterols— in blood, induce inflammation, and affect the bloodclotting process. Both excessive alcohol use and infection with hepatitis C virus further enhance the risk. Also, the medicines used to treat cholesterol problems can be particularly harmful when taken by patients with liver damage from alcohol abuse or hepatitis C virus. Heavy alcohol consumption( more than six drinks per day) has been linked to heart disease in HIV-infected people; thus, stopping or cutting down on their drinking may help to reduce the risk of heart disease. 9
The socioecological framework for HIV / AIDS risk shows the factors that affect risk on a number of different levels. Risks range from“ broken windows”( or the number of abandoned or vacant buildings in a neighborhood) to the individual’ s use of alcohol and his or her sexual behavior.
SOURCE: Scribner, R.; Theall, K. P.; Simonsen, N.; and Robinson, W. HIV risk and the alcohol environment: advancing an ecological epidemiology for HIV / AIDS. Alcohol Research & Health 33( 3): 179 – 183, 2010.
Another organ impacted by alcohol use and by HIV infection is the lung. Patients who drink or who have HIV infection are more likely to suffer from pneumonia and to have chronic conditions such as emphysema. Scientists do not yet know if alcohol and HIV together raise the risk for
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