has led some scientists to suggest that one way to improve the care of HIV patients is to provide screening for alcohol use disorders on a regular basis. Those who screen positive could then receive a treatment aimed at reducing alcohol consumption. 19
Though it is clear that substance abuse treatment among HIV-infected patients can contribute greatly to their care, little research has been done in this area. The use of behavioral interventions in HIV-infected people who have a history of alcohol problems has produced only limited evidence that such interventions work. 21 Some clinical trials have produced promising results, using interventions that combine one-on-one counseling with various forms of peer education, support group sessions, and telephone-based interactive methods to guide participants through stages to change their drinking behavior. In those studies, both drinking levels and risky sexual behavior were reduced in some patients. 22 Interestingly, a review of studies aimed at reducing drinking in HIV-infected people found that no trials have examined the success of the four medications now available to treat alcohol dependence( i. e., disulfram, naltrexone, acamprosate, and topiramate) in HIV patients.
There are significant barriers that exist when addressing alcohol problems among HIV-infected patients, including the additional commitments of time, money, and effort involved in treating alcoholism. Drinkers who do not suffer from severe alcohol problems may not think treatment is worthwhile or may fear the stigma associated with alcoholism treatment. Those patients may be more likely to receive treatment if the interventions are simple, require little effort, and take place in settings in which the patients already are receiving testing or treatment for HIV. 1 Along these lines, studies using telephone-based interactive interventions show that this technology also may help to boost the effectiveness of treatment for alcohol problems.
Clearly, questions remain concerning the treatment of alcoholism in HIV-infected patients. For example, is it better to treat a patient for alcoholism before starting ART therapy or concurrently? If ART regimens were simpler, would alcohol use have a reduced impact on patients’ ability to adhere to the treatments?
NIAAA and other Institutes at the National Institutes of Health are sponsoring the Veterans Aging Cohort Study( VACS), which looks at the effects of alcohol on HIV patients as they age. 23 One innovation in this study is the VACS Risk Index, which uses indicators of liver and kidney injury, hepatitis, immune suppression and illnesses— such as certain forms of pneumonia— to predict alcohol’ s impact on illness and death. Because it relies on biological markers, the index provides an accurate measure of how much alcohol the patients have consumed. VACS study authors hope to use the index to answer these questions and to identify behavioral and medical treatments that can help decrease patients’ alcohol use and reduce their risk of illness and death.
Conclusion
Epidemiologic data show that HIV’ s spread has not slowed in recent years and may be on the rise in certain populations. 24 Alcohol problems promote the spread of HIV, and increase illness and death in people with HIV. Decreasing drinking and the behaviors it encourages is one of the most promising ways to reduce these problems. Understanding the complex interplay between alcohol use and HIV will lead to better care for those already infected. Such knowledge also will play a vital role in developing behavioral, medical, and social policy tools for reducing the spread of the disease.
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