of homosexual White men is now composed increasingly of people of color, women, and young people. Of these new HIV cases, the proportion of women rose from 7 percent in 1985 to 25 percent in 2000. In that group, African American and Hispanic women were disproportionately represented compared with White women. Also, HIV / AIDS is now a leading cause of death among women in the United States, especially those of childbearing ages( i. e., between 25 and 44 years). 1 As more young women are becoming infected, there is growing concern that the virus will be transmitted to their children, either during pregnancy or after birth.
One of the main reasons for this shift in the HIV population is that heterosexual sex is now a primary route for HIV transmission. Alcohol use is one of the factors that increases the risk of HIV transmission among heterosexuals. Particularly among women, a strong association has been seen between alcohol and other drug abuse, infection with HIV, and progression to AIDS. 2 Although additional studies are needed to further define alcohol use patterns among infected and at-risk people, it is clear that alcohol use is closely intertwined with the spread of HIV.
ART as a Prevention Tool
In hospital settings, health care workers accidentally exposed to HIV( e. g., through needle sticks) receive temporary ART regimens to prevent infection. This has led scientists to examine whether ART could be used to prevent as well as treat HIV. According to that research, HIV patients who take ART regimens do have a reduced rate of transmitting HIV to their sex partners. Other studies are looking at whether oral ART regimens used for treatment could protect against infection when taken either before or after exposure to HIV. In real-world settings, alcohol use may interfere with the effectiveness of these approaches. Alcohol consumption is associated with missing doses of medication, and HIV patients’ ART is less effective at keeping the virus in check if they do not adhere to their regimens. Also, drinking would likely interfere with people’ s ability to stick to the ART regimens taken for prevention just as it does in treatment. 25
Conceptual Model for Living With HIV Infection
Presenting Conditions
AGING
Viral Hepatitis
HIV
Alcohol and Other Substance Use
Interacting Pathophysiologic Process |
Immune Dysfunction and Senescence |
Microbial Translocation“ Leaky Gut” |
Chronic Inflammation and Platelet Hypercoagulability |
HIV + Non HIV Treatment Toxocity |
Oxidative Stress |
Associated Comorbid Disease |
VACS Risk Index |
Organ System Injury |
|
Incremental Depletion in Organ System Reserve |
|
|
Advanced Clinical Disease |
Functional Decline |
Organ System Failure |
Repeated Hospitization / Nursing Home Placement |
Health Care Outcomes |
|
|
Death |
|
|
This figure is based on findings from the Veteran Aging Cohort Study, a large( approximately 7,000 participants) and lengthy( currently 7 to 8 years) study exploring the effects of alcohol on HIV outcomes within the broader context of aging. The study has helped to define a VACS Risk Index to identify those individuals most at risk. The researchers hope to use the VACS Risk Index to design better interventions for helping people with HIV to live longer and healthier lives.
SOURCE: Justice, A.; Sullivan, L.; and Fiellin, D. HIV / AIDS, comorbidity, and alcohol. Alcohol Research & Health. 33( 3): 258 – 266, 2010.
2