Many older HIV-positive military veterans in the US drink hazardous amounts of alcohol, and these individuals also have an increased risk of having a detectable HIV viral load as well as liver-related and other side-effects, according to a study published in the August 1st edition of the Journal of Acquired Immune Deficiency Syndromes.
Excess alcohol use has been widely documented in HIV-positive individuals and has previously been associated with poor adherence to medication regimens, an increased risk of liver problems, and more unprotected sex. In view of this, investigators involved in the Veterans Aging Cohort 3-Site Study conducted a prospective examination of levels of alcohol use in 881 HIV-positive veterans.
The investigators also wished to establish if there was a connection between levels of alcohol use and HIV viral load and CD4 cell counts and liver function.
Other objectives of the study included an assessment of doctors’ awareness of their patients current and past alcohol use and to establish if there were any patient characteristics associated with doctors’ failure to identify problem drinking.
Earlier published data from this cohort showed that doctors were failing to warn patients coinfected with HIV and hepatitis C about alcohol use (see link below).
The study ran between summer 1999 and July 2000. Alcohol consumption was assessed in several ways. Doctors were asked to say if an individual drank too much now, in the past, or never. Patients were asked to assess their “at-risk alcohol use” using the Alcohol Use Disorders Identification Test (AUDIT), wit ha score of eight or above indicative of at-risk alcohol use. Finally, medical records were examined for diagnoses of alcohol problems, including alcohol psychosis, alcohol dependence, alcohol abuse, excess blood alcohol, toxic effects of alcohol, alcohol poisoning, complications from alcohol use, and history of alcohol use.
Average age of the study patients was 49 years, 99% were male, 54% were African American and 36% were gay. Nearly all patients, 90% were taking anti-HIV medication, and median baseline CD4 cell count was 331 cells/mm3 and median HIV viral load was 723 copies/mL.
A total of 33% of patients reported binge drinking (defined by the investigators as six or more units of alcohol in one drinking session), 20% had audit scores indicative of hazardous drinking, and 36% had both high AUDIT scores or reported binge drinking. In addition, 27% of individuals had been diagnosed with at least one alcohol-related problem in the previous five years. These categories were not mutually exclusive.
Current hazardous drinkers tended to be younger (46 years versus 49 years, p
Doctors were more likely to miss current alcohol problems if a patient was in good health and had an undetectable viral load (p=0.01), was negative for hepatitis C (p=0.09) and had normal liver function (p=0.07). Good health particularly being hepatitis C negative (p
The investigators comment, “our study demonstrated that hazardous drinking was common in a cohort of HIV-positive veterans”, and add that as health care providers often missed alcohol problems, particularly if a patients was well, all HIV-positive patients should be screened for problem drinking.
Several limitations are acknowledged by the investigators with their study, in particular their single question to doctors to assess alcohol consumption. The comment “this single item could reflect a health care provider’s personal definition of drinking too much, together with his/her opinion and clinical experience with level of training.”
Nevertheless, the investigators conclude “our…data support the association with poor virologic control (presumably from non-adherence), anemia and hepatitis” with hazardous drinking. Adding, “it is essential that health care providers routinely screen for current hazardous alcohol use to identify patients who would benefit from interventions to reduce alcohol consumption. It is also important that health care providers be aware of those patients with a diagnosis of alcoholism to appropriately manage antiretroviral therapies that may cause additional injury to viral organ systems such as bone marrow and liver.”
Further information on this website
Alcohol - factsheet
Doctors failing to warn HIV-HCV patients about alcohol risk, Veterans study reports - news story
Alcohol increases SIV 64-fold in monkeys: implications for HIV transmission - news story
Conigliaro J et al. How harmful is hazardous alcohol use and abuse in HIV infection: Do health care providers know who is at risk?. JAIDS 33 521 – 525, 2003.