Drinking alcohol doesn't increase the risk of HIV treatment failure

Alcohol consumption has little impact on key markers used to monitor the health of individuals with HIV, Swiss research published in the online edition of the Journal of Acquired Immune Deficiency Syndromes shows. The study involved people starting antiretroviral therapy (ART) for the first time and individuals who remained treatment naïve. There was no evidence that drinking alcohol increased the risk of HIV treatment failure or affected CD4 cell count. However, patients who were heavy drinkers were more likely to interrupt their antiretroviral therapy compared to non/light drinkers.

“We found no association between CD4 cell count change over time and the different alcohol drinking categories, neither in ART initiating nor in ART naïve individuals,” comment the authors. “However, we found a higher rate of ART interruption in initiating individuals with severe health risk drinking, but no increased risk of virological failure.”

There is controversy about the impact of alcohol consumption on the two key markers used to monitor the health of patients with HIV – CD4 cell count (am marker of immune competence) and viral load (level of HIV replication).

Given these uncertainties Swiss investigators designed a study involving patients who received care between 2005 and 2012. A total of 2982 individuals starting HIV therapy were recruited to the study as were 2085 patients who remained antiretroviral naïve.

Patients were asked if they drank alcohol and if so the weekly amount they consumed. Individuals who reported drinking were divided into three categories: light health risk drinkers, moderate health risk drinkers and severe health risk drinkers.

For patients starting HIV therapy, the investigators examined the association between alcohol consumption and virological failure. This was defined as never suppressing viral load or a sustained rebound in viral load after previous suppression to undetectable levels. The researchers also explored the association between drinking and the risk of unauthorised treatment interruptions lasting seven or more days. The impact of alcohol consumption on changes in CD4 cell count was examined in both groups of patients.

“Our study uses one of the largest datasets of self-reported alcohol consumption in HIV-infected individuals to assess the putative association with immunological and virological parameters among individuals initiating first ART and ART-naïve individuals,” comment the investigators.

Overall, 54% of those starting HIV therapy and 58% of patients who remained treatment naïve reported the use of alcohol. Only 2% of individuals in each group were classified as having severe health risk levels of alcohol consumption – weekly consumption above 40g for women and 60g for men.

The rate of virological failure among patients starting HIV therapy was 8%. “There was no significant effect of alcohol consumption on the risk of virological failure,” write the authors. “As severe health risk drinkers were not shown to have a higher risk of virological failure, ART should not be withheld.”

Interruption of HIV treatment without medical approval was noted in 15% of patients. Patients whose levels of alcohol consumption represented a severe risk to health were twice as likely to interrupt their therapy than patients who did not drink or who were light drinkers (HR = 2.24; 95% CI< 1.42-3.52, p < 0.01). This association was unchanged when non-adherence to therapy was included in the analysis.

There was no evidence that alcohol consumption affected changes in CD4 cell count in either group of patients.

“Our data contribute valuable knowledge to the controversy whether alcohol has an influence on HIV surrogates or not,” the researchers conclude.