Untreated HIV infection is associated with higher blood alcohol levels

Starting HIV treatment is associated with reductions in blood alcohol levels, results of a small pilot study published in the online edition of the Journal of Acquired Immune Deficiency Syndromes suggest. The investigators believe this could be related to “inflammatory responses to untreated HIV infection” in gut tissue, which could produce “greater likelihood of alcohol-related toxicities.”

A number of studies have already shown that alcohol abuse is related to faster HIV disease progression. However, the effect of HIV on alcohol metabolism and responses has received little attention. It is also unclear if the body’s response to alcohol is affected by starting antiretroviral therapy.

Investigators in San Francisco therefore designed a small trial involving 15 HIV-positive patients. The patients were randomised to take an oral 1g/kg dose of alcohol.

Blood alcohol levels and subjective responses to alcohol were assessed at a baseline visit and again two to three weeks after starting HIV therapy. The study was part of a larger assessment of interactions between alcohol and antiretroviral drugs that are processed using the cytochrome P450 pathway.

None of the patients had current substance abuse problems. Three were co-infected with hepatitis C virus, but their liver function was normal and none had significant fibrosis.

The mean peak blood alcohol level prior to the initiation of antiretroviral therapy was 131 (60) mg/dl. This fell to a peak of 116 (6.2) mg/dl after treatment with anti-HIV drugs was started. The observed differences in blood alcohol levels ranged from 10-15% lower once patients had started HIV therapy. These differences were significant (p = 0.015).

There were also significant differences in the pharmacokinetics of alcohol prior to and after starting HIV therapy. Both the alcohol area under the curve (the overall amount of alcohol in the bloodstream) and C_min (minimum concentrations) fell significantly (p = 0.011 and p = 0.05 respectively).

However, starting antiretroviral therapy had no impact on alcohol elimination times. Nor did it have any significant effect on subjective responses to alcohol, such as feelings of intoxication. Cardiovascular responses to alcohol were also unaffected by the initiation of HIV treatment.

“This is the first study, to our knowledge, that demonstrates a significant difference in blood alcohol concentrations in individuals with HIV/AIDS prior to and following initiation and stabilization of ART [antiretroviral therapy],” write the authors. “These effects were the result of treating the HIV infection, rather than being direct pharmacokinetic drug interactions.”

They believe their findings “support other investigations indicating that HIV infection is associated with damage to intestinal epithelium.” The investigators hypothesise that HIV replication in the lining of the gut could cause a decrease in alcohol metabolism in the gut and therefore greater absorption of alcohol.

If supported by larger study, then the findings of the current research could have implications for HIV treatment and care strategies. The investigators conclude: “These results support the rationale for the early detection and treatment of hazardous alcohol use and alcohol use disorders, as well as earlier or universal ART in untreated HIV-infected populations.”