Alcohol negatively affects adherence chances.
Highly active antiretroviral therapy has increased the longevity and quality of life for people living with human immunodeficiency virus. But it requires strict adherence in taking the medicine, something that is extremely difficult for many individuals to do. A recent study looked at the effects of drinking alcohol on adherence and showed the risk for non-adherence was double among drinkers compared to abstainers.
We spoke with Christian Hendershot, lead author of the alcohol study, about his findings. Hendershot is now a postdoctoral researcher at the University of New Mexico after earning his doctorate at the UW.
Can you describe your research, how you came to work on it, and what you hoped to find?
We wanted to look at the association of alcohol use and HAART adherence by combining the results of multiple studies. There has been some inconsistent evidence about whether and to what extent alcohol use is associated with lower rates of adherence to antiretroviral medication. Establishing whether the association is consistent across studies could help to inform clinical decisions or the design of interventions. For instance, physicians might have different types of discussions with patients depending on their drinking patterns. Also, if we’re hoping to develop interventions to improve medication adherence among drinkers, it’s helpful to first be able to characterize this association based on the overall evidence.
How do you explain the correlation between alcohol use and lower ARV adherence?
Based on this study we know that the correlation is significant and reliable across studies. Overall, people who were classified as drinkers were around 50-60% as likely to be classified as adherent, and people who were categorized as drinking at relatively higher levels had a higher likelihood of nonadherence compared to people who drank relatively less. What’s less clear is why this relationship exists. Alcohol use is a significant marker for medication nonadherence, but the association could partly be explained by other risk factors that are common to drinking alcohol and not being adherent to medications.
For the most part, the studies we examined can’t speak directly to whether drinking actually causes people to miss medication doses. But some recent studies that measured alcohol use and medication adherence on a daily basis, which is a stronger approach than looking at overall correlations, showed that there is in fact a close relationship between the number of drinks consumed on a given day and the likelihood of nonadherence on that day. It also appears that low levels of drinking–for instance 1-2 drinks on a given day–might not have a negative effect on adherence, whereas heavy drinking on a given day is very likely to be associated with missed doses. So while drinking is clearly a risk factor, whether it’s detrimental to adherence probably depends on other things, one being the number of drinks consumed.
Based on your data and conclusions, would you suggest people being treated of for HIV with HAART abstain from drinking alcohol?
I think the main message is that it’s important to evaluate patients’ alcohol use as a part of clinical management of HIV. Patients should be aware that drinking is a risk factor for nonadherence, and clinicians can aim to help patients evaluate whether drinking is posing a risk for staying adherent to medications. Because the link between drinking and adherence seems to depend on situational factors, for instance how many drinks are consumed on a given day and how that compares to the person’s normal drinking pattern, complete abstinence doesn’t have to be the goal in all cases. What’s probably most important is that people keep taking their medications regardless of whether they’re drinking. There is a proportion of patients who report skipping their doses because they’re worried about interactions of alcohol with mediactions, when in fact this should not be a concern.
Aside from medication adherence there are other reasons why people living with HIV should be aware of their level of alcohol consumption. In some studies heavier drinking has been linked to poorer outcomes on biological markers, such as lower CD4 counts. Alcohol is also implicated in sexual risk behavior, so there are multiple reasons why it’s important to consider drinking patterns among people living with HIV.
What are you researching next?
My colleagues and I are continuing to study alcohol and substance use in the context of HIV-related risk behaviors, in particular sexual risk behaviors. Ultimately the goal is to develop interventions that can reduce HIV transmission and other HIV-related health risks associated with substance use.
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