Date Published: September 27, 2017
Publisher: BioMed Central
Author(s): R. L. Cook, Z. Zhou, N. E. Kelso-Chichetto, J. Janelle, J. P. Morano, C. Somboonwit, W. Carter, G. E. Ibanez, N. Ennis, C. L. Cook, R. A. Cohen, B. Brumback, K. Bryant.
Alcohol consumption has been associated with poor antiretroviral therapy (ART) adherence but less is known about its relationship to HIV viral suppression, or whether certain drinking patterns have a stronger association than others. The objectives of this study were to determine the association of different patterns of alcohol consumption to HIV viral suppression and ART adherence, and to determine whether any associations of alcohol with HIV viral suppression were mediated by poor ART adherence.
This observational study used baseline data from 619 HIV+ participants, recruited across 8 clinical and community settings across Florida as part of the Florida Cohort from 2014 to 2016. Alcohol consumption was measured by self-report, and grouped into four categories: heavy drinking (>7/week for women or >14 drinks/week for men); binge, but not heavy drinking (≥4 or >5 drinks/occasion for women and men, respectively), low level drinking (neither heavy nor binge), and abstinence. Serum HIV RNA measurements were obtained from statewide HIV surveillance data, and durable viral suppression was defined as achieving HIV viral suppression (<200 copies/ml) at every assessment in the past 12 months. The majority of the 619 participants were male (63%) and aged 45 or greater (65%). The proportion of participants with heavy, binge, low-level drinking and abstinence was 9, 25, 37 and 30%, respectively. Optimal ART adherence (≥95%) was reported by 68%, and 60% achieved durable viral suppression. In multivariable analysis controlling for demographic factors, drug use, and homelessness, heavy drinking (compared to abstinence) was associated with increased odds of failing to achieve durable viral suppression (OR 2.16, 95% CI 1.08–4.32) whereas binge drinking alone was not significantly associated with this outcome (OR 1.04, 95% CI 0.64–1.70). Both heavy drinking and binge drinking were significantly associated with suboptimal ART adherence. Mediation analyses suggested that only a small proportion of the relationship between heavy drinking and suboptimal viral suppression was due to poor ART adherence. Exceeding weekly recommended levels of alcohol consumption (heavy drinking) was significantly associated with poor HIV viral suppression and ART non-adherence, while binge drinking was associated with suboptimal ART adherence in this sample. Clinicians should attempt to address heavy drinking in their patients with HIV.
Despite widespread availability of antiretroviral therapy (ART) in the United States, viral suppression (<200 copies/ml) is achieved in only 25% of all persons living with HIV and 70% of those retained in care . Lack of HIV viral suppression is associated with more rapid HIV disease progression, cardiovascular complications  and transmission of HIV within the community . Therefore, strategies to improve HIV viral suppression are an important part of the current national HIV strategy .
Characteristics of the 619 study participants are presented in Table 1. The majority of the sample was male (63%), aged 45 years or greater (65%), and diverse in terms of race/ethnicity and education status (Table 1). Homelessness in the past year was reported among 16%. Current smoking and illicit drug use was reported by 53 and 58%, respectively. Symptoms of depression (31%) and anxiety (29%) were relatively common. Durable viral load suppression was achieved among only 60% of the sample. Among those currently using ART (94%), 68% reported optimal ART adherence. Thirty percent of the sample reported no use of alcohol in the past year, 9% met criteria for heavy drinking (exceeds weekly limits), 25% met criteria for binge drinking (but not heavy drinking), and 37% reported low level, non-binge drinking.Table 1Baseline characteristics of persons living with HIV in the Florida Cohort (N = 619), 2014–2016Baseline characteristicsNo. (column %)Gender Male393 (63) Female226 (37)Race Non-Hispanic White137 (22) Non-Hispanic Black346 (56) Hispanic112 (18) Other24 (4)Age group 18–3492 (15) 35–44125 (20) 45–54246 (40) ≥55156 (25)Education
In this sample of persons living with HIV infection in Florida, heavy alcohol consumption was associated with approximately twice the odds of having suboptimal HIV viral suppression compared to non-drinkers, even when accounting for several potential confounding variables. In contrast, adults who reported occasional binge drinking but did not meet criteria for heavy drinking were not as a group significantly different from non-drinkers in terms of overall durable HIV viral suppression. The findings demonstrate that differences in the way that alcohol consumption is measured and defined can result in different conclusions about the relationship of alcohol consumption with HIV-related health outcomes or behaviors.