Date Published: March 11, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Manuela G. Neuman, Michelle Schneider, Radu M. Nanau, Charles Parry.
The present paper describes the possible connection between alcohol consumption and adherence to medicine used to treat human deficiency viral (HIV) infection. Highly active antiretroviral therapy (HAART) has a positive influence on longevity in patients with HIV, substantially reducing morbidity and mortality, including resource-poor settings such as South Africa. However, in a systematic comparison of HAART outcomes between low-income and high-income countries in the treatment of HIV-patients, mortality was higher in resource-poor settings. Specifically, in South Africa, patients often suffer from concomitant tuberculosis and other infections that may contribute to these results. Alcohol influences the use of medicine for opportunistic infections (e.g., pneumonia, tuberculosis), or coinfections HIV-hepatitis viruses-B (HBV) and C (HCV), cytomegalovirus, or herpes simplex virus. Furthermore, alcohol use may negatively impact on medication adherence contributing to HIV progression. The materials used provide a data-supported approach. They are based on analysis of published (2006–2011) world literature and the experience of the authors in the specified topic. Intended for use by health care professionals, these recommendations suggest approaches to the therapeutic and preventive aspects of care. Our intention was to fully characterize the quality of evidence supporting recommendations, which are reflecting benefit versus risk, and assessing strength or certainty.
Failure to recognize alcohol behaviour remains a significant problem that impairs efforts directed towards the prevention and management of patients with alcoholic liver damage. Although there are limitations in the available data, the World Health Organization’s Global Alcohol database, which has been in existence since 1996, has been used to estimate worldwide patterns of alcohol consumption, and it allows comparisons of alcohol-related morbidity and mortality. The burden of alcohol-related disease is highest in the developing world, including South Africa. Pithey and Parry  describe the association between alcohol use and human immunodeficiency virus (HIV) infection in a systematic review of sub-Saharan African studies. The authors present studies that have quantified the association between alcohol consumption and HIV infection in this region. They analyzed work performed between 2000 and 2008 that reported relative measures of the association between alcohol use and HIV prevalence and/or seroconversion rates. However, the authors sustain that in order to confirm causality, the use of clearly defined standardised measures of alcohol use is needed . Patterns of alcohol consumption are expressed and regulated differently in diverse geographical regions. There are contradictory drinking guidelines defining low-risk and high-risk drinking in different countries. In the United States of America, the National Institute of Alcohol and Alcohol Abuse (NIAAA) and the United States Department of Agriculture define low risk drinking as ≤14 drinks/week and ≤4 drinks on any day for men. For women, the definition of low risk drinking is ≤7 drinks/week or ≤3 drinks on any day (http://www.rethinkingdrinking.niaaa.nih.gov/; http://www.cnpp.usda.gov/dgas2010-dgacreport.htm). Proposed guidelines specific for each nation make it difficult to conduct an international generalization of “moderate, low-risk drinking” versus “high-risk drinking.”
We performed a systematic review of published PubMed literature, searching for articles that contained information about “alcohol”, “HIV” and “antiretroviral therapy” published between January 2006 and June 2011. We did not limit our search to literature published in English. We found over 365 results using the key words “alcohol,” “adherence,” “ART” and “HIV,” from which we selected 230 articles that we analyzed.
The primary goal of ART is to increase disease-free survival through suppression of viral replication and improvement in immunological function. The optimal time to initiate treatment is influenced by these known benefits and the risk of drug toxicity, potential emergence of viral drug resistance, and the need for lifetime therapy. The complexities of adherence-resistance relationships are related to characteristics of the virus, the medication, misuse of alcohol, and their interactions. Nevertheless, the effectiveness of ART can be limited by lack of access to therapy. Additionally, a set of acquired behaviour, such as alcohol misuse and poor adherence and/or intolerance, can lead to ART resistance. Therefore, especially in low-income populations, the education of individuals who live with HIV and alcohol abuse is relevant.