How Drinking Alcohol Can Increase HIV Progression

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Researchers believe that both alcohol abuse and HIV infection play roles in compromising the body's immune functions. In fact, some research shows that alcohol may actually accelerate the progression of HIV disease.

This is a problem because statistics also show that alcohol problems are more prevalent among people with the human immunodeficiency virus (HIV) than among the general population.

It has long been established that alcohol abuse can suppress multiple functions of the immune system, leading to increased risk of infections. In alcohol-abusing patients, the normal course and resolution of both bacterial and viral infections are severely impaired.

Studies have found that HIV-infected patients with a history of alcohol problems, who are receiving highly active antiretroviral therapy (HAART), and are currently drinking, have greater HIV progression than those who do not drink.

Drinking Alcohol and the Immune System

"Part of our interest in examining the relationship between alcohol use and HIV infection was based on clinical experience," explained Jeffrey H. Samet, professor of medicine and public health at Boston University, and the study's first author. "In the urban setting where I work, a substantial number of patients—with or without HIV, but even more so with HIV—have had alcohol problems."

"In the world before HIV, we knew that chronic alcohol use led to problems that are more common in immunodeficiency states such as tuberculosis and pneumonia. Of course, we also know that HIV attacks the immune system. So you can pose the question, 'could these two things—HIV and alcohol—be interacting in some way that makes the immune state worse than just HIV alone?'"

Drinking Affects Treatment Adherence

"Although we do not yet understand how alcohol directly interacts with the already compromised immune system of a human infected with HIV," added Amy C. Justice, a researcher with the University of Pittsburgh School of Medicine and the VA Pittsburgh Healthcare System, "nonhuman studies suggest that heavy alcohol consumption can immediately elevate viral load, presumably by decreasing the ability to kill virus."

Justice added that the indirect effects of alcohol are also caused for concern. "Heavy alcohol consumption is known to limit a person's ability to adhere to HIV treatment," she said, "and nonadherence is known to lead to more rapid disease progression. Further, alcohol is known to exacerbate common comorbid conditions among those with HIV infection, such as hepatitis C or chronic hepatitis B."

Increases Toxicity Risks

"Finally, heavy alcohol consumption may also lead to increased rates of serious toxicity from antiretroviral therapy as both can be toxic to the liver and bone marrow. Thus, heavy alcohol consumption may lead to nonadherence and even complete cessation of antiretroviral therapy through a multitude of mechanisms."

The current treatment for HIV infection, HAART, has contributed to a steady decrease in HIV morbidity and mortality. The term does not refer specifically to any particular medication, but to a minimum of three antiretroviral medications that are known to work against HIV, which belongs to a class of retroviruses.

High RNA Levels, Lower Cell Counts

For this study, researchers examined 349 (276 or 79 percent males; 73 or 21 percent females) HIV-infected individuals with a history of alcohol problems. HAART use during the previous month was determined; as was alcohol consumption, and then quantified as none, moderate, or at-risk. In addition, two markers of HIV disease progression were assessed: CD4 cell counts, and HIV ribonucleic acid (RNA) levels.

The study found that among HIV-infected patients with a history of alcohol problems and who were treated with HAART, those who consumed moderate or at-risk amounts of alcohol had higher HIV RNA levels and lower CD4 cell counts, compared with those who did not drink. No significant differences were found in HIV RNA levels or CD4 cell counts among HIV-infected patients who consumed alcohol but were not on antiretroviral therapy.

Alcohol, HIV, and the Gastrointestinal Tract

Other studies have confirmed that alcohol use by people with HIV infection can exacerbate an already badly strained immune system. One study found a clear connection between alcohol, HIV and immune dysfunction in the gastrointestinal tract where alcohol does damage to the mucosal lining of the intestines.

This damage can lead to inflammation, barrier damage, and bacterial leakage, which in turn appears to strengthen HIV’s grip on the body, researchers believe. The same is true of alcohol's effect on many of the body's mucosal tissues—in the intestines, the genital tract, and the lungs.

Alcohol effects on those tissues can result in creating an environment which can worsen the progression of diseases and increase the risk of viral transmission.

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