At-risk alcohol use linked to lower ART adherence among people with HIV/AIDS

Advancements in antiretroviral therapy (ART) have allowed people living with HIV/AIDS to maintain a quality of life similar to those without HIV infection. Medication adherence is key, however, as non-adherence to ART can lead to poorer HIV suppression, decreased CD4 cell count, and an increased risk for antiretroviral drug resistance. Prior research has shown that alcohol use is common among persons living with HIV/AIDS, and that the rate of current heavy drinking may be almost double that of the general population. This study examined whether "at-risk" alcohol use – defined as more than three drinks per day for women and more than four drinks per day for men – was associated with ART non-adherence among persons living with HIV/AIDS.

Participants were 535 HIV-infected adults (458 men, 77 women) enrolled in research studies at the University of California, San Diego HIV Neurobehavioral Research Program. All participants were receiving ART at the time of their initial visit and reported drinking alcohol in the previous 30 days. ART non-adherence was identified through either self-reported missed doses or plasma viral load detectability (≥50 copies/mL) reflecting limited suppression of the virus.

Approximately one-quarter of the group (n=133) were engaged in at-risk alcohol use, which significantly predicted lower ART adherence. Heavy drinkers were younger, less educated, and more likely to be diagnosed with lifetime alcohol use and lifetime cocaine use disorders. The authors suggest that a stronger focus on the treatment of at-risk alcohol use may improve ART adherence among persons living with HIV.