Living with HIV is difficult under the best of circumstances, but for people carrying the virus, alcohol consumption can become particularly perilous in intricate ways that are only beginning to be understood. At the Brown Alcohol Research Center on HIV (ARCH) funded by a new $7.5-million, five-year grant from the National Institutes of Health, Brown University scientists will study the health effects of drinking with HIV and provide doctors and patients with the latest guidance their results suggest.
Alcohol can produce many unique complications and risks in the life of an HIV-positive person, said Peter Monti, the Donald G. Millar Distinguished Professor of Alcohol and Addiction Studies at Brown and the director of the ARCH. Both alcohol and the virus can independently weaken the brain and the liver, for example. Researchers suspect that the confluence of health effects becomes even more complicated when alcohol undermines a patient's adherence to antiretroviral medications or inclination to remain abstinent or engage in safe sex.
"We want healthier individuals living with HIV, especially now that they are living longer," Monti said. "We'll hopefully determine whether people have to stop drinking or reduce their drinking."
Alcohol use is generally understood to be more prevalent among at least some major groups of HIV-positive people than in the general population, said Monti, who directs the Center for Alcohol and Addiction Studies at the Warren Alpert Medical School of Brown University.
Starting studies
The ARCH will be organized to conduct research both on the physiological and behavioral aspects of HIV and alcohol, including funding two major and four pilot studies as well as several cores.
In one study, researchers led by Ronald Cohen, professor of psychiatry and human behavior (research) and director of the Department of Neuropsychology at The Miriam Hospital, will study changes in the brain structure, metabolism, and cognitive functioning of heavier and lighter drinkers with HIV over three years.
In another study at Fenway Health in Boston led by Christopher Kahler, professor of community health (research) and scientific director of the ARCH, and Kenneth Mayer, professor of medicine based at The Miriam, Monti will adapt an effective emergency room alcohol intervention he has developed for a clinical trial with chronic heavy drinkers with HIV. The "motivational interview" technique presents facts and feedback about a patient's consumption compared to that of peers and relays information about the health effects of the patient's level of drinking.
"You don't hammer patients over the head with it, but you present them with the information in a nonconfrontational style and ask them what they think about it," Monti said. "You ask them whether they'd be interested in changing and if the answer is yes, you give them some thumbnail sketches about how they might want to go about that."
In another new but separate $4-million grant, Monti will develop and test an emergency room intervention method to curb sexual risk-taking and heavy alcohol consumption.
The ARCH pilot studies will investigate the role of occult hepatitis C in the HIV and alcohol mix, the effects of HIV and drinking during pregnancy on newborns, the brain response that HIV-positive drinkers have to various stimuli depending on their level of use and acute brain response to alcohol, and the effects of drinking and HIV among fishermen and commercial sex workers in Uganda. Additional pilot studies will be jointly funded by the ARCH and Brown's Center for AIDS Research, directed by Charles Carpenter, professor of medicine based at The Miriam.
Another major element of the program, led by Mayer and Suzanne Colby, associate professor of psychiatry and human behavior (research), will be to educate postdoctoral trainees and doctors in the specialty of alcohol and HIV.
Getting the word out
Throughout ARCH's five-year grant period, the center faculty will share results via newsletters and the Internet with colleagues, clinicians, and patients who so far have many more questions than answers. Monti points out that there are well-established clinical communities around AIDS and around alcohol addiction, but very few clinical, research or education efforts that span both health problems.
"Doctors often ask me what they should tell their HIV positive patients who have no other risk factors than being HIV-positive about whether they can safely take a glass or two of wine with dinner," said Monti. "We simply do not know."
GLP-1 drugs, like semaglutide, lower risk of hospitalizations for alcohol use disorder