Academic journal article Alcohol Research

HIV/AIDS, Comorbidity, and Alcohol: Can We Make a Difference?

Academic journal article Alcohol Research

HIV/AIDS, Comorbidity, and Alcohol: Can We Make a Difference?

Article excerpt

Alcohol use is common among people at risk for, and aging with, human immunodeficiency virus (HIV) infection and plays a central modifiable role in their health outcomes (Braithwaite et al. 2007; Conigliaro et al. 2003, 2004; Cooper and Cameron 2005; Justice et al. 2004, 2006b; McGinnis et al. 2006; Rees et al. 2001; Samet et al. 2004; Shaffer et al. 2004). Past and present alcohol consumption directly influences HIV progression and survival by altering timing of and adherence and response to medication designed to minimize levels of HIV in the body (i.e., antiretroviral treatment [ART]) (Bean 2000; Braithwaite et al. 2005, 2007, 2008; Cook et al. 2006; Kresina et al. 2002; Samet et al. 1998, 2003). Alcohol use also influences patient outcomes by increasing the risk for HIV and antiretroviral-associated comorbidities, including liver disease, cardiovascular and cerebrovascular disease, pulmonary disease, bone disease, and cancer (Conigliaro et al. 2003, 2006; Justice et al. 2006b). People with HIV have a lower tolerance for alcohol (Braithwaite et al. 2008) yet maintain heavy levels of consumption as they age (Green 2009). The cumulative effects of past and current alcohol consumption is likely to increase now that patients with HIV infection are expected to live 20 to 30 years on ART (Hogg et al. 2008).

Health care providers can help to mitigate the harmful effects of alcohol use in patients with HIV. A growing body of research has demonstrated that behavioral and pharmacologic interventions for alcohol can be implemented successfully in primary-care and office-based settings (see Samet and Walley, pp. 267-279 in this issue). However, practitioners and researchers must adapt and coordinate such interventions to the complex clinical context of HIV infection. This will require prioritization and integration of alcohol treatment with medical management of long-term HIV infection and associated comorbidity. The only reasonable way to integrate and jointly prioritize treatment for HIV, comorbid disease, and alcohol use is to estimate the impact each condition has on the patient's risk of morbidity and mortality and thus help inform patient and provider decision making (Braithwaite et al. 2007; Justice 2006). Researchers must therefore develop methods to prioritize, integrate, and coordinate treatment for alcohol, HIV, and associated comorbid conditions.

Because HIV infection has become a complex chronic disease in which alcohol has a multifaceted impact on health outcomes, strategy implementation studies are needed. Strategy implementation studies combine behavioral and pharmacologic methods to decrease alcohol consumption with clinical strategies to mitigate the short and long-term effects of alcohol on morbidity and mortality. Long-term (i.e., longitudinal) observational studies are particularly useful in helping to characterize HIV-infected populations at risk and their alcohol-associated disease trajectories. Further, data from observational studies can suggest means of objectively gauging the effects of this combined approach. This article reviews the prevalence of alcohol use among people with HIV and the complex and interacting role of alcohol use in HIV and selected comorbid diseases, describes ongoing plans for continued longitudinal observation, and, finally, discusses the authors' plan to develop multilevel strategy implementation trials within the Veterans Aging Cohort Study (VACS).

PREVALENCE

The majority of people receiving care for HIV infection report current alcohol consumption (i.e., consuming alcohol during the previous 12 months). Among people coinfected with hepatitis C virus (HCV) or with evidence of liver injury, the proportion comprising current alcohol users is even higher (Conigliaro et al. 2006; Goulet et al. 2005). In a national sample of patients with HIV 8 to 12 percent were classified as current heavy drinkers, a rate approximately twice that of the U.S. national average (Burnam et al. …

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