Academic journal article Alcohol Research

Interventions Targeting HIV-Infected Risky Drinkers: Drops in the Bottle

Academic journal article Alcohol Research

Interventions Targeting HIV-Infected Risky Drinkers: Drops in the Bottle

Article excerpt

Alcohol use is common among people infected with HIV and may contribute to adverse consequences such as reduced adherence to treatment regimens and increased likelihood of risky sexual behaviors. Therefore, researchers and clinicians are looking for treatment approaches to reduce harmful alcohol consumption in this population. However, clinical trials of existing treatment models are scarce. A literature review identified only 11 studies that included HIV-infected patients with past or current risky alcohol use and which targeted alcohol use and other health behaviors. Four studies focusing on HIV-infected participants with alcohol problems found mixed effects on adherence and on alcohol use. Five clinical trials included at least 10 percent of HIV-infected subjects who use alcohol; of these, only one reported significant evidence of a favorable impact on alcohol consumption. Finally, two trials targeting alcohol users at high risk for HIV infection identified treatment effects that were not sustained. Taken together, these findings provide limited evidence of the benefit of behavioral interventions in this population. Nevertheless, these studies give some guidance for future interventions in HIV-infected patients with alcohol problems. KEY WORDS: Alcohol and other drug use; alcohol consumption; alcohol use disorder; human immunodeficiency virus; HIV-infected patients; sexually transmitted disease; unsafe sex; treatment method; treatment outcome; intervention; clinical trial; literature review

In the United States, people infected with the human immunodeficiency virus (HIV) drink more alcohol than people in the general population. Specifically, a higher proportion drink risky amounts1 or have an alcohol use disorder (i.e., abuse or dependence) (Conigliaro et al. 2003; Galvan et al. 2002; Lefevre et al. 1995; Samet et al. 2003a,b, 2004). Risky alcohol use in HIV-infected people has been associated with the following range of adverse effects:

* Reduced adherence to medication regimens for treatment of HIV infection (Chander et al. 2006; Conen et al. 2009; Cook et al. 2001; Golin et al. 2002; Halkitis et al. 2003; Samet et al. 2004);

* Lack of a health care provider for the HIV infection (Metsch et al. 2009);

* Delayed linkage to HIV medical care (Samet et al. 1998);

* Increase in risky sexual behaviors (Kalichman et al. 2002; Metsch et al. 2009);

* Increased transmission of sexually transmitted infections (Kalichman et al. 2000); and

* Progression of HIV disease (Conigliaro et al. 2003; Miguez et al. 2003; Samet et al. 2007).

Given the spectrum of problems associated with such alcohol use among HIV-infected patients, one important avenue to improving the health of this population is to develop interventions that target alcohol use and its associated consequences. Accordingly, interventions have been designed to both decrease alcohol consumption and address the specific adverse health consequences.

The concept that negative consequences of alcohol use can be reduced in patients with HIV infection is based on research demonstrating the impact of clinical interventions on alcohol consumption and associated negative consequences in patients without HIV infection (Institute of Medicine 1990; Kristenson et al. 1983). Alcohol research over the past three decades has demonstrated that behavioral interventions can be effective, with benefits varying based on setting, severity of alcohol problems, and patient characteristics. For example, metaanalyses of randomized controlled trials (RCTs)2 of interventions to reduce risky alcohol use demonstrated decreased drinking for patients in primary care settings (Beich et al. 2003; Kaner et al. 2007). However, no such effects were found in metaanalyses of interventions delivered in hospital settings (Emmen et al. 2004), possibly because inpatients typically have greater severity of alcohol problems (i.e., most are alcohol dependent) (Saitz et al. …

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