Integrating HIV/AIDS and Alcohol Research
Bryant, Kendall J., Nelson, Steve, Braithwaite, R. Scott, Roach, Deidra, Alcohol Research
The acquired immune deficiency syndrome (AIDS) was first recognized in 1981; subsequently, researchers determined that it was caused by infection with the human immunodeficiency virus (HIV). Since then, the disease has become a pandemic, with the virus infecting almost 60 million people worldwide, killing 25 million of them (Doran 2009). Although researchers have learned much about the nature of the virus, the course of the disease, the routes of transmission, and strategies to suppress viral replication and disease progression, the epidemic continues unabatedly, particularly in less developed countries. Even in the United States, where many prevention campaigns have been implemented and awareness of the transmission routes is relatively high, between 55,000 and 60,000 people become newly infected with HIV every year (Centers for Disease Control and Prevention [CDC] 2008a). With improved treatment options, HIV infection in the United States and other Western countries has evolved from an acute illness with rapid progression and death to a chronic condition with, in many cases, a life expectancy of 20 to 40 years, thanks to the knowledge gained from research. Globally, however, approximately 2 million people died from the disease in 2008 (Doran 2009).
Nevertheless, many challenges remain in preventing both infection with the virus and progression of the disease. One of the many factors contributing to the difficulties of preventing the spread of the infection and treating infected patients is the acute or chronic alcohol use of people who are at risk for infection or who already are infected. The alcohol-HIV/ AIDS literature has grown extensively over the past 15 years, and a variety of recent reviews of this literature have summarized the interactions of alcohol use and HIV/AIDS in behavioral, biological, and biomedical areas (e.g., Bryant 2006; Van Thieu and Koblin 2009). This attention to the effects of alcohol consumption and mechanisms of impairment reflects an increasing desire to fully address a broader scope of the epidemic in strategic ways.
A plethora of studies has demonstrated that alcohol use can impact the risk and consequences of HIV infection on a variety of levels. For example, both acute and chronic alcohol use, as well as the venues where people consume alcohol, can increase the likelihood of risky sexual behavior, thereby influencing the incidence of infection. After infection has occurred, alcohol use may hasten the progression of the disease to full-blown AIDS, for example, because alcohol-abusing patients may delay testing for infection, accessing appropriate medical care, and initiating antiretroviral therapy (ART). All of these factors can amplify the risk that the infection goes untreated and that other people are infected. Furthermore, chronic alcohol use and the presence of alcohol use disorders (i.e., alcohol abuse or dependence) also contribute to various comorbid conditions (e.g., liver disease, other co-occurring infections, or cognitive dysfunction) that have an impact on the progression of the HIV infection. Finally, alcohol interacts with many of the medications used to treat HIV infection/AIDS, and chronic alcohol use impairs patients' adherence to ART regimens, thereby contributing to greater morbidity and mortality among the affected patients. In fact, studies found that even nonhazardous alcohol use (i.e., less than five standard drinks per drinking day) once a week or more can reduce survival of HIV-infected people by 1 year, and daily hazardous use (i.e., five or more standard drinks per day) reduces survival by 6.4 years (Braithwaite et al. 2007). To date, however, HIV/AIDS prevention and treatment strategies do not adequately take into consideration patients' drinking behaviors. Moreover, prevention specialists and health care providers dealing with alcohol-consuming patients at risk of or already infected with HIV need additional information in order to implement effective interventions in both uninfected (i. …