Original Research

Journal of General Internal Medicine

, Volume 28, Issue 3, pp 399-405

First online:

Intentional Non-Adherence to Medications among HIV Positive Alcohol Drinkers: Prospective Study of Interactive Toxicity Beliefs

  • Seth C. KalichmanAffiliated withDepartment of Psychology, University of Connecticut Email author 
  • , Tamar GreblerAffiliated withDepartment of Psychology, University of Connecticut
  • , Christina M. AmaralAffiliated withDepartment of Psychology, University of Connecticut
  • , Megan McNereyAffiliated withDepartment of Psychology, University of Connecticut
  • , Denise WhiteAffiliated withDepartment of Psychology, University of Connecticut
  • , Moira O. KalichmanAffiliated withDepartment of Psychology, University of Connecticut
  • , Chauncey CherryAffiliated withDepartment of Psychology, University of Connecticut
  • , Lisa EatonAffiliated withDepartment of Psychology, University of Connecticut

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ABSTRACT

BACKGROUND

Antiretroviral therapy (ART) adherence is key to successful treatment of HIV infection and alcohol is a known barrier to adherence. Beyond intoxication, ART adherence is impacted by beliefs that mixing alcohol and medications is toxic.

PURPOSE

To examine prospective relationships of factors contributing to intentional medication non-adherence when drinking.

METHODS

People who both receive ART and drink alcohol (N = 178) were enrolled in a 12-month prospective cohort study that monitored beliefs about the hazards of mixing ART with alcohol (interactive toxicity beliefs), alcohol consumption using electronic daily diaries, ART adherence assessed by both unannounced pill counts and self-report, and chart-abstracted HIV viral load.

RESULTS

Participants who reported skipping or stopping their ART when drinking (N = 90, 51 %) demonstrated significantly poorer ART adherence, were less likely to be viral suppressed, and more likely to have CD4 counts under 200/cc3. Day-level analyses showed that participants who endorsed interactive toxicity beliefs were significantly more likely to miss medications on drinking days.

CONCLUSIONS

Confirming earlier cross-sectional studies, the current findings from a prospective cohort show that a substantial number of people intentionally skip or stop their medications when drinking. Interventions are needed to correct alcohol-related interactive toxicity misinformation and promote adherence among alcohol drinkers.

KEY WORDS

medication adherence alcohol use HIV treatment beliefs