Current HIV/AIDS Reports

, Volume 12, Issue 4, pp 421–436 | Cite as

The Impact of Alcohol Use and Related Disorders on the HIV Continuum of Care: a Systematic Review

Alcohol and the HIV Continuum of Care
  • Panagiotis VagenasEmail author
  • Marwan M. Azar
  • Michael M. Copenhaver
  • Sandra A. Springer
  • Patricia E. Molina
  • Frederick L. Altice
Behavioral-Bio-Medical Interface (JL Brown and RJ DiClemente, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Behavioral-Bio-Medical Interface


Alcohol use is highly prevalent globally with numerous negative consequences to human health, including HIV progression, in people living with HIV (PLH). The HIV continuum of care, or treatment cascade, represents a sequence of targets for intervention that can result in viral suppression, which ultimately benefits individuals and society. The extent to which alcohol impacts each step in the cascade, however, has not been systematically examined. International targets for HIV treatment as prevention aim for 90 % of PLH to be diagnosed, 90 % of them to be prescribed with antiretroviral therapy (ART), and 90 % to achieve viral suppression; currently, only 20 % of PLH are virally suppressed. This systematic review, from 2010 through May 2015, found 53 clinical research papers examining the impact of alcohol use on each step of the HIV treatment cascade. These studies were mostly cross-sectional or cohort studies and from all income settings. Most (77 %) found a negative association between alcohol consumption on one or more stages of the treatment cascade. Lack of consistency in measurement, however, reduced the ability to draw consistent conclusions. Nonetheless, the strong negative correlations suggest that problematic alcohol consumption should be targeted, preferably using evidence-based behavioral and pharmacological interventions, to indirectly increase the proportion of PLH achieving viral suppression, to achieve treatment as prevention mandates, and to reduce HIV transmission.


Alcohol use disorders Alcoholism HIV HIV continuum of care HIV treatment cascade ART Antiretroviral therapy Adherence Viral suppression 


Compliance with Ethics Guidelines

Funding Source

This review was funded by the National Institute on Drug Abuse (NIDA) through research (R01 DA032106) and career development (K24 DA017072 and K02 DA033139) awards and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (R01 AA018944 and U01 AA021995). The funding sources played no role in study design, data collection, data analysis, data interpretation, writing of the manuscript, or the decision to submit the paper for publication.

Conflict of Interest

Dr. Vagenas, Dr. Azar, Dr. Copenhaver, and Dr. Springer declare that they have no conflict of interest. Dr. Molina reports personal fees and non-financial support from the National Advisory Council on Alcohol Abuse and Alcoholism (Council Member), outside the submitted work. Dr. Altice reports Speakers Bureau (Bristol Myers Squibb, Merck, Gilead, Rush University Simply Speaking HIV, Practice Point Communications Grant Funds to Yale University) with Dr. Altice as PI (NIH, NIAAA, SAMHSA, HRSA, Gilead Foundation).

Human and Animal Rights and Informed Consent

Research involving human subjects, human material, or human data was performed in accordance with the Declaration of Helsinki and was approved by the appropriate ethics committee (Institutional Review Boards of Yale University, Asociacion Civil Impacta Salud y Educacion (Peru), Emory University, and Abt Associates). All research was carried out within the appropriate ethical framework.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Panagiotis Vagenas
    • 1
    Email author
  • Marwan M. Azar
    • 1
  • Michael M. Copenhaver
    • 2
  • Sandra A. Springer
    • 1
  • Patricia E. Molina
    • 3
  • Frederick L. Altice
    • 1
    • 4
    • 5
  1. 1.Section of Infectious Diseases, AIDS Program, Department of Internal MedicineYale School of MedicineNew HavenUSA
  2. 2.Center for Health, Intervention, and Prevention, Department of Allied Health SciencesUniversity of ConnecticutStorrsUSA
  3. 3.Department of Physiology, Alcohol and Drug Abuse Center of ExcellenceLouisiana State UniversityNew OrleansUSA
  4. 4.Department of Epidemiology of Microbial DiseasesYale School of Public HealthNew HavenUSA
  5. 5.Centre of Excellence in Research on AIDSUniversity of MalayaKuala LumpurMalaysia

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