The Impact of Alcohol Use and Related Disorders on the HIV Continuum of Care: a Systematic Review
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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.
KeywordsAlcohol use disorders Alcoholism HIV HIV continuum of care HIV treatment cascade ART Antiretroviral therapy Adherence Viral suppression
Compliance with Ethics Guidelines
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
- 1.Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention Atlanta, GA: Centers for Disease Control and Prevention. Available from: http://www.cdc.gov/hiv/prevention/research/compendium/rr/complete.html.
- 2.Report G. UNAIDS report on the global AIDS epidemic. Geneva: UNAIDS; 2012.Google Scholar
- 4.Joint United Nations Programme on HIV/AIDS. 90-90-90—an ambitious treatment target to help end the AIDS epidemic. New York. 2014. p. http://www.unaids.org/en/resources/documents/4/90-90-90. Accessed 12 Mar 2015
- 7.••INSIGHT START Study Group, Lundgren JD, Gordin F, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373:795–807. The START trial showed that early initiation of antiretroviral therapy (CD4+ count >500) provided net benefits over starting therapy after the CD4+ was <350.CrossRefGoogle Scholar
- 8.•Stahre M, Roeber J, Kanny D, Brewer RD, Zhang X. Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States. Prev Chronic Dis. 2014;11:E109. Excessive drinking accounts for 1 in 10 deaths among working-age adults in the USA.PubMedCentralCrossRefPubMedGoogle Scholar
- 9.Results from the 2013 National Survey on Drug Use and Health: summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014Google Scholar
- 13.Scott-Sheldon LA, Carey KB, Cunningham K, Johnson BT, Carey MP, MASH Research Team. Alcohol use predicts sexual decision-making: a systematic review and meta-analysis of the experimental literature. AIDS Behav. 2015 (in press).Google Scholar
- 19.Ajithkumar K, Neera PG, Rajani PP. Relationship between social factors and treatment adherence: a study from South India. Eastern J Med. 2011;16(2):147–52.Google Scholar
- 26.Farley J, Miller E, Zamani A, Tepper V, Morris C, Oyegunle M, et al. Screening for hazardous alcohol use and depressive symptomatology among HIV-infected patients in Nigeria: prevalence, predictors, and association with adherence. J Int Assoc Physicians AIDS Care. 2010;9(4):218–26.CrossRefGoogle Scholar
- 27.•Ferro EG, Weikum D, Vagenas P, Copenhaver MM, Gonzales P, Peinado J, et al. Alcohol use disorders negatively influence antiretroviral medication adherence among men who have sex with men in Peru. AIDS Care. 2015;27(1):93–104. This study demonstrates that AUDs are associated with sub-optimal adherence among HIV-infected MSM.CrossRefPubMedGoogle Scholar
- 31.Jones AS, Lillie-Blanton M, Stone VE, Ip EH, Zhang Q, Wilson TE, et al. Multi-dimensional risk factor patterns associated with non-use of highly active antiretroviral therapy among human immunodeficiency virus-infected women. Womens Health Issues. 2010;20(5):335–42.PubMedCentralCrossRefPubMedGoogle Scholar
- 49.Venkatesh KK, Srikrishnan AK, Mayer KH, Kumarasamy N, Raminani S, Thamburaj E, et al. Predictors of nonadherence to highly active antiretroviral therapy among HIV-infected South Indians in clinical care: implications for developing adherence interventions in resource-limited settings. AIDS Patient Care STDS. 2010;24(12):795–803.PubMedCentralCrossRefPubMedGoogle Scholar
- 50.•Woolf-King SE, Neilands TB, Dilworth SE, Carrico AW, Johnson MO. Alcohol use and HIV disease management: the impact of individual and partner-level alcohol use among HIV-positive men who have sex with men. AIDS Care. 2014;26(6):702–8. Hazardous drinkers were shown to be less likely to achieve viral suppression, compared to non-drinkers.PubMedCentralCrossRefPubMedGoogle Scholar
- 51.Carrieri MP, Protopopescu C, Raffi F, March L, Reboud P, Spire B, et al. Low alcohol consumption as a predictor of higher CD4+ cell count in HIV-treated patients: a French paradox or a proxy of healthy behaviors? The ANRS APROCO-COPILOTE CO-08 cohort. J Acquir Immune Defic Syndr. 2014;65(4):e148–e50.CrossRefPubMedGoogle Scholar
- 52.Dahab M, Charalambous S, Karstaedt AS, Fielding KL, Hamilton R, La Grange L, et al. Contrasting predictors of poor antiretroviral therapy outcomes in two South African HIV programmes: a cohort study. BMC Public Health. 2010;10.Google Scholar
- 54.•Kader R, Seedat S, Govender R, Koch JR, Parry CD. Hazardous and harmful use of alcohol and/or other drugs and health status among South African patients attending HIV clinics. AIDS Behav. 2014;18(3):525–34. This study shows that hazardous/harmful drinkers are less likely to be prescribed with ART.CrossRefPubMedGoogle Scholar
- 65.•Vagenas P, Ludford KT, Gonzales P, Peinado J, Cabezas C, Gonzales F, et al. Being unaware of being HIV-infected is associated with alcohol use disorders and high-risk sexual behaviors among men who have sex with men in Peru. AIDS Behav. 2014;18(1):120–7. This study with a large sample of MSM in Peru showed that AUDs are associated with being unaware of being HIV infected.CrossRefPubMedGoogle Scholar
- 69.Altice FL, Bruce RD, Lucas GM, Lum PJ, Korthuis PT, Flanigan TP, et al. HIV treatment outcomes among HIV-infected, opioid-dependent patients receiving buprenorphine/naloxone treatment within HIV clinical care settings: results from a multisite study. J Acquir Immune Defic Syndr. 2011;56 Suppl 1:S22–32.PubMedCentralCrossRefPubMedGoogle Scholar
- 72.Babor TF, Delafuente JR, Saunders J. AUDIT: the Alcohol Use Disorders Identification Test: guidelines for use in primary health care. Geneva: World Health Organization; 1992.Google Scholar
- 74.WHO. Global status report on alcohol and health. Geneva: World Health Organization; 2014.Google Scholar
- 75.••Lourenco L, Hull M, Nosyk B, Montaner JSG, Lima VD. The need for standardisation of the HIV continuum of care. Lancet HIV. 2015;2(6):e225–e6. This paper describes how stages of the HIV continuum of care are defined differently in different locations and urges for standardization across the world.CrossRefPubMedGoogle Scholar
- 80.Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–95.CrossRefPubMedGoogle Scholar
- 86.Bruce RD, Moody DE, Altice FL, Gourevitch MN, Friedland GH. A review of pharmacological interactions between HIV or hepatitis C virus medications and opioid agonist therapy: implications and management for clinical practice. Expert Rev Clin Pharmacol. 2013;6(3):249–69.PubMedCentralCrossRefPubMedGoogle Scholar
- 89.WHO. Global status report on alcohol and health. Geneva: World Health Organization; 2011.Google Scholar
- 90.World Health Organization (WHO). International guide for monitoring alcohol consumption and related harm. Geneva: Dependence DoMHaS; 2000.Google Scholar
- 103.Brown SE, Vagenas P, Konda KA, Clark JL, Lama JR, Gonzales P, et al. Men who have sex with men in Peru: acceptability of medication-assisted therapy for treating alcohol use disorders. Am J Mens Health. 2015 (in press).Google Scholar
- 105.Armstrong ML, LaPlante AM, Altice FL, Copenhaver MM, Molina PE. Advancing behavioral HIV prevention: adapting an evidence-based intervention for people living with HIV and alcohol use disorders. AIDS Research and Treatment. 2015 (in press).Google Scholar
- 106.Centers for Disease Control and Prevention. Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: summary guidance from CDC and the U.S. Department of Health and Human Services. MMWR Recomm Rep. 2012;61(RR-5):1–40.Google Scholar
- 107.WHO/UNODC/UNAIDS. Policy guidelines for collaborative TB and HIV services for injecting and other drug users: an integrated approach 2008. December 16, 2008. Available at http://whqlibdoc.who.int/publications/2008/9789241596930_eng.pdf. Accessed 16 Dec 2008.Google Scholar