Alcohol Consumption, Progression of Disease and Other Comorbidities, and Responses to Antiretroviral Medication in People Living with HIV

Table 3

Alcohol Consumption and Nonadherence to ART.

Ref.	Study settings	Population characteristics	Alcohol use patterns	Main findings
			Found Nonadherence
[36]	USA	391 HIV positive patients	154 (39.4%) report past week alcohol consumption, for a mean number of 4 drinks	At-risk drinkers (4 drinks/week for women and 5 drinks/week for men) are less likely to have current HAART prescription (𝑃<0.05).; At-risk drinking a predictor for not being on HAART (𝑃=0.025)
[40]	USA	1074 HIV positive patients	315 (29.4%) patients presented with current or past history of drugs and/or alcohol abuse	Current or past history of drugs and/or alcohol abuse (OR 2.10, 95% CI 1.32–3.35, 𝑃=0.002) and suboptimal adherence (OR 2.84, 95% CI 1.77–4.55, 𝑃<0.001) predictors for virological failure
[42]	USA	43 HIV positive children	Alcohol abused by caregiver	Substance use by the caregiver associated with having higher viral loads in children patients (𝑃=0.007)
[43]	USA	197 HIV-infected individuals with history of alcohol problems who were receiving HAART	79 (40.1%) use alcohol	HIV positive drinkers less adherent to HAART than HIV positive alcohol abstainers (𝑃<0.05)
[44]	USA	1944 HIV positive patients	55% of 640 men and 28% of 1304 women consumed low levels of alcohol; 15% of men and 8% of women consumed high levels of alcohol; 7% of men and 4% of women engaged in binge drinking	Binge drinking (OR 1.75, 95% CI 1.17–2.64, 𝑃≤0.05), moderate-to-heavy alcohol consumption (OR 1.47, 95% CI 1.08–1.99, 𝑃≤0.05) and low alcohol consumption (OR 1.28, 95% CI 1.05–1.54, 𝑃≤0.05) associated with nonadherence for women only
[45]	USA	82 HIV positive African-American patients		Alcohol can affect ART adherence through conscious decisions to skip medication while drinking and not through drunken forgetfulness
[46]	USA	5887 HIV positive patients	3573 (60.7%) respondents report alcohol use in past 12 months; 630 (17.6%) alcohol users were nonadherent	Alcohol use in past 12 months associated with nonadherence (OR 1.3, 95% CI 1.1–1.5, 𝑃<0.05)
[47]	USA	105 HIV positive patients without alcohol dependence	Mean monthly alcohol consumption was 4.64±8.00 drinks/person	Monthly alcohol consumption associated with missed medication in the past 2 weeks (OR 1.08, CI 1.02–1.15, 𝑃<0.01) and over the past weekend (OR 1.09, CI 1.03–1.15, 𝑃<0.01); 47 (44.8%) patients missed a medication dose in the past 2 weeks, and 23 (21.9%) missed medication during the previous weekend
[48]	USA	275 HIV positive patients with alcohol use disorders; 154 (56.0%) patients were nonadherent	An average of 84.9 standard drinks over the thirty days prior to the baseline interview	Alcohol consumption (𝑃=0.001) and number of drinks (𝑃=0.002) related to nonadherence
[49]	USA	1671 HIV positive women	60% of sample were abstainers and 26% were light drinkers (<3 drinks/week)	Light drinking (<3 drinks/week) (OR 1.51, CI 1.30–1.76, 𝑃<0.01), moderate drinking (3–13 drinks/week) (OR 2.46, CI 1.96–3.09, 𝑃<0.01), and heavy drinking (OR 4.37, CI 2.99–6.40, 𝑃<0.01) associated with self-reported ART nonadherence
[50]	USA	67 HIV positive patients		Alcohol dependence is a specific and significant predictor of ART nonadherence in women only (𝑃<0.05)
[51]	USA	643 HIV positive IDUs		Fewer at-risk drinkers that nondrinkers reported receiving ART (OR 1.19, 95% CI 0.59–2.42)
[52]	USA	145 HIV positive patients	60 (41.4%) participants were current drinkers; 11 participants (18% of drinkers) were problem drinkers (AUDIT score ≥8)	1 in 4 drinkers report stopping medication while consuming alcohol; Alcohol use predicted treatment nonadherence (𝑃<0.05)
[53]	USA	335 HIV positive IDUs		Heavy alcohol use associated with first nonstructured treatment interruption (OR 1.58, 95% CI 0.92–2.70), early (within the first year) versus late treatment interruption (OR 1.55, 95% CI 0.51–4.73), and interruption of longer duration (≥6 months) (OR 3.21, 95% CI 0.83–12.5)
[54]	USA	1354 HIV positive women for whom HAART was indicated		Light drinking (OR 1.39, 95% CI 1.03–1.89, 𝑃≤0.05), moderate drinking (OR 1.72, 95% CI 1.10–2.70, 𝑃≤0.05) and heavy drinking (OR 2.29, 95% CI 0.96–5.47) associated with nonadherence, compared to nondrinking
[55]	USA	224 HIV positive patients	Baseline prevalence of past year hazardous drinking was 27% (AUDIT score ≥8)	Hazardous drinking associated with nonadherence
[56]	France	445 HIV positive patients	329 (73.9%) patients consumed ≤1 unit of alcohol/day at baseline; 116 (26.1%) patients consumed >1 unit of alcohol/day at baseline	Baseline alcohol consumption associated with nonsignificant nonadherence after 4 months (𝑃=0.09)
[57]	France	276 HIV positive IDUs receiving HAART	Approximately 84% of patients report alcohol consumption during the past 6 months	Monthly alcohol consumption during past 6 months associated with ART nonadherence (OR 1.15, CI 1.08–1.23, 𝑃<0.001)
[58]	France	1010 HIV positive patients	59 (5.8%) patients report daily alcohol consumption	Nonadherence more common among subjects who consume alcohol daily (OR 0.39, CI 0.20–0.58, 𝑃<0.001)
[59]	France	2340 HIV positive patients receiving HAART.; Harmful alcohol consumption was frequent	12% of patients had symptoms of potential alcohol abuse/dependence during the previous 12 months (CAGE questionnaire score of ≥2); 27% of patients suffered from hazardous drinking or alcohol use disorders (AUDIT-C questionnaire score of >4 for women and >5 for men); 9% of patients reported regular binge drinking (≥6 alcohol units drunk consecutively at least twice a month)	Harmful alcohol consumption associated with nonadherence to HAART (𝑃<0.001) for regular binge drinking and symptoms of alcohol abuse or dependence
[60]	Switzerland	6709 HIV positive patients		Increasing alcohol intake associated with deteriorating adherence to ART (OR 1.25, 95% CI 1.10–1.43)
[61]	Sweden	946 HIV positive patients	15.5% of patients report alcohol and drug problems	Adherent patients more likely not to have problems with alcohol (OR 1.8, 95% CI 9 1.18–3.01, 𝑃=0.008)
[62]	Australia	1106 HIV-infected patients; 867 (78.4%) report taking cART, 339; (39.1%) of which report difficulty adhering to medication		Alcohol use associated with self-reported nonadherence (OR 1.47, 95% CI 1.03–2.09, 𝑃<0.05)
[63]	South Africa	12 HIV positive patients receiving HAART		Alcohol abuse identified as barrier to adherence
[64]	South Africa	8 male HIV positive patients		Patients delay HIV treatment while coping with alcohol dependence
[65]	South Africa	56 HIV positive children		Alcohol use by caregiver associated with poorer ART adherence in children patients (𝑃<0.01)
[66]	Cameroon	533 HIV positive patients	60 (11.3%) patients reported binge drinking	Binge drinking associated with interruption of ART
[67]	Ethiopia	422 HIV positive patients	31 (7.3%) subjects report alcohol consumption, 6 of which did so on a regular basis	Alcohol drinking associated with nonadherence (OR 0.210, CI 0.071–0.617, 𝑃=0.003)
[68]	Botswana	300 adult HIV positive patients		Alcohol use predicted poor ART adherence (𝑃<0.02)
[69]	Benin, Côte d’Ivoire, and Mali	2920 HIV positive patients		Current drinking (OR 1.4, 95% CI 1.1–2.0), especially hazardous drinking (OR 4.7, 95% CI 2.6–8.6), associated with nonadherence
[70]	Brazil	306 HIV positive patients	37.6% of sample consumed alcohol in month prior to baseline interview	ART nonadherence associated with alcohol use in month before baseline interview (OR 1.61, 95% CI 1.08–2.39, 𝑃=0.018)
[71]	Brazil	295 HIV positive patients	109 (37.3%) subjects consumed alcohol in month prior to baseline interview	Nonadherence to ART associated with alcohol use (𝑃<0.001)
[72]	Thailand	205 HIV positive patients	13 (6.3%) subjects report current alcohol use	Current alcohol use sole predictor of nonadherence to HAART (OR 1.67, CI 1.05–2.48, 𝑃<0.001)
[73]	India	198 HIV-infected patients receiving HAART		Alcohol use associated with nonadherence (OR 5.68, 95% CI 2.10–15.32, 𝑃=0.001)
Did Not Find Nonadherence
[74]	USA	1030 HIV-infected women		No delay in ART initiation between heavy drinkers and nondrinkers
[75]	USA	300 HIV positive men who have sex with men	43% of sample report alcohol consumption in first 2 weeks post-baseline	No association found between alcohol use and nonadherence
[76]	UK	394 HIV positive patients		Excessive alcohol consumption borderline significantly lower in patients receiving HAART (𝑃<0.08)
[77]	Uganda	2311 HIV positive patients; 928 (40.2%) presented late for treatment	123 (5.3%) used moderate levels of alcohol and 360 (15.5%) used high levels of alcohol	Alcohol consumption in past year (assessed using AUDIT-C) negatively associated with late presentation for treatment (OR 0.65, 95% CI 0.44–0.96, 𝑃=0.03 for moderate use and OR 0.79, 95% CI 0.61–1.00, 𝑃=0.05 for heavy use)