Alcohol Use Decreases Antiretroviral Therapy Adherence

For patients with HIV, there is a negative correlation between drinking frequency and antiretroviral therapy (ART) adherence, according to a cross-sectional study published online in Patient Preference and Adherence. The study also explored patients’ perceptions of available counselling programs.

In a cross-sectional study, researchers in South Africa interviewed 304 patients (67.4% female) aged 30 to 39 years undergoing ART at 2 HIV clinics. The researchers recorded the subjects’ drug and alcohol use, ART adherence, reasons for missing medication doses, and opinions of currently available counselling programs. Patients were also interviewed about the likely effectiveness of potential facilitators, the preferred quantity, duration, format, and setting of the sessions, the usefulness of having caregivers and supporters attend the sessions, and potential skills learned.

Of the subjects interviewed, 40% were identified as lifetime alcohol drinkers. Additionally, 74.5% of males and 54.9% of females participated in harmful drinking.

Moreover, the researchers discovered that the frequency of a patient’s drinking influenced their ART adherence habits.

“There was a general trend of a lower proportion of high ART adherence with increasing quantity of alcohol use, i.e., light drinking (62.5%), moderate drinking (54.7%), and binge drinking (45.4%),” the authors wrote.

In addition, the researchers reported that the most common reason reported for missing ART doses was patients simply forgetting (49.7%). Only a small amount of patients cited alcohol or drugs as a reason they missed ART dosages (12.8%).

“In contrast, 30.1% of lifetime drinkers indicated taking alcohol/drugs as a reason for missing ART doses, 25.2% whom indicated either ‘sometimes’ or ‘often,’” the researchers wrote.

Additionally, most participants expressed that in counselling there was a focus on alcohol and ART, however they felt more should be done. Regardless of drinking habits, most patients would prefer a counselor that was on ART, the researchers found.

“Participants affirmed (71%) the clinic’s existing ART counseling program did periodically focus on those with alcohol-related ART non-adherence,” the investigators said. “Nevertheless, about 95% of the participants felt that was still a need for an additional non-adherence counseling program that would address alcohol-related ART non adherence.”

From their study, the authors recommended that special attention be given to alcohol when treating HIV patients.

“Based on the marked prevalence of hazardous drinking amongst patients who drink alcohol, we propose routine and ongoing screening for harmful use of alcohol and alcohol use disorders among all HIV patients,” the researchers wrote. “The need for such interventions is not in question, but how they can be integrated into an already overburdened health care system is a question worthy of further investigation.”