Alcohol Types and HIV Disease Progression Among HIV-Infected Drinkers Not Yet on Antiretroviral Therapy in Russia and Uganda

Abstract

Objectives In HIV-infected drinkers, alcohol types more likely to cause inflammation could plausibly increase the risk of HIV disease progression. We therefore assessed the association between alcohol type and plasma HIV RNA level (HIV viral load) among HIV-infected drinkers not on antiretroviral therapy (ART) in Russia and Uganda. Methods We analyzed the data of participants from cohorts in Russia and Uganda and assessed their HIV viral load at enrollment by the alcohol type predominantly consumed. We defined predominant alcohol type as the alcohol type contributing >50% of total alcohol consumption in the 1 month (Russia) or 3 months (Uganda) prior to enrollment. Using multiple linear regression, we compared log10 HIV viral load by predominant alcohol type, controlling for age, gender, socioeconomic status, total number of standard drinks, frequency of drinking ≥6 drinks/occasion, and in Russia, history of injection drug use. Results Most participants (99.2% of 261 in Russia and 98.9% of 352 in Uganda) predominantly drank one alcohol type. In Russia, we did not find evidence for differences in viral load levels between drinkers of fortified wine (n=5) or hard liquor (n=49), compared to drinkers of beer/low-ethanol-content cocktails (n=163); however, wine/high-ethanol-content cocktail drinkers (n=42) had higher mean log10 viral load than beer/low-ethanol-content cocktail drinkers (β=0.38, 95%CI: 0.07 to 0.69; p=0.02). In Uganda, we did not find evidence for differences in viral load levels between drinkers of locally-brewed beer (n=41), commercially-distilled spirits (n=38), or locally-distilled spirits (n=43), compared to drinkers of commercially-made beer (n=218); however, wine drinkers (n=8) had lower mean log10 HIV viral load (β=−0.65, 95% CI −1.36 to 0.07, p = 0.08), although this did not reach statistical significance. Conclusions Among HIV-infected drinkers not yet on ART in Russia and Uganda, we observed an association between the alcohol type predominantly consumed and the HIV viral load level in the Russia sample. These exploratory results suggest that, in addition to total number of drinks and drinking patterns, alcohol type might be a dimension of alcohol use that merits examination in studies of HIV and alcohol related outcomes.

Situational and motivational factors associated with unhealthy alcohol use among Russian women with HIV and hepatitis C Virus co-infection

“…This is amongst the first studies to qualitatively assess situational factors associated with unhealthy drinking and drinking motives among Russian women with HIV/HCV co-infection. A large proportion of women in this sample had a history of heavy episodic drinking, which may result in adverse health outcomes for this population ( Asiimwe et al, 2017 ; Barve et al, 2010 ; Salmon-Ceron et al, 2005 ). Our findings aligned with the four types of drinking motives described by Cooper et al’s motivational model for alcohol use ( Cooper et al, 2015 ).…”

Alcohol Use and the Risk of Communicable Diseases

“…Alcohol may also enhance HIV viral replication by increasing or altering the HIV-binding CXCR4 coreceptor [77,78]. Accordingly, among ARTnaïve individuals, heavy drinking (vs. lower consumption) has been linked to higher CD8 cell counts and lower CD4 cell counts [79][80][81], and among those taking ART, it has been associated with reduced CD4 cell counts and higher log HIV RNA, even after controlling for adherence and age [80,[82][83][84]. Relevant to this latter group, some ART medications are metabolized by the Cytochrome P450 enzyme pathway in the liver, which may be induced or inhibited by acute or chronic alcohol consumption [63,85,86].…”

Development and Cultural Adaptation of a Computer-Delivered and Multi-Component Alcohol Reduction Intervention for Russian Women Living with HIV and HCV

“…For example, consumption of higher alcohol content drinks was associated with higher HIV viral loads among PLWH in Russia. 15 Alcohol dependence may result in neurocognitive impairment, diminished cerebral cortex functioning, and increased prevalence of HIV-associated dementia. 16,17 In addition to health complications posed by alcohol directly, interactions between alcohol and ARV medications heighten the health risks posed to HIV-infected individuals who engage in problematic alcohol use.…”