Alcohol use disorders negatively influence antiretroviral medication adherence among men who have sex with men in Peru

Abstract

Objective-As international guidelines increase access to antiretroviral therapy (ART) globally, ART adherence becomes increasingly important to achieve HIV treatment as prevention (TasP) goals. In the concentrated HIV epidemic among men who have sex with men (MSM) and transgendered women (TGW) in Lima, Peru, the independent correlates of ART non-adherence were examined to inform treatment intervention priorities.Design-Cross sectional survey of HIV-infected MSM and TGW who are engaged in clinical care in Lima, Peru. Methods-FromJune to August 2012, 302 HIV-infected Peruvian MSM/TGW from three clinical care sites were recruited using convenience sampling to participate in a cross-sectional computer-assisted adherence survey. Several standardized screening measures associated with ART non-adherence were examined in order to determine the independent correlates of optimal (≥90%) and perfect (100%) adherence, which were assessed using logistic regression.Results-Of the 302 participants recruited, 263 (87.1%) were prescribed ART. Among those prescribed ART, 229 (87.1%) reported optimal and 146 (55.5%) reported perfect adherence. The prevalence of alcohol use disorders (AUD; 43.2%), alcohol dependence (5.3%), recent drug use (6.0%) and depression (44.5%) was high and most participants had some evidence of neurocognitive impairment. Meeting criteria for having an AUD and depression were collinear (p<0.001). On multivariate analysis, having an AUD was inversely related and the only Conclusions-AUDs are highly prevalent among Peruvian HIV-infected MSM and contribute significantly to ART non-adherence. These findings support the need for screening and treating underlying AUDs. In order to meet HIV TasP goals, evidence-based strategies targeting AUDs are likely to directly improve ART adherence and indirectly improve overall individual health, HIV treatment engagement and reduce transmission to sexual partners among this vulnerable and disproportionally affected population.

Harmful alcohol drinking among HIV-positive people in Nepal: an overlooked threat to anti-retroviral therapy adherence and health-related quality of life

“…In a study in Peru, harmful alcohol drinking had inverse effects on ART adherence among men who have sex with men (MSM) [10]. In this study, 31.9% of the HIV-positive people practiced drinking alcohol at a harmful level, as measured by the alcohol-use disorders identification test (AUDIT).…”

“…The extent of harmful drinking was measured using the Alcohol Use Disorders Identification Test (AUDIT), which is a 10-item scale designed to measure alcohol use covering amount, frequency, and hazardous drinking [10,28]. The available alcoholic drinks such as locally brewed alcohol; bottled wine, beer, whisky, vodka, etc.…”

Substance use among men who have sex with men: patterns, motivations, impacts and intervention development need

“…There is also evidence to indicate complications with the use of ART in combination with certain illicit substances, although the evidence is limited. Adherence is similarly negatively associated with alcohol use disorders, with studies from Peru,55 USA56 and Latin America57 all documenting a higher propensity for missed doses among MSM who drink alcohol more frequently.…”

Trastornos neuropsiquiátricos en la población con VIH: una revisión narrativa

“…Ferro y colaboradores [43] estudiaron el consumo de alcohol de pacientes HSH contagiados por VIH, mediante la herramienta AUDIT de la Organización Mundial de la Salud. Los autores encontraron que el abuso o dependencia de alcohol fue la única variable que se encontraba asociada, incluso después de realizar el análisis multivariable, con problemas con la adherencia a la TAR, con un OR de 0,427 (IC 95 %: 0,187-0,976) para adherencia óptima y un OR de 0,552 (IC 95 %: 0,327-0,93) para adherencia del 100 %.…”