Alcolhol consumption in HIV-1 infected persons: a study of immunological markers, Harare, Zimbabwe

Chandiwana, S.K.; Sebit, M B; Latif, A.S.; Gomo, Exnevia; Acuda, S. W.; Makoni, F; Vushe, J.

doi:10.4314/cajm.v45i11.8505

Cited by 10 publications

(11 citation statements)

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“…For example, Samet et al assessed alcohol use by CAGE questionnaire and the outcome was the average difference in CD4+ T-cell count between abstinent participants and heavy/moderate alcohol use over a 7 year period. Chandiwana et al looked at any alcohol consumption and CD4+ T-cell count six months later as the outcome[11,13]. Unlike previously published studies, our study assessed alcohol use using the AUDIT which is an effective tool for identifying participants with hazardous drinking.…”

Section: Discussionmentioning

confidence: 99%

“…For example, among persons not yet on ART, the multi-center AIDS cohort study, consisting of men who have sex with men and another study of HIV infected heterosexual men and women not on ART in Zimbabwe [10,11] as well as a longitudinal study among 266 women not on ART in the HIV Epidemiologic Research Study (HERS) cohort showed no significant association between level of alcohol use and CD4+ T-cell count[12]. …”

Section: Introductionmentioning

confidence: 99%

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Hazardous alcohol consumption is not associated with CD4+ T-cell count decline among PLHIV in Kampala Uganda: A prospective cohort study

et al. 2017

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IntroductionThere is limited data on the effects of alcohol on immunological response among persons living with HIV (PLHIV) in sub-Saharan Africa. We assessed the relationship between hazardous alcohol use and CD4+ T-cell count, among PLHIV in Uganda.MethodsPLHIV aged ≥ 18 years were enrolled in a cohort study at the Infectious diseases clinic Kampala, Uganda. Alcohol consumption was assessed at enrolment (baseline) and 6 monthly thereafter using the alcohol use disorders identification test (AUDIT). The CD4+ T-cell counts, assessed at baseline and over the next 12 months were compared between alcohol use strata, using linear mixed effects regression. Using longitudinal mediation analysis methods, we estimated the effect of alcohol induced ART non-adherence on CD4+ T-cell count.ResultsOf the 1566 participants enrolled, 863(44.1%) were non-alcohol users (AUDIT score = 0), 433(27.7%) were non-hazardous (AUDIT score 1–7) alcohol users while 270 (17.2%) were hazardous (AUDIT score ≥ 8) alcohol users.The overall median (IQR) baseline CD4+ T-cell count was 356 (243–516) cells/μl. There were no differences in the median baseline CD4+ T-cell count between hazardous and non-hazardous alcohol users compared to non-alcohol users in both the non-ART (p = 0.43) and ART group (p = 0.77).The mean CD4+ T-cell count over 12 months was not different between hazardous alcohol users and non-alcohol users (non-ART group p = 0.88 and ART group p = 0.62), nor between non-hazardous alcohol users and non-alcohol users (and non-ART group p = 0.66 and ART group p = 0.20).Alcohol use was not associated with a significant natural direct effect on CD4+ T-cell count (1.37 95%CI [-1.78, 4.52] cells/μl, p = 0.39) but had a statistically significant natural indirect effect on reduction of CD4+ T-cell count (-0.91 cells/μl [-1.36, -0.45], p < 0.001) mediated through ART non-adherence.ConclusionHazardous alcohol use among PLHIV was not directly associated with lower CD4+ T-cell count but had a significant natural indirect effect on CD4+ T-cell count mediated through ART non-adherence. Among PLHIV with lower than expected CD4+ T-cell count, alcohol consumption should be excluded as an underlying factor for non-adherence to ART and any interventions targeting alcohol use should tackle possible ART non-adherence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hazardous alcohol consumption is not associated with CD4+ T-cell count decline among PLHIV in Kampala Uganda: A prospective cohort study

et al. 2017

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“…On the other hand, two prospective studies that examined those not on ART found that heavy alcohol consumption was associated with lower CD4 cell count [77] and shorter time to CD4 cell count <200 cells/mm 3 [78]. Only one study of this issue was conducted in Africa [73]. Therefore, this question is unresolved, and more work is needed, especially in SSA, where both HIV and heavy alcohol consumption are common.…”

Section: Alcohol Consumption As a Risk Factor For Hiv Disease Progresmentioning

confidence: 94%

“…While several experimental studies have supported the evidence for an effect of heavy alcohol consumption on simian immunodeficiency virus progression in macaques, the results of human observational studies have been much more mixed. Of the several prospective studies conducted in the prehighly active ART era [66][67][68][69][70][71][72][73], none found a positive association between alcohol consumption and the onset of AIDS, and three more recent studies found no association between heavy alcohol consumption and CD4 cell count or HIV viral load after controlling for ART use [74][75][76]. On the other hand, two prospective studies that examined those not on ART found that heavy alcohol consumption was associated with lower CD4 cell count [77] and shorter time to CD4 cell count <200 cells/mm 3 [78].…”

Section: Alcohol Consumption As a Risk Factor For Hiv Disease Progresmentioning

confidence: 99%

Adding Fuel to the Fire: Alcohol’s Effect on the HIV Epidemic in Sub-Saharan Africa

2011

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Alcohol consumption adds fuel to the HIV epidemic in sub-Saharan Africa (SSA). SSA has the highest prevalence of HIV infection and heavy episodic drinking in the world. Alcohol consumption is associated with behaviors such as unprotected sex and poor medication adherence, and biological factors such as increased susceptibility to infection, comorbid conditions, and infectiousness, which may synergistically increase HIV acquisition and onward transmission. Few interventions to decrease alcohol consumption and alcohol-related sexual risk behaviors have been developed or implemented in SSA, and few HIV or health policies or services in SSA address alcohol consumption. Structural interventions, such as regulating the availability, price, and advertising of alcohol, are challenging to implement due to the preponderance of homemade alcohol and beverage industry resistance. This article reviews the current knowledge on how alcohol impacts the HIV epidemic in SSA, summarizes current interventions and policies, and identifies areas for increased research and development.

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“…In studies conducted prior to the widespread use of ART, several investigators examined the potential association between alcohol use and HIV disease progression, as determined by the development of AIDS. Most did not find an association between alcohol use and the diagnosis of AIDS [19-24]. Variations in study design, including a lack of repeated measures of alcohol consumption during the course of disease and variation in the measure of alcohol intake limited the ability of these studies to rigorously evaluate the relationship between alcohol consumption and HIV disease progression [18].…”

Section: Introductionmentioning

confidence: 99%

Chronic Alcohol Abuse and HIV Disease Progression: Studies with the Non-Human Primate Model

Amedee¹,

Nichols²,

Robichaux³

et al. 2014

CHR

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The populations at risk for HIV infection, as well as those living with HIV, overlap with populations that engage in heavy alcohol consumption. Alcohol use has been associated with high-risk sexual behavior and an increased likelihood of acquiring HIV, as well as poor outcome measures of disease such as increased viral loads and declines in CD4+ T lymphocytes among those living with HIV-infections. It is difficult to discern the biological mechanisms by which alcohol use affects the virus:host interaction in human populations due to the numerous variables introduced by human behavior. The rhesus macaque infected with simian immunodeficiency virus has served as an invaluable model for understanding HIV disease and transmission, and thus, provides an ideal model to evaluate the effects of chronic alcohol use on viral infection and disease progression in a controlled environment. In this review, we describe the different macaque models of chronic alcohol consumption and summarize the studies conducted with SIV and alcohol. Collectively, they have shown that chronic alcohol consumption results in higher levels of plasma virus and alterations in immune cell populations that potentiate SIV replication. They also demonstrate a significant impact of chronic alcohol use on SIV-disease progression and survival. These studies highlight the utility of the rhesus macaque in deciphering the biological effects of alcohol on HIV disease. Future studies with this well-established model will address the biological influence of alcohol use on susceptibility to HIV, as well as the efficacy of anti-retroviral therapy.

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Alcolhol consumption in HIV-1 infected persons: a study of immunological markers, Harare, Zimbabwe

Cited by 10 publications

References 0 publications

Hazardous alcohol consumption is not associated with CD4+ T-cell count decline among PLHIV in Kampala Uganda: A prospective cohort study

Hazardous alcohol consumption is not associated with CD4+ T-cell count decline among PLHIV in Kampala Uganda: A prospective cohort study

Adding Fuel to the Fire: Alcohol’s Effect on the HIV Epidemic in Sub-Saharan Africa

Chronic Alcohol Abuse and HIV Disease Progression: Studies with the Non-Human Primate Model

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