Pathophysiological Consequences of At-Risk Alcohol Use; Implications for Comorbidity Risk in Persons Living With Human Immunodeficiency Virus

Abstract

At-risk alcohol use is a significant risk factor associated with multisystemic pathophysiological effects leading to multiorgan injury and contributing to 5.3% of all deaths worldwide. The alcohol-mediated cellular and molecular alterations are particularly salient in vulnerable populations, such as people living with HIV (PLWH), diminishing their physiological reserve, and accelerating the aging process. This review presents salient alcohol-associated mechanisms involved in exacerbation of cardiometabolic and neuropathological comorbidities and their implications in the context of HIV disease. The review integrates consideration of environmental factors, such as consumption of a Western diet and its interactions with alcohol-induced metabolic and neurocognitive dyshomeostasis. Major alcohol-mediated mechanisms that contribute to cardiometabolic comorbidity include impaired substrate utilization and storage, endothelial dysfunction, dysregulation of the renin-angiotensin-aldosterone system, and hypertension. Neuroinflammation and loss of neurotrophic support in vulnerable brain regions significantly contribute to alcohol-associated development of neurological deficits and alcohol use disorder risk. Collectively, evidence suggests that at-risk alcohol use exacerbates cardiometabolic and neurocognitive pathologies and accelerates biological aging leading to the development of geriatric comorbidities manifested as frailty in PLWH.

Moderate‐to‐severe cognitive impairment is associated with both recent and chronic alcohol misuse in people with HIV: The New Orleans alcohol use in HIV (NOAH) study

“…These data also suggest a potential impact of alcohol on select cognitive domains, including memory and language, although these findings should be confirmed with additional cognitive tasks assessing these domains given the limitations of the MoCA test. Additional preclinical studies will also be vital in understanding important mechanistic relationships among the variables investigated here (Simon et al., 2021). With the current demographic trends, these efforts will become increasingly important to effectively support the cognitive health of aging populations of PWH.…”

“…Additional preclinical studies will also be vital in understanding important mechanistic relationships among the variables investigated here (Simon et al, 2021). With the current demographic trends, these efforts will become increasingly important to effectively support the cognitive health of aging populations of PWH.…”

The hidden risks of alcohol use for pain relief

“…In this regard, a focus on interactions between chronic pain and binge drinking patterns in individuals displaying a higher Alcohol Use Disorders Identification Test (AUDIT) score would be valuable. Over time, binge drinking places individuals at risk for the development of alcohol use disorder (AUD) and can also result in damage to multiple organ systems (Simon et al, 2021). Moreover, evidence suggests that the pain‐relieving effects of alcohol may diminish over time (Neddenriep et al, 2019), further motivating individuals to escalate drinking.…”