The Impact of Alcohol Use and Related Disorders on the HIV Continuum of Care: a Systematic Review

Abstract

Alcohol use is highly prevalent globally with numerous negative consequences to human health, including HIV progression, in people living with HIV (PLH). The HIV continuum of care, or treatment cascade, represents a sequence of targets for intervention that can result in viral suppression, which ultimately benefits individuals and society. The extent to which alcohol impacts each step in the cascade, however, has not been systematically examined. International targets for HIV treatment as prevention aim for 90 % of PLH to be diagnosed, 90 % of them to be prescribed with antiretroviral therapy (ART), and 90 % to achieve viral suppression; currently, only 20 % of PLH are virally suppressed. This systematic review, from 2010 through May 2015, found 53 clinical research papers examining the impact of alcohol use on each step of the HIV treatment cascade. These studies were mostly cross-sectional or cohort studies and from all income settings. Most (77 %) found a negative association between alcohol consumption on one or more stages of the treatment cascade. Lack of consistency in measurement, however, reduced the ability to draw consistent conclusions. Nonetheless, the strong negative correlations suggest that problematic alcohol consumption should be targeted, preferably using evidence-based behavioral and pharmacological interventions, to indirectly increase the proportion of PLH achieving viral suppression, to achieve treatment as prevention mandates, and to reduce HIV transmission.

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

“…A systematic review found that alcohol users were more likely to have missed at least one or more cascades of continuum of care such as attending treatment services, ART compliance, routine investigation of viral loads, and CD4 count [20]. Additionally, alcohol users also engage in substance use as a coping mechanism for reducing stress related to HIV, which further deteriorates their health [21].…”

Relación entre la adherencia al tratamiento antirretroviral en pacientes VIH+ y el consumo de alcohol, asociado o no al uso de otras sustancias

“…Esto suscribe en nuestro entorno asistencial y cultural lo señalado amplia y consistentemente en la literatura previa en otros contextos (Azar et al, 2010;Vagenas et al, 2015;Hendershot et al, 2009). En el presente estudio, además, la asociación entre el consumo de alcohol y la falta de adherencia se mantiene tras el ajuste por otros consumos por lo que, en la muestra estudiada, el alcohol deteriora la adherencia de manera independiente al uso o no de otras sustancias.…”

“…En los últimos años, numerosos autores han prestado especial atención a las repercusiones del consumo de alcohol sobre el cumplimiento terapéutico (Vagenas et al, 2015). Diferentes revisiones sistemáticas sustentan de manera consistente la relación entre ambos factores (Azar et al, 2010;Vagenas et al, 2015;Hendershot, Stoner, Pantalone y Simoni, 2009).…”

“…En los últimos años, numerosos autores han prestado especial atención a las repercusiones del consumo de alcohol sobre el cumplimiento terapéutico (Vagenas et al, 2015). Diferentes revisiones sistemáticas sustentan de manera consistente la relación entre ambos factores (Azar et al, 2010;Vagenas et al, 2015;Hendershot, Stoner, Pantalone y Simoni, 2009). Además, el consumo de alcohol u otras sustancias puede influir también en la adherencia a otros tratamientos médicos relacionados con enfermedades o infecciones comunes en pacientes VIH+ (Gonzalez, Barinas y O'Cleirigh, 2011).…”

A genetic marker of risk in HIV-infected individuals with a history of hazardous drinking

“…Among persons living with HIV (PLH), there is consistent evidence linking hazardous drinking to lower adherence to antiretroviral therapy, higher rates of condomless sex, and greater number of sexual partners (Azar, Springer, Meyer, & Altice, 2010; Kalichman et al, 2014; Shuper, Joharchi, Irving, & Rehm, 2009; Vagenas et al, 2015), and an increased risk of HIV progression and transmission (Baliunas, Rehm, Irving, & Shuper, 2009; Shuper et al, 2010). Impulsivity and sensation seeking have been linked to hazardous drinking, increased sexual risk behaviors, and lower treatment adherence (Hendershot, Stoner, George, & Norris, 2007; Shin, Hong, & Jeon, 2012).…”