Untreated HIV Infection Is Associated With Higher Blood Alcohol Levels

Abstract

Alcohol abuse has been associated with HIV/AIDS progression, but the effects of HIV infection and treatment on alcohol exposure have not been explored to date. This pilot study examines the relationship of untreated HIV infection to blood alcohol concentrations (BAC) relative to BAC following initiation of antiretroviral therapy (ART). Methods Fifteen volunteers with untreated HIV/AIDS participated in two sets of alcohol or alcohol placebo administration studies prior to and following initiation of ART. Oral alcohol (1 g/kg) or alcohol placebo was administered, participants were followed for pharmacokinetics, subjective responses, and cognitive effects over 8 hours. Following initial alcohol studies, the ART regimen selected by participant clinicians was instituted. Observed ART dosing took place for at least 2 weeks. Participants then returned for a second set of alcohol/placebo administration studies while on ART. Results Participants had significantly higher BAC (p<0.001) prior to ART than following ART administration. Alcohol AUC was significantly higher in untreated HIV disease (p=0.011) with significantly higher Cmax (p=0.015) and Cmin (p=0.05). The elimination rate was not different between pre- and post-ART conditions. Despite declines in BAC following ART initiation, no differences in subjective responses were observed with alcohol administration. Conclusions Untreated HIV infection is associated with risk for higher BAC than that observed following ART. These findings indicate that patients with untreated HIV disease who ingest alcohol are at greater risk for alcohol associated adverse events and toxicities and underscores the need for simultaneous treatment of alcohol use disorders and HIV in patients with co-occurring conditions.

Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men

“…First, they may experience higher blood alcohol levels given a unit exposure. This has been demonstrated among those with untreated HIV infection (McCance-Katz et al, 2013, 2012). Recent analyses in VACS have demonstrated that HIV+ individuals with unsuppressed HIV-1 RNA report the lowest number of drinks required to feel intoxicated, HIV+ individuals with suppressed HIV-1 RNA report a higher number to experience intoxication and uninfected individuals report an even higher number of drinks to experience intoxication (McGinnis et al, 2015).…”

“…Given a unit dose of alcohol, HIV+ individuals experience higher blood alcohol concentrations before, compared to after, initiating ART (McCance-Katz et al, 2012). In addition, having a detectable HIV viral load is associated with a lower number of drinks to feel intoxicated among HIV+ individuals (McGinnis et al, 2015).…”

Number of Drinks to “Feel a Buzz” by HIV Status and Viral Load in Men

“…Previous research has reported that blood alcohol concentration was reduced by 10 to 15% after start of ART but participants reported “no significant changes in perception of intoxication” (10) before and after start of ART. However the sample size was relatively small and the amount of alcohol consumed was modest.…”

“…To prevent such consequences, some suggest that recommended drinking limits in the HIV infected should be lower than limits used in the uninfected populations (5, 6). In laboratory studies, upon exposure to the same amount of alcohol, HIV infected individuals achieve higher blood alcohol concentrations prior to receiving ART compared to after initiating ART (10). The impact of HIV infection and ART treatment on alcohol metabolism and sensitivity to alcohol’s effects is unclear (11).…”

HIV-1, HCV and Alcohol in the CNS: Potential Interactions and Effects on Neuroinflammation

“…Further, alcohol has been reported to induce CYP3A4 in hepatocytes [96, 99], which may contribute to the decreased effect of many drugs including NNRTIs and PIs in the liver. Indeed, alcohol has been shown to interact with NNRTIs/PIs leading to altered levels of NNRTIs/PIs plasma concentrations in human [100, 101]. Similarly, we have shown that alcohol induces CYP3A4 in extrahepatic monocytes/macrophages, which are one of the major targets of HIV-1 infection and a major viral reservoir [102].…”