New Study Says Half of HIV-Positive Drinkers Choose to Skip Their Meds
What HIV-positive drinkers believe about alcohol and antiretroviral medications may influence how much they benefit from their treatment regimen.
A study presented on June 4 at the 7th International Conference on HIV Treatment and Prevention Adherence in Miami found that fully half the study group deliberately skipped their antiretroviral therapy (ART) when drinking, primarily because they feared toxic effects from mixing alcohol and meds. [View the presentation slides here.]
Over the 12-month study period, 139 men and 39 women kept a daily electronic “diary” to record whether and how much alcohol they drank. Participants reported their adherence to ART; researchers also took periodic pill counts.
Heavier drinkers, the study revealed, were more likely to intentionally skip their meds: People who accidentally missed their ART had nine drinks per day on average, compared with 11.5 drinks per day among people who skipped their meds on purpose.
This isn’t the first study to connect people’s beliefs about alcohol and medication interactions with HIV treatment adherence. “ART and alcohol do not mix,” according to a whopping 85% of participants in a study published in 2007, for example. [View the article abstract here.] HIV specialists and other care providers also note the role of alcohol in less-than-ideal adherence to ART.
Susan Buchbinder, MD, Director of Research in the HIV Prevention Section of the San Francisco Department of Public Health, served as a panelist at a public forum hosted by San Francisco AIDS Foundation last February and was asked how alcohol affects the health of people with HIV. “Probably the biggest issue,” she replied, “is that when people are drinking too much, they’re not taking their meds.” [Read a summary from the forum here.]
Heavy drinking is “so destructive to the rhythm of people’s days that it’s really challenging to help people use meds effectively,” Buchbinder explained. “If you aren’t using them effectively, you may be developing resistance, and you may be eliminating your future [treatment] options.”
Whether accidental or deliberate, missed doses put people at risk for drug-resistant HIV, as well as lower CD4 cell counts (indicating poorer immune system health) and higher viral loads. Indeed, the study reported in Miami earlier this month found viral loads above 75 copies/mm3 in 33% of drinkers who missed their meds accidentally and 50% of those who deliberately skipped doses.
The new study and others like it highlight an opportunity for medical providers to correct the view that people should avoid taking their pills when drinking, and work with their clients around alcohol and medication adherence.
“I think there’s a message that goes out—and sometimes we [providers] reinforce it—that if you’re drinking or you’re doing drugs, you’re a hopeless lost cause,” said Michael Siever, PhD, who is the director of behavioral health services at San Francisco AIDS Foundation and was also a panelist at the recent forum. “I think it’s important to reverse that and say, ‘You know, regardless of how much you’re drinking or what drugs you’re doing, you can still take your meds every day.'”
“If you drink, you should still take your pills,” agreed Buchbinder. “If you come in regularly [for medical visits], we can check to see if it is causing a problem, and then we’ll deal with that problem.” Ultimately, Buchbinder said, “You’re going to be healthier taking your meds than not taking them.”
“People need to determine what their own personal barriers to adherence are and then problem-solve those barriers,” said Seth Kalichman, PhD, who led the new study, to TheBodyPRO.com. [Read the full article here.] If alcohol poses an obstacle to consistently taking HIV meds, “then learning strategies to take medications before drinking, or even when drinking, is important.”
Kalichman suggested getting organized, using a pillbox, and integrating med-taking with other daily routines to make adherence easier—sound advice for drinkers and teetotalers alike.
Reilly O’Neal is a freelance writer and former editor of BETA.
Kalichman, S. and others. Intentional non-adherence to antiretroviral medications among alcohol drinkers: Prospective study of interactive toxicity beliefs. 7th International Conference on HIV Treatment and Prevention Adherence. Miami. June 3–5, 2012. Abstract 80461.
Sankar, A. and others. Sero-positive African Americans’ beliefs about alcohol and their impact on anti-retroviral adherence. AIDS and Behavior 11(2): 195–203. March 2007.