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Alcohol and Resistance
Jan 10, 2008

I have been on ART for not more than a month now and my body has responded very well to the therapy,gained 3kgs, no longer have drowsy spells and my chest seems to have cleared. I used to drink alcohol before, will continued intake of alcohol affect my treatment even if there is strict adherence to my meds?

Response from Dr. Sherer

Moderate alcohol use is not prohibited for people living with HIV who are on ART.

As your question suggests, the problem with alcohol or drug use with HIV medications is the increased risk of impaired judgement and lapses in adherence when these recreational substances are used, and this can happen even when they are used in moderation.

I hear that things have gone well so far in the first month. So far, so good. I would discourage you from making any lifestyle changes at this moment, as you are still in the 'fragile' period of ART when the chances for drug resistance and virologic failure are still very high - because your viral load is still declining from its initial high level.

What did your doctor say? I would also ask you fairly pointedly, what does it mean that 'you used to drink before.'? Does that mean you might have a beer or a glass of wine 1x or 2x per week? Or does that mean you drank regularly - 2-3 drinks per night or more - in the bar scene nightly? I would be more wary of encouraging you to drink ANY alcohol if I thought you had a history of heavy use that might meet a definition of alcoholism.

My conservative advice, therefore, is that you just stick with EXACTLY what you have been doing for this month for the first 6 months of your ART, and until you have a big rise in your CD4 cell count and a viral load <50 copies for 3 months.

Once you have achieved those important milestones, you could consider loosening up SLIGHTLY and allowing, say, ONE glass of wine at dinner, or ONE beer with friends.

My rationale is, why take any risk when what you and your doctor want to achieve is a viral load below detection and rising CD4 cells for YEARS on this same initial ART regimen? This is a far more imporant goal to achieve than the limited pleasure you might get from occassion mild alcohol use.

There are also a few other issues with long term heavy alcohol use, for example liver disease and the metabolism of ART medications. These would be more important if you were known to have other liver disease such as hepatitis B or C.

So to sum up: - there is no contraindication to mild-moderate alcohol use with ART - optimal adherence is CRITICAL in the first 6 months of ART...and enormously important for the rest of your life - one month into ART is not a good time to think about changing your lifestyle, and particularly resuming the use of drugs or alcohol - my advice is to stick with what you are doing for the first 6 months until you have achieved full viral suppression and rising CD4 cells for 3 months, and then, and only then, to consider allowing mild-moderate alcohol intake.

I encourage you to take this question and this response to your doctor and talk to him or her about it at your next visit.


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