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Alcohol's effect on drug efficacy
Apr 19, 2012

I have read everything on the site regarding alcohol and HIV meds. My background is this: I was diagnosed four years ago. I'm a drug addict (crack) and I stopped in May 2011 and haven't used since. At that time, my CD4 count dropped to 150 (from 320 6 months earlier). It since rebounded to the 260-320 range.

I started meds 6 weeks ago. I don't have my meds with me, but I recall for sure I take Truvada. I also take one white pill and 2 orange pills. This, I believe, is standard and very common cocktail triad. I have been drinking a great deal, anywhere between one and three bottles of wine. I have since stopped with help from an addictions counselor, a sponsor and AA. I was also drinking this amount for the past six months.

What is the risk that I've done damage to myself from alcohol use, and how is that risk increased by also having HIV and having started meds? What would be the actual risks had I continued to drink at this level? I understand the risk to adherence, so you don't need to speak to that. I'm thinking more damage to organs and reduced efficacy. I have seen nothing at all that speaks to drug efficacy while drinking. Does the alcohol inhibit the drugs' effectiveness?

Thanks in advance.

Response from Dr. Fawcett

Congratulations on getting clean and sober! That is a significant achievement and the positive impact on your health cannot be overstated. Drugs, including alcohol, account for a significant portion of new HIV infections and have a negative impact on those living with the virus, both through drug interactions and (as you note) problems with adherence.

Much research is underway examining the exact reasons for the deleterious effects of combining alcohol and antiretrovirals. It appears that alcohol combined with ARVs causes something resembling cell death (in the lab) and increases the work of the liver enzyme CYP3A4 (responsible for metabolizing antiretrovirals and alcohol). The bottom line is that combining these alcohol and HIV meds negatively impacts the liver. Co-infection with hepatitis obviously makes this situation even more serious.

The rule of thumb is that someone on HIV meds can tolerate one alcoholic drink per day. As someone in recovery you know, of course, that you can't safely use ANY recreational drugs or alcohol.

Keep up the great work - your liver is thanking you.

-David



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