June 19, 2012
Half of HIV-positive individuals who are on treatment and drink alcohol skip taking their HIV medications on purpose, under the erroneous belief that mixing antiretrovirals and alcohol is harmful, according to a prospective study presented at the 7th International Conference on HIV Treatment and Prevention Adherence.
Researchers, led by Seth Kalichman, Ph.D., examined whether beliefs of toxic interactions between HIV meds and alcohol would lead to intentional non-adherence. They enrolled 178 HIV-infected alcohol drinkers who were currently on HIV treatment and monitored them for 12 months; 171 of the volunteers completed the 12-month study.
The study found that 52% of the volunteers endorsed the idea of skipping doses when they have been drinking or know they will be drinking alcohol. About 51% ended up being intentionally non-adherent, mainly because of the belief that mixing their meds with alcohol was toxic.
To measure alcohol consumption, the participants kept an electronic diary and received daily text messages to report if and how much they drank. The study found that the more people drank, or the closer they got to having what could be considered a serious drinking problem (as measured by the Alcohol Use Disorders Identification Test), the more likely they were to intentionally skip their HIV meds. Unsurprisingly, those who intentionally skipped antiretrovirals were also more likely to have a higher viral load, as well as a CD4 count below 200 cells/mm3, Kalichman noted.
Adherence was measured by self-reporting, as well as monthly unannounced pill counts, where the researchers would randomly call and ask the participants to count their pills.
The study was made up of 139 men and 39 women. The mean age was 45. About 93% were African American and 58% had incomes of less than $10,000 a year.
Medscape reported (note: this article requires free registration on Medscape.com to read):
"There are many who hold the belief, not only those with HIV infection but those with other chronic diseases, that if they mix their medications with alcohol it creates a toxic poison that is harmful. ... However, there is no evidence that mixing alcohol [with antiretroviral medications] increases the harm of the alcohol itself," Dr. Kalichman said.
"Of course, if you have HIV infection and liver disease, that is an entirely different scenario. You should definitely not drink alcohol if you have liver disease," he said. ...
Dr. Kalichman noted that misinformed beliefs can be easily corrected. "Doctors can tell their patients that it is not a good idea to drink if you are taking medications because you can miss doses, but don't skip your medications just because you are drinking. When it comes to these antiretroviral medications, the harm of missing the medications is greater than the harm of drinking with medications," Dr. Kalichman said.
When asked if depression in HIV-infected individuals could lead to heavier drinking or non-adherence, Kalichman told TheBodyPRO.com, "In general, depression and other negative mood states play a complex role in adherence. Depression has direct impacts on adherence by interfering with memory, routines, sleep patterns, as well as motivation to adhere. And yes, depression can lead to heavier drinking, which is also related to poor adherence."
He offered some adherence advice, stating, "People need to determine what their own personal barriers to adherence are and then problem-solve those barriers. If depression is a factor, then getting treatment for the depression is crucial. The good news is that there are many therapies for depression that have proven effective -- not just more medications, but counseling and psychotherapy as well.
"If alcohol is a barrier, then learning strategies to take medications before drinking, or even when drinking, is important," Kalichman continued. "Getting organized, like using a pillbox, is often helpful. So too is integrating medications with other daily routines."
Kalichman and his team are conducting further research to test an intervention that helps substance users better adhere to their meds. The project also focuses on reducing HIV transmission through adherence and safer sex practices.
Warren Tong is the research editor for TheBody.com and TheBodyPRO.com.
Follow Warren on Twitter: @WarrenAtTheBody.
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