Heavy Alcohol Drinking Linked to Worse HIV Disease in U.S. Veterans

We already know some of the dangers of drinking too much alcohol, but new research suggests that heavy alcohol consumption exacerbates the negative effects of HIV in people living with the virus. The study, which analyzed data on HIV-positive veterans, found that higher-risk alcohol drinkers had the worst HIV disease severity. Researchers rated 8% of study participants as higher-risk alcohol drinkers. For people living with HIV, the old adage of, "Everything in moderation," may be especially true when it comes to drinking alcohol.

Data from the Centers for Disease Control and Prevention (CDC) show that a considerable proportion of people with HIV abuse alcohol.

Heavy drinking can have a negative impact on HIV disease by:

  1. Making it harder to reach and maintain an undetectable viral load.
  2. Interfering with HIV appointment keeping.
  3. Lowering CD4 count and (4) harming the immune system.

Researchers working with the Veterans Aging Cohort Study (VACS) aimed to chart alcohol use over time in men and women with HIV and to see whether heavier alcohol use is linked to more severe HIV disease progression.

The VACS is an ongoing study of U.S. veterans in care for HIV. This analysis involved veterans who regularly completed a detailed health questionnaire during an eight-year period, 2002-2010. The questionnaire included a standard test of alcohol use disorders called AUDIT-C.

For each study participant, researchers used medical records to establish HIV disease severity using the VACS index. In people with HIV, the VACS index can predict mortality risk. The researchers calculated the VACS index for each veteran from data collected closest to the time when the veteran completed AUDIT-C.

The analysis included 3,539 veterans with a median age of 49 years. Most veterans, 98%, were men and 68% were African American.

AUDIT-C results allowed researchers to divide the veterans into four alcohol groups: alcohol abstainers (24%), lower-risk group (44%), moderate-risk group (24%) and higher-risk group (8%). In the higher-risk group AUDIT-C results indicated persistent unhealthy alcohol drinking. The researchers also measured the levels of a marker for alcohol consumption to confirm the accuracy of the AUDIT-C questionnaire in determining alcohol use.

Alcohol Groups Among HIV-Positive Veterans
Warren Tong

The research team used the VACS index to create four HIV disease severity groups: low (2% of veterans), moderate (46%), high (36%) and extreme (16%).

HIV Disease Severity Groups Among HIV-Positive Veterans
Warren Tong

No one in the higher-risk alcohol use group fell into the low HIV disease severity group. The proportion of veterans in the higher-risk alcohol group rose steadily with each higher HIV disease severity group: 7% with moderate severity, 8% with high severity and 9% with extreme severity. Alcohol abstainers made up 28% of the low HIV disease severity group, 19% of the moderate group, 26% of the high group and 33% of the extreme group. Proportions of veterans in the lower- and moderate-risk alcohol groups dropped across each higher HIV disease severity group.

Statistical analysis that considers many risk factors for HIV disease severity determined that AUDIT-C group (which measured alcohol use), by itself, predicted HIV disease severity. Veterans in the higher-risk alcohol group had an 83% greater chance of being in the extreme HIV disease severity group than did veterans in the moderate-risk alcohol group. This association was statistically significant, meaning there is almost no possibility that the association could be explained by chance.

The researchers conclude that their eight-year study shows a strong link between heavy alcohol use and worse HIV disease. No one in the low HIV disease severity group fell into the heavy alcohol use group. And the highest proportion of people in the heavy alcohol use group fell into the worst HIV disease severity group. The researchers suggest that the link between heavy alcohol use and the worst HIV disease severity partly reflects inconsistent antiretroviral pill taking in heavy drinkers.

They add that the direct effect of alcohol on health also plays a role. According to the National Institute on Alcohol Abuse and Alcoholism, drinking too much impairs brain function, damages the liver, inflames the pancreas, may lead to heart problems or stroke and may contribute to cancer of the mouth, esophagus, throat, liver or breast.