Alcohol Consumption and Antiretroviral Adherence Among HIV-Infected Persons With Alcohol Problems

Authors

  • Jeffrey H. Samet,

    Corresponding author
    1. From Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine (JHS, SM), Boston University School of Medicine; Department of Social and Behavioral Sciences (JHS), Boston University School of Public Health; Department of Mathematics (NJH), Smith College, Northampton, MA; Division of General Medicine and Partners AIDS Research Center (KAF), Massachusetts General Hospital, Boston, MA; and the Centre for Health Evaluation and Outcome Sciences (AP), St. Paul's Hospital, Department of Medicine, University of British Columbia, Vancouver, British Columbia.
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  • Nicholas J. Horton,

    1. From Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine (JHS, SM), Boston University School of Medicine; Department of Social and Behavioral Sciences (JHS), Boston University School of Public Health; Department of Mathematics (NJH), Smith College, Northampton, MA; Division of General Medicine and Partners AIDS Research Center (KAF), Massachusetts General Hospital, Boston, MA; and the Centre for Health Evaluation and Outcome Sciences (AP), St. Paul's Hospital, Department of Medicine, University of British Columbia, Vancouver, British Columbia.
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  • Seville Meli,

    1. From Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine (JHS, SM), Boston University School of Medicine; Department of Social and Behavioral Sciences (JHS), Boston University School of Public Health; Department of Mathematics (NJH), Smith College, Northampton, MA; Division of General Medicine and Partners AIDS Research Center (KAF), Massachusetts General Hospital, Boston, MA; and the Centre for Health Evaluation and Outcome Sciences (AP), St. Paul's Hospital, Department of Medicine, University of British Columbia, Vancouver, British Columbia.
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  • Kenneth A. Freedberg,

    1. From Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine (JHS, SM), Boston University School of Medicine; Department of Social and Behavioral Sciences (JHS), Boston University School of Public Health; Department of Mathematics (NJH), Smith College, Northampton, MA; Division of General Medicine and Partners AIDS Research Center (KAF), Massachusetts General Hospital, Boston, MA; and the Centre for Health Evaluation and Outcome Sciences (AP), St. Paul's Hospital, Department of Medicine, University of British Columbia, Vancouver, British Columbia.
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  • Anita Palepu

    1. From Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine (JHS, SM), Boston University School of Medicine; Department of Social and Behavioral Sciences (JHS), Boston University School of Public Health; Department of Mathematics (NJH), Smith College, Northampton, MA; Division of General Medicine and Partners AIDS Research Center (KAF), Massachusetts General Hospital, Boston, MA; and the Centre for Health Evaluation and Outcome Sciences (AP), St. Paul's Hospital, Department of Medicine, University of British Columbia, Vancouver, British Columbia.
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  • Supported, in part, by Grants RO1-AA13766 (Clinical Impact of HCV and Alcohol in HIV-Infected Persons), RO1-AA11785 (Medication Adherence in Alcohol Abusing HIV Patients), and RO1-AA10870 (Enhanced Linkage of Alcohol Abusers to Primary Care) from NIAAA; by USPHS Grant M01 RR00533; and by a Canadian Institute for Health Research New Investigator Award (AP).

Reprint requests: Jeffrey H. Samet, MD, MA, MPH, Boston Medical Center, 91 East Concord St., Suite 200, Boston, MA 02118; Fax: 617-414-4676; E-mail: jsamet@bu.edu.

Abstract

Abstract: Background: Alcohol abuse has been associated with poor adherence to highly active antiretroviral therapy (HAART). We examined the relative importance of varying levels of alcohol consumption on adherence in HIV-infected patients with a history of alcohol problems.

Methods: We surveyed 349 HIV-infected persons with a history of alcohol problems at 6-month intervals. Of these subjects, 267 were taking HAART at one or more time periods during the 30-month follow-up period. Interviews assessed recent adherence to HAART and past month alcohol consumption, defined as “none”, “moderate”, and “at risk”. We investigated the relationship between adherence to HAART and alcohol consumption at baseline and at each subsequent 6-month follow-up interval using multivariable longitudinal regression models, while controlling for potential confounders.

Results: Among the 267 HIV-infected persons with a history of alcohol problems who were receiving HAART, alcohol consumption was the most significant predictor of adherence (p < 0.0001), with better adherence being associated with recent abstinence from alcohol, compared with at-risk level usage (odds ratio = 3.6, 95% confidence interval = 2.1–6.2) or compared with moderate usage (odds ratio = 3.0, 95% confidence interval = 2.0–4.5).

Conclusions: Any alcohol use among HIV-infected persons with a history of alcohol problems is associated with worse HAART adherence. Addressing alcohol use in HIV-infected persons may improve antiretroviral adherence and ultimately clinical outcomes.

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