Drinking Worsens HIV+ Cardiovascular Risks

posted: 23/12/2009

Heavy drinking increases the risk of cardiovascular disease for men with HIV, a USA study shows. “Hazardous drinking and alcohol abuse or dependence were significantly associated with an increased prevalence of cardiovascular disease as compared with infrequent or moderate drinkers”, they comment.
 

Even 'light-weight' drinking harms more with HIV

What they mean by 'hazardous drinking' may seem pretty light-weight to men on the gay scene in England. They counted anything over 14 alcoholic drinks in one week as hazardous, and six drinks in a single session, more than once a month, as binge-drinking. At Christmas and New Year many men will be drinking well over these.
 

They emphasise that the study shows the risks of heart and other circulation disease harm is there for men with HIV, even after they took account of the usual risks.

We already know drinking is linked to several health problems in people with HIV. These include

• poor adherence to HIV treatments
• liver disease
• worsening HIV disease, as well as a
• bigger risk of cardiovascular disease.

Among HIV negative people, heavy drinking, binge drinking and alcohol dependency, are well known to cause more heart disease and strokes. Is this the same or worse for people with HIV, was the question this study investigated.

So the US investigators studied 4743 HIV positive and negative men veterans from the USA armed forces. Just over half the men (2422, 51%) were HIV-positive. Both HIV-positive and HIV-negative men were likely to be hazardous drinkers, or to binge drink, or be dependant on alcohol - alcoholics.

HIV negative more likely to have some drinking risks

The HIV negative men were statistically more likely to have several traditional risk factors for cardiovascular disease than HIV positive men. These risks include

• having high cholesterol,
• diabetes,
• high blood pressure and
• being overweight.

HIV positive men have more of these usual drinking risks

HIV positive men were statistically more likely to

• smoke,
• have hepatitis C, and
• have liver disease.

So the study shows HIV-positive, but not HIV-negative men, who are hazardous drinkers or alcohol dependent have a higher risk of cardiovascular disease.

Similar drinking risks shared by positive and negative men

For both HIV-positive and HIV-negative men, these traditional risk factors 

• being older,
• higher cholesterol,
• high blood pressure, and
• smoking

were also significantly associated with more cardiovascular disease.

Affect of HIV on drinking men

They then looked more closely at how HIV itself affects the risks for men with HIV, by taking out of the equation the traditional risk factors for cardiovascular disease.

HIV and drinking – more heart failure, heart disease, cardiovascular disease, strokes
 

They found that hazardous drinking for men with HIV was significantly linked with heart failure; that alcohol dependency was linked to heart disease, and that past alcohol consumption (defined as one or more drink, ever), increased the risk of stroke. Binge drinking increases the risk of cardiovascular disease for those with HIV. [The source quotes how strong these statistical significances are].

“Among HIV-infected veterans, there was a significant increase in the prevalence of cardiovascular disease for hazardous drinking and alcohol abuse”, write the investigators. They suggest that this could partly be explained by the increases in lipids associated with heavy drinking. However, they also note that previous research among this group of US veterans “also demonstrated a temporal and dose-response relationship between alcohol consumption and medication adherence.”

“The effect of alcohol may be more pronounced among those infected with HIV”, conclude the investigators.

How does your own drinking measure up?

One of our earlier articles includes useful weblinks to drink calculators to help you check how much you are drinking and it also tells you where you can get help to cut your drinking down.

Drinking is a common way for men with HIV to manage stress and to socialise, but there is quite a price to pay down the line. As men with HIV live longer because of better HIV treatments, it is more likely men with HIV will die earlier than necessary of alcohol-related cardiovascular disease, [heart attacks, heart failure, strokes, blocked arteries], than of HIV.

Men with HIV who tick these risk boxes, as well as drinking, worsen their life prospects

• smoker
• overweight
• older
• have higher cholesterol
• high blood pressure
• have hepatitis C
• have liver disease
• diabetic.

The more you tick, the higher the risk of harming health and life.

British Heart Foundation page on cardiovasular disease and how to cut your risks

Source

Reference Freiberg and others. The association between alcohol consumption and prevalent cardiovascular diseases among HIV-infected and HIV-uninfected men. J Acquir Immune Defic Syndr 2009.
 

Pride Drink Check

posted: 27/08/2009

Pride drinkers will be knocking back more alcohol units than most realise. Many people with HIV will be binge drinking over this coming Manchester Pride weekend because drinks are so much stronger than they were just 10 years ago.

Drinkers in the UK consume 10% more by alcoholic strength than in 2000, figures from the research company Mintel show, even though the volume of alcohol consumed overall has not changed during that period.

Researchers said consumers were often unaware of the alcohol content – alcohol by volume, or ABV, on products labels – and warned the findings posed a major challenge for the government.

Drinks Confuse

Drinkers are understandably confused - the size of cans and bottles varies, wine is served in bigger glasses than before, spirit measures have changed, as well as wines, beers and lagers all having more alcohol in them.

By stealth the drinks industry contributes to people drinking even more alcohol without realising.
The ‘units’ system for counting how much alcohol you are drinking so you know if you are binge drinking or exceeding the weekly recommended safe amount, is not user friendly when you are deciding what to have in a bar or club.

Stronger

Jonny Forsyth, senior drinks analyst at Mintel, said: "In the 1970s a bottle of wine may have been around 11% in ABV but now the same bottle is more likely to be around 13%. Equally, we have seen stronger lager become much more popular over the past couple of decades, with the growth of the 5% premium lager sector.

"It may be that the majority of consumers are not aware of ABV and don't even notice. So despite a greater concern with being healthy leading to a decline in drinking penetration, by stealth we are drinking more pure alcohol than ever."

Relaxing

People with HIV often use drink as a way of relaxing and coping with stress and depression, like many other people. But with HIV, drinking carries extra risks.

Alcohol risks and HIV
Long-term heavy alcohol consumption (ten or more units a day in a man, or six or more in a woman) can cause ill health, affecting the liver, heart and brain. Drinking every day can also lead to physical and psychological dependence on alcohol.

People who drink heavily often don’t eat well and this can cause further health problems. Alcohol is a depressive drug and can cause or make worse mental, psychological or emotional problems. Used in conjunction with other drugs, such as painkillers like paracetamol, alcohol can have more serious effects.

There is no evidence that moderate drinking does any harm to people with HIV. However, if you have hepatitis or high levels of blood fats, then you may be advised to stop drinking alcohol or cut down alcohol consumption.

Adherence halved

We recently reported that a major study showed that around half the people with HIV who drink don't take their treatments properly. And the more alcohol people drink, the worse their adherence to HIV treatment. Among heavier drinkers 6 out of 10 don't take treatments properly - missing doses of HIV drugs gives time for HIV to become drug resistant.

However, alcohol dependency is common amongst those with HIV and heavy drinking may affect your immune system and slow down recovery from infections. Studies suggest that alcohol interferes with the normal functions of various components of our immune system, impairing our body’s immune response to infection.

Immune system doesn't work so well

HIV-positive people who drink heavily and who are not on anti-HIV drugs tend to have lower CD4 counts (a measure of immune system function) than moderate drinkers.

While, the same difference in CD4 count isn’t true for heavy drinkers who are taking anti-HIV drugs, they are more likely to miss doses of their treatment than those who don’t drink. Alcohol can also damage the liver and a healthy liver is important for the body to process some antiretroviral medicines effectively. The blood fat increases caused by some anti-HIV drugs can be made worse by heavy drinking.

Hepatitis and drinking

People who have hepatitis as well as HIV are advised not to drink alcohol at all, or to keep alcohol consumption to a minimum. People whose liver has been damaged by drinking too much alcohol (especially if they have hepatitis) are more likely to experience side-effects from anti-HIV drugs, particularly protease inhibitors.
 

Safer drinking
• Men should not regularly drink more than three to four units of alcohol per day.
• Women should not regularly drink more than two to three units of alcohol per day.
You should also take a break for 48 hours after a heavy session to let your body recover.
 

The NHS gives daily limits for regular drinking to make it clear that you can't store up your whole week's 'allowance' until the weekend and then drink heavily (this type of heavy or binge drinking is often harmful). The different limits are set as ranges ('one to two', 'two to three' and 'three to four' units) because there isn't one single amount that applies to every person every day.
 

How many units are in your drinks?
This has a useful illustrated chart which helps you work out how much you are drinking for different types of drinks.
Online unit calculator

Help with drinking
Alcohol factsheet from NAM
If you are concerned about your alcohol use, speak to an adviser at George House Trust, your GP, or the HIV clinic.
 

Alcohol Concern's website is worth a look, or call Drinkline on 020 7264 0510.
 

Gay men may find the drink pages from LGF useful 
 

The different parts of NW England each have their own NHS services for alcohol, provided by your local Primary Care Trust.

Source for part of this

Alcohol Halves Adherence

posted: 14/08/2009

The more alcohol people drink, the worse their adherence to HIV treatment. HIV-positive people who drink alcohol are about half as likely (50%) to take HIV treatments properly, compared with people who don't drink.

A meta analysis, a study of all the past studies, of drinking and HIV treatment adherence, reveals this in a leading HIV journal.

And people who are heavier drinkers are even more likely to miss taking HIV drugs - 60% of heavier drinkers have poor adherence. It's the amount drunk in a session, rather than how often you drink, that seems to make adherence worse.

Taking HIV treatments properly is vital

For HIV drugs to work properly people need to take their HIV drugs at least 95% of the time - if some medications are not taken at the correct time interval, the drug level can either be too high (causing unnecessary side-effects) or too low (encouraging viral resistance).

Not taking treatments properly also makes it more likely HIV will be passed on and that this HIV will be drug resistant too.

If you want your treatment to work, daily, near-perfect adherence (above 95%) is needed.

This includes following any instructions about 

• taking the drug on an empty stomach OR
• with food
• taking ALL the drugs prescribed, and
• taking each drug at the correct dosing time.

This means a lot of accuracy, consistency, and commitment. Help is available - many people find 95% adherence hard to match, but there are tips and tricks and bits of kit to help.

What does 95% adherence mean?

• Take drugs once a day - miss up to one dose a month
• Take drugs twice a day - miss up to three doses a month
• Take drugs three times a day - miss up to four doses a month.

You should aim for better - ideally never missing any doses, with 100% adherence.

Alcohol and treatment

Drinking alcohol has been linked with reduced adherence to HIV treatment in many studies. However, it wasn't clear exactly what the links between drinking and treatment-taking were. Therefore the investigators put together all the published and scientifically reliable studies made between 1996 and 2007.

They analysed 40 studies. The studies had used different methods and adherence wasn't always the golden guide of at least 95% ('adherence' in the 40 studies ranged between 90% - 100% of doses).

However, when combined, the studies showed that people who drank alcohol were between 50% and 60% more likely to be considered non-adherent, compared with people who did not drink.

Heavier drinking, worse adherence

Furthermore, the amount someone drinks affects adherence. People who drink above the USA 'problem drinker' level are roughly 60% more likely to not take their treatments properly, compared with moderate drinkers or non-drinkers.

When they looked at the evidence more closely they found that what matters is how much you drink at a time, not how often you have a drink. The investigators write, “taken together, the available evidence suggests that drinking quantity is a more robust and important criteria of adherence than drinking frequency, a finding that seems consistent with dose-related alcohol effects on adherence.”

Male drinkers have worse adherence than women drinkers

One of the things they found was male drinkers are worse at taking treatments properly than women. In the past it had been thought women drinkers took treatments less well than men. Putting all 40 studies together mean that we now know this was wrong. Many men drinkers are worse at taking treatments properly.

Why is taking treatments worse among drinkers?

The study authors are less clear about the reasons why drinking affects taking treatments. They therefore suggest “future research should continue to evaluate potential moderators to clarify the conditions under which alcohol use is likely to influence adherence.”

Immune system doesn't work so well for drinkers 

Drinking alcohol has also been shown to affect how well the immune system works. In the light of this research and their own meta-analysis, the researchers conclude, “successful alcohol interventions could potentially show salutary effects on disease progression and, theoretically, life expectancy.”
 

Help with adherence

Adherence Tips factsheet from NAM

Adherence factsheet from NAM

Adherence booklet from NAM - page 25 includes useful tips, tricks and hints to help take HIV treatments properly. There are pill boxes, setting a daily alarm on your watch or mobile, keeping a little notebook and diary to jot down dates and times you've taken the treatment. And page 28 gives advice on clubbing and late nights out.  

Help with drinking

Alcohol factsheet from NAM

If you are concerned about your alcohol use, speak to an adviser at George House Trust, your GP, or the HIV clinic. 

Alcohol Concern's website is worth a look, or call Drinkline on 020 7264 0510.

Gay men may find the drink, drugs and smoking help from LGF useful.

The different parts of NW England each have their own NHS services for alcohol, provided by your local Primary Care Trust.

Reference Hendershot CS et al. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr (online edition), 2009.

Source edited and added to

Gay and using Drink and Drugs

posted: 23/06/2009

Over the summer, people at Pride events across the country will be surveyed about the use by gay, lesbian and bisexual people of alcohol and drugs.

Part of the Picture - England's first ever research into drug and alcohol use is now underway.

The Part of the Picture research teams have been to Birmingham already and will visit Newcastle Pride (18 July), Leeds Pride (2 August), Cornwall Pride (8 August) and Manchester Pride from 29 - 31 August.
 

They hope the research will shape the future provision of drug and alcohol services to ensure that they are inclusive of the needs of LGB people, as well as developing a national evidence database of drug and alcohol usage amongst LGB communities.

HIV and drug and alcohol use

It would be helpful if gay men living with HIV made sure their views and experiences are heard. Please complete a questionnaire, whether you are diagnosed with HIV or not.

"Substance use is under-researched within these communities" says Christina Marriott, one of the research team from ISCRI. "The little existing research there is suggests that lesbian, gay and bisexual people may be at much higher risk of problematic substance use and drinking. Our pilot showed staggeringly high levels of problematic use and it is important we confirm or disprove these.
"We also found very different patterns of drug use to the general population. For example, poppers (the alkyl nitrates) were more widely used than cannabis and this is not true in any other community. This may suggest that the services to help people with substance misuse issues will fail most lesbian, gay and bisexual people - because they are based on a different pattern of use. We hope that, in providing a great evidence base, we can support agencies in meeting the needs of these communities."
 

Autumn Outcomes

The first wave of results will be known in the autumn, and will be passed on to drug and alcohol teams across the UK to advise them of LGB areas of need.
 

Taking Part

If you are lesbian, gay or bisexual and want your experiences of drug and alcohol use to help shape the future provision of services for LGB people go to the Part of The Picture website to complete the survey.
 

For more information on Part of the Picture, contact:
Helen Burdett, Substance Misuse Co-ordinator

Lesbian and Gay Foundation

0161 235 8026
 

Email
 

Check Your Drinking in NW

posted: 23/09/2008

How do you know if you could be drinking more than is good for you? If you’re worried about your own drinking, take the  DrinkCheck Quiz. It’ll help you assess the effects of your drinking. And if it suggests you are drinking too much, there's advice on how to drink less. DrinkCheck

This site - Know your Units - explains the mystery of those alcohol units

The 9 Types of Heavy Drinker

The Department of Health identifies the nine personality types of heavy drinkers at risk of liver damage and other alcohol-related illnesses that are costing the NHS in England about £2.7bn a year.

Its researchers investigated the social and psychological characteristics of problem drinkers in an attempt to devise more effective public health campaigns to encourage safer use of alcohol.

They found that people who regularly drink at least twice the recommended limit, ie 35 units a week for women and 50 for men, ranged from depressives drinking at home alone over extended periods to macho exhibitionists who spend almost every evening in the pub.

The department said it was using social marketing techniques to tailor its propaganda to suit all the target personalities.

A spokesman said: "This will be a tough one to crack. Research found many positive associations with alcohol among the general public - even more so among those drinking at higher-risk levels. For these people alcohol is embedded in their identity and lifestyle: so much so that challenging this behaviour results in high levels of defensiveness, rejection or even outright denial."

The nine alcohol-fuelled personality types are:

De-stress drinkers use alcohol to regain control of life and calm down. They include middle-class women and men.

Conformist drinkers are driven by the need to belong and seek a structure to their lives. They are typically men aged 45 to 59 in clerical or manual jobs.

Boredom drinkers consume alcohol to pass the time, seeking stimulation to relieve the monotony of life. Alcohol helps them to feel comforted and secure.

Depressed drinkers may be of any age, gender or socioeconomic group. They crave comfort, safety and security.

Re-bonding drinkers are driven by a need to keep in touch with people who are close to them.

Community drinkers are motivated by the need to belong. They are usually lower middle class men and women who drink in large friendship groups.

Hedonistic drinkers crave stimulation and want to abandon control. They are often divorced people with grown-up children, who want to stand out from the crowd.

Macho drinkers spend most of their spare time in pubs. They are mostly men of all ages who want to stand out from the crowd.

Border dependents regard the pub as a home from home. They visit it during the day and the evening, on weekdays and at weekends, drinking fast and often.

The department launchs a trial information campaign in north-west England to persuade problem drinkers to cut down. It will include self-help packs, available online and in printed form, telling drinkers how to calculate the medical risks associated with different levels of alcohol intake. The DrinkCheck web tool is available at DrinkCheck

Dawn Primarolo, the public health minister, said: "The pilot will help up to 4,000 drinkers cut down in the first year alone."
 

source