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

 

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