Table 3.
Alcohol Consumption and Nonadherence to ART.
| Ref. | Study settings | Population characteristics | Alcohol use patterns | Main findings |
|---|---|---|---|---|
| Found Nonadherence | ||||
|
| ||||
| [36] | USA | 391 HIV positive patients | 154 (39.4%) report past week alcohol consumption, for a mean number of 4 drinks | At-risk drinkers (4 drinks/week for women and 5 drinks/week for men) are less likely to have current HAART prescription (P < 0.05). At-risk drinking a predictor for not being on HAART (P = 0.025) |
|
| ||||
| [40] | USA | 1074 HIV positive patients | 315 (29.4%) patients presented with current or past history of drugs and/or alcohol abuse | Current or past history of drugs and/or alcohol abuse (OR 2.10, 95% CI 1.32–3.35, P = 0.002) and suboptimal adherence (OR 2.84, 95% CI 1.77–4.55, P < 0.001) predictors for virological failure |
|
| ||||
| [42] | USA | 43 HIV positive children | Alcohol abused by caregiver | Substance use by the caregiver associated with having higher viral loads in children patients (P = 0.007) |
|
| ||||
| [43] | USA | 197 HIV-infected individuals with history of alcohol problems who were receiving HAART | 79 (40.1%) use alcohol | HIV positive drinkers less adherent to HAART than HIV positive alcohol abstainers (P < 0.05) |
|
| ||||
| [44] | USA | 1944 HIV positive patients | 55% of 640 men and 28% of 1304 women consumed low levels of alcohol 15% of men and 8% of women consumed high levels of alcohol 7% of men and 4% of women engaged in binge drinking |
Binge drinking (OR 1.75, 95% CI 1.17–2.64, P ≤ 0.05), moderate-to-heavy alcohol consumption (OR 1.47, 95% CI 1.08–1.99, P ≤ 0.05) and low alcohol consumption (OR 1.28, 95% CI 1.05–1.54, P ≤ 0.05) associated with nonadherence for women only |
|
| ||||
| [45] | USA | 82 HIV positive African-American patients | Alcohol can affect ART adherence through conscious decisions to skip medication while drinking and not through drunken forgetfulness | |
|
| ||||
| [46] | USA | 5887 HIV positive patients | 3573 (60.7%) respondents report alcohol use in past 12 months 630 (17.6%) alcohol users were nonadherent |
Alcohol use in past 12 months associated with nonadherence (OR 1.3, 95% CI 1.1–1.5, P < 0.05) |
|
| ||||
| [47] | USA | 105 HIV positive patients without alcohol dependence | Mean monthly alcohol consumption was 4.64 ± 8.00 drinks/person | Monthly alcohol consumption associated with missed medication in the past 2 weeks (OR 1.08, CI 1.02–1.15, P < 0.01) and over the past weekend (OR 1.09, CI 1.03–1.15, P < 0.01) 47 (44.8%) patients missed a medication dose in the past 2 weeks, and 23 (21.9%) missed medication during the previous weekend |
|
| ||||
| [48] | USA | 275 HIV positive patients with alcohol use disorders 154 (56.0%) patients were nonadherent |
An average of 84.9 standard drinks over the thirty days prior to the baseline interview | Alcohol consumption (P = 0.001) and number of drinks (P = 0.002) related to nonadherence |
|
| ||||
| [49] | USA | 1671 HIV positive women | 60% of sample were abstainers and 26% were light drinkers (<3 drinks/week) | Light drinking (<3 drinks/week) (OR 1.51, CI 1.30–1.76, P < 0.01), moderate drinking (3–13 drinks/week) (OR 2.46, CI 1.96–3.09, P < 0.01), and heavy drinking (OR 4.37, CI 2.99–6.40, P < 0.01) associated with self-reported ART nonadherence |
|
| ||||
| [50] | USA | 67 HIV positive patients | Alcohol dependence is a specific and significant predictor of ART nonadherence in women only (P < 0.05) | |
|
| ||||
| [51] | USA | 643 HIV positive IDUs | Fewer at-risk drinkers that nondrinkers reported receiving ART (OR 1.19, 95% CI 0.59–2.42) | |
|
| ||||
| [52] | USA | 145 HIV positive patients | 60 (41.4%) participants were current drinkers 11 participants (18% of drinkers) were problem drinkers (AUDIT score ≥8) |
1 in 4 drinkers report stopping medication while consuming alcohol Alcohol use predicted treatment nonadherence (P < 0.05) |
|
| ||||
| [53] | USA | 335 HIV positive IDUs | Heavy alcohol use associated with first nonstructured treatment interruption (OR 1.58, 95% CI 0.92–2.70), early (within the first year) versus late treatment interruption (OR 1.55, 95% CI 0.51–4.73), and interruption of longer duration (≥6 months) (OR 3.21, 95% CI 0.83–12.5) | |
|
| ||||
| [54] | USA | 1354 HIV positive women for whom HAART was indicated | Light drinking (OR 1.39, 95% CI 1.03–1.89, P ≤ 0.05), moderate drinking (OR 1.72, 95% CI 1.10–2.70, P ≤ 0.05) and heavy drinking (OR 2.29, 95% CI 0.96–5.47) associated with nonadherence, compared to nondrinking | |
|
| ||||
| [55] | USA | 224 HIV positive patients | Baseline prevalence of past year hazardous drinking was 27% (AUDIT score ≥8) | Hazardous drinking associated with nonadherence |
|
| ||||
| [56] | France | 445 HIV positive patients | 329 (73.9%) patients consumed ≤1 unit of alcohol/day at baseline 116 (26.1%) patients consumed >1 unit of alcohol/day at baseline |
Baseline alcohol consumption associated with nonsignificant nonadherence after 4 months (P = 0.09) |
|
| ||||
| [57] | France | 276 HIV positive IDUs receiving HAART | Approximately 84% of patients report alcohol consumption during the past 6 months | Monthly alcohol consumption during past 6 months associated with ART nonadherence (OR 1.15, CI 1.08–1.23, P < 0.001) |
|
| ||||
| [58] | France | 1010 HIV positive patients | 59 (5.8%) patients report daily alcohol consumption | Nonadherence more common among subjects who consume alcohol daily (OR 0.39, CI 0.20–0.58, P < 0.001) |
|
| ||||
| [59] | France | 2340 HIV positive patients receiving HAART. Harmful alcohol consumption was frequent |
12% of patients had symptoms of potential alcohol abuse/dependence during the previous 12 months (CAGE questionnaire score of ≥2) 27% of patients suffered from hazardous drinking or alcohol use disorders (AUDIT-C questionnaire score of >4 for women and >5 for men) 9% of patients reported regular binge drinking (≥6 alcohol units drunk consecutively at least twice a month) |
Harmful alcohol consumption associated with nonadherence to HAART (P < 0.001) for regular binge drinking and symptoms of alcohol abuse or dependence |
|
| ||||
| [60] | Switzerland | 6709 HIV positive patients | Increasing alcohol intake associated with deteriorating adherence to ART (OR 1.25, 95% CI 1.10–1.43) | |
|
| ||||
| [61] | Sweden | 946 HIV positive patients | 15.5% of patients report alcohol and drug problems | Adherent patients more likely not to have problems with alcohol (OR 1.8, 95% CI 9 1.18–3.01, P = 0.008) |
|
| ||||
| [62] | Australia | 1106 HIV-infected patients 867 (78.4%) report taking cART, 339 (39.1%) of which report difficulty adhering to medication |
Alcohol use associated with self-reported nonadherence (OR 1.47, 95% CI 1.03–2.09, P < 0.05) | |
|
| ||||
| [63] | South Africa | 12 HIV positive patients receiving HAART | Alcohol abuse identified as barrier to adherence | |
|
| ||||
| [64] | South Africa | 8 male HIV positive patients | Patients delay HIV treatment while coping with alcohol dependence | |
|
| ||||
| [65] | South Africa | 56 HIV positive children | Alcohol use by caregiver associated with poorer ART adherence in children patients (P < 0.01) | |
|
| ||||
| [66] | Cameroon | 533 HIV positive patients | 60 (11.3%) patients reported binge drinking | Binge drinking associated with interruption of ART |
|
| ||||
| [67] | Ethiopia | 422 HIV positive patients | 31 (7.3%) subjects report alcohol consumption, 6 of which did so on a regular basis | Alcohol drinking associated with nonadherence (OR 0.210, CI 0.071–0.617, P = 0.003) |
|
| ||||
| [68] | Botswana | 300 adult HIV positive patients | Alcohol use predicted poor ART adherence (P < 0.02) | |
|
| ||||
| [69] | Benin, Côte d'Ivoire, and Mali | 2920 HIV positive patients | Current drinking (OR 1.4, 95% CI 1.1–2.0), especially hazardous drinking (OR 4.7, 95% CI 2.6–8.6), associated with nonadherence | |
|
| ||||
| [70] | Brazil | 306 HIV positive patients | 37.6% of sample consumed alcohol in month prior to baseline interview | ART nonadherence associated with alcohol use in month before baseline interview (OR 1.61, 95% CI 1.08–2.39, P = 0.018) |
|
| ||||
| [71] | Brazil | 295 HIV positive patients | 109 (37.3%) subjects consumed alcohol in month prior to baseline interview | Nonadherence to ART associated with alcohol use (P < 0.001) |
|
| ||||
| [72] | Thailand | 205 HIV positive patients | 13 (6.3%) subjects report current alcohol use | Current alcohol use sole predictor of nonadherence to HAART (OR 1.67, CI 1.05–2.48, P < 0.001) |
|
| ||||
| [73] | India | 198 HIV-infected patients receiving HAART | Alcohol use associated with nonadherence (OR 5.68, 95% CI 2.10–15.32, P = 0.001) | |
|
| ||||
| Did Not Find Nonadherence | ||||
|
| ||||
| [74] | USA | 1030 HIV-infected women | No delay in ART initiation between heavy drinkers and nondrinkers | |
|
| ||||
| [75] | USA | 300 HIV positive men who have sex with men | 43% of sample report alcohol consumption in first 2 weeks post-baseline | No association found between alcohol use and nonadherence |
|
| ||||
| [76] | UK | 394 HIV positive patients | Excessive alcohol consumption borderline significantly lower in patients receiving HAART (P < 0.08) | |
|
| ||||
| [77] | Uganda | 2311 HIV positive patients 928 (40.2%) presented late for treatment |
123 (5.3%) used moderate levels of alcohol and 360 (15.5%) used high levels of alcohol | Alcohol consumption in past year (assessed using AUDIT-C) negatively associated with late presentation for treatment (OR 0.65, 95% CI 0.44–0.96, P = 0.03 for moderate use and OR 0.79, 95% CI 0.61–1.00, P = 0.05 for heavy use) |