In a new study, about half of HIV patients on antiretroviral therapy
skipped their medications whenever they were drinking alcohol, an ill-advised
behavior that could lead to higher viral loads, researchers say.
Nearly 200 people with HIV who were on antiretroviral drugs and drank
alcohol were followed for a year, and 51 percent stopped taking their
medications while drinking - and those same patients tended to have higher
viral loads, according to the new report.
Lapses in pill-taking could be due to forgetfulness while under the
influence, but a widespread - and erroneous - belief that mixing alcohol and
HIV drugs can be toxic appears to play a role, researchers found. Seth
Kalichman, a professor at the University of Connecticut and lead author of the
study, said patients need to be better educated about drinking and HIV
treatments. "The harms caused by missing their medications far outweigh
the harms caused by mixing the two, if the person doesn't have liver disease.
That's the reality of it," Kalichman told Reuters Health.
Drinking has been known to interfere with people's adherence to their
medications, but "the consequences of inconsistent use of medications for
HIV can be more severe in some ways," said Dr. Michael Ohl, a professor of
medicine and infectious disease at the University of Iowa, who was not involved
in the study. Antiretroviral drugs suppress the HIV virus, and patients must
take the medications continuously to prevent the virus from surging.
Additionally, going on and off the pills can lead to drug resistance, in
which the antiretrovirals lose their potency. To see how patients' beliefs
about drinking and taking medication might contribute to poor adherence to the
drugs, Kalichman and his colleagues surveyed 178 people - about four out of
five of them men - who were currently using antiretroviral therapy and who
reported that they drank alcohol.
At the beginning of the study, the researchers asked the participants
about their alcohol-related beliefs, such as whether they thought their drugs
wouldn't work as well if the two mixed. They also asked whether people would
not take both at the same time - either by avoiding alcohol or the medicines.
Over the following year, the team checked in with patients every month
to see how well they were sticking to their prescriptions through a pill count,
and every other month they called to ask how often the patient had been
drinking recently. In addition, doctors' offices provided each patient's level
of virus in the body and his or her CD4-cell counts, a measure of immune system
health.
Kalichman's group found that 51 percent of the patients would avoid
their medications at times when they drank, and half of the people in this
group had poor adherence to their prescriptions. In addition, half of the group
that would skip pills also said they do not take their medications until
alcohol is completely out of their system. "It's pretty remarkable that
about 50 percent of their patients reported doing this," said Catherine
Grodensky, a researcher at the Center for AIDS Research at the University of
North Carolina, who was not part of the study. "That's pretty surprising
to me that it was such a high percentage."
In comparison, of the patients who reported not skipping their
medications when they drank, 36 percent also did not adhere well to their
prescriptions and 31 percent said they don't take the drugs until alcohol is
out of their system. "I think it's pretty well demonstrated that alcohol
use is tied to poor adherence, and I think most people think it's because
they're impaired in some way or they forget and it's an unintentional missing
their medications, whereas here it shows they're (often) intentionally missing
their medications," said Grodensky. "And it looks like it's having
some significant impacts on their treatment," she added.
People who skipped their medications while drinking were also more
likely to have higher levels of HIV in their bodies and lower numbers of CD4
cells. "People living with HIV who deliberately stop their medications
when they are drinking are at risk for treatment failure," the authors
write in the Journal of General Internal Medicine. Ohl said the belief that
antiretrovirals and alcohol are a toxic mix is something he hears frequently in
his medical practice, but that there's no evidence that drinking should
preclude taking HIV medication.
Andrea Sankar, a professor at Wayne State University, who did not
participate in the study, said the belief likely comes from the advice that doctors
typically give to patients, which is that they shouldn't drink when they are on
therapy. "When clinicians say, 'if you're taking antiretroviral therapy
you shouldn't drink,' then what happens is rather than people stopping
drinking, they stop taking their medications," she told Reuters Health. Sankar
said that doctors' offices are the best place to start changing behavior to
make sure people continue to take their medication. "We think it may be a
pretty simple fix, just educating patients," said Kalichman.
Source: Chicago Tribune
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