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HIV-Positive Drinkers Choose Alcohol Over ART


June 11, 2012 (Miami Beach, Florida) — Half of HIV-positive drinkers receiving antiretroviral therapy (ART) intentionally skipped or stopped taking their medications when they consumed alcohol, in the mistaken belief that combining ART drugs and alcohol is somehow toxic, according to a prospective cohort study.
The study, which monitored patients' beliefs about mixing alcohol and ART medicines, was presented here at the 7th International Conference on HIV Treatment and Prevention Adherence.
"It's really a bad idea for people to stop taking their HIV medications, but we found that there was a substantial number of people with HIV who are choosing to stop taking their medication when they are drinking," lead author Seth Kalichman, PhD, from the University of Connecticut, in Storrs, told Medscape Medical News.
"There are many who hold the belief, not only those with HIV infection but those with other chronic diseases, that if they mix their medications with alcohol it creates a toxic poison that is harmful.... However, there is no evidence that mixing alcohol [with antiretroviral medications] increases the harm of the alcohol itself," Dr. Kalichman said.
"Of course, if you have HIV infection and liver disease, that is an entirely different scenario. You should definitely not drink alcohol if you have liver disease," he said.
Study Design and Results
In their study, Dr. Kalichman and his group enrolled 178 people with HIV who consume alcohol and receive ART, and monitored them for 12 months to see how many of them held the false belief and whether those who did were less adherent to their medications than those who did not.
Patients kept an electronic diary on their cell phone, and received daily text messages reminding them to report whether they had consumed alcohol and what and how much they drank.
Adherence to ART was assessed using monthly unannounced pill counts (patients were contacted and asked to count their pills), self-report, and chart abstracted HIV viral load.
The study found that 90 patients (51%) skipped or stopped taking their ART when drinking. The most common reason given for not taking ART when drinking was the belief that to do so would be dangerous.
Patients who believed that this combination was dangerous were 3 times as likely to be treatment nonadherent as those who did not hold the belief; this difference was significant (P < .01).
Those who skipped doses or stopped ART when drinking were also less likely to be virally suppressed, and more likely to have CD4 cell counts below 200 cells/mm3, Dr. Kalichman reported.
The belief about toxic interaction predicted nonadherence to a greater degree than alcohol use itself.
Message to Patients: Don't Skip ART Doses
Dr. Kalichman noted that misinformed beliefs can be easily corrected. "Doctors can tell their patients that it is not a good idea to drink if you are taking medications because you can miss doses, but don't skip your medications just because you are drinking. When it comes to these antiretroviral medications, the harm of missing the medications is greater than the harm of drinking with medications," Dr. Kalichman said.
Medscape Medical News asked Robert Gross, MD, associate professor of medicine, biostatistics and epidemiology at the University of Pennsylvania Perelman School of Medicine in Philadelphia, for his opinion of the study. Dr. Gross's research is in HIV, health promotion, disease prevention, and behavioral change.
"This perception that it is dangerous to take medications and alcohol probably stems from a time in the 1950s and 1960s when combining the 2, particularly barbiturates, would be fatal," said Dr. Gross, who was not part of the study.
"Having heard that you shouldn't take pills and alcohol at the same time, people have perhaps overgeneralized the idea of not taking antiretroviral therapy at a time when they are drinking alcohol," he said.
"Dr. Kalichman suggested that this mistaken belief might be one of the barriers to taking antiretroviral therapy that is most easily dealt with, and I agree with his conclusion," Dr. Gross said.
He added that clinicians could bring up the topic with their patients to make sure they understand that it is best to continue even if they drink.
"Try to probe whether your patients have these misperceptions," Dr. Gross said. "I find one of the things that is challenging for a provider is to conceptualize the way a patient is thinking about their disease or their treatment.... The bottom line is we want to get them to take medications because we know it will lead to treatment success. The goal should be to meet the patient where they are with their beliefs and try to correct the ones that are correctable."
The study was funded by the National Institutes of Health. Dr. Kalichman and Dr. Gross have disclosed no relevant financial relationships.

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