Alcohol consumption and antiretroviral adherence among HIV-infected persons with alcohol problems.
BACKGROUND
Alcohol abuse has been associated with poor adherence to highly active antiretroviral therapy (HAART). We examined the relative importance of varying levels of alcohol consumption on adherence in HIV-infected patients with a history of alcohol problems.


METHODS
We surveyed 349 HIV-infected persons with a history of alcohol problems at 6-month intervals. Of these subjects, 267 were taking HAART at one or more time periods during the 30-month follow-up period. Interviews assessed recent adherence to HAART and past month alcohol consumption, defined as "none", "moderate", and "at risk". We investigated the relationship between adherence to HAART and alcohol consumption at baseline and at each subsequent 6-month follow-up interval using multivariable longitudinal regression models, while controlling for potential confounders.


RESULTS
Among the 267 HIV-infected persons with a history of alcohol problems who were receiving HAART, alcohol consumption was the most significant predictor of adherence (p < 0.0001), with better adherence being associated with recent abstinence from alcohol, compared with at-risk level usage (odds ratio = 3.6, 95% confidence interval = 2.1-6.2) or compared with moderate usage (odds ratio = 3.0, 95% confidence interval = 2.0-4.5).


CONCLUSIONS
Any alcohol use among HIV-infected persons with a history of alcohol problems is associated with worse HAART adherence. Addressing alcohol use in HIV-infected persons may improve antiretroviral adherence and ultimately clinical outcomes.
Samet
Jeffrey H
JH
Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA. jsamet@bu.edu
Horton
Nicholas J
NJ
Meli
Seville
S
Freedberg
Kenneth A
KA
Palepu
Anita
A
D000328:Adult; D000428:Alcohol Drinking / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D000437:Alcoholism / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data; D013695:Temperance / Q000523:psychology / Q000706:statistics & numerical data