Alcohol use and antiretroviral adherence: review and meta-analysis.
BACKGROUND
Alcohol use is frequently implicated as a factor in nonadherence to highly active antiretroviral therapy (HAART). There have not been efforts to systematically evaluate findings across studies. This meta-analysis provides a quantitative evaluation of the alcohol-adherence association by aggregating findings across studies and examining potential moderators.


METHODS
Literature searches identified 40 qualifying studies totaling over 25,000 participants. Studies were coded on several methodological variables.


RESULTS
In the combined analysis, alcohol drinkers were approximately 50%-60% as likely to be classified as adherent [odds ratio (OR) = 0.548, 95% confidence interval (CI): 0.490 to 0.612] compared with abstainers (or those who drank relatively less). Effect sizes for problem drinking, defined as meeting the National Institute on Alcohol Abuse and Alcoholism criteria for at-risk drinking or criteria for an alcohol use disorder, were greater (OR = 0.474, 95% CI = 0.408 to 0.550) than those reflecting any or global drinking (OR = 0.604, 95% CI = 0.531 to 0.687). Several variables moderated the alcohol-adherence association.


CONCLUSIONS
Results support a significant and reliable association of alcohol use and medication nonadherence. Methodological variables seem to moderate this association and could contribute to inconsistent findings across studies. Future research would benefit from efforts to characterize theoretical mechanisms and mediators and moderators of the alcohol-adherence association.
Hendershot
Christian S
CS
Department of Psychology, University of Washington, Seattle, WA 98195, USA. chender@u.washington.edu
Stoner
Susan A
SA
Pantalone
David W
DW
Simoni
Jane M
JM
D000428:Alcohol Drinking / Q000009:adverse effects*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D016903:Drug Monitoring
D019380:Anti-HIV Agents