title: Causal considerations on alcohol and HIV/AIDS--a systematic review.
abstract: OBJECTIVE
  The study aimed to explore the possible causal nature of the association between alcohol consumption and HIV/AIDS.
  
  
  METHODS
  A review based on meta-analyses and reviews was conducted according to standard epidemiological criteria to distinguish causality from association, examining (i) the potential impact of alcohol on the incidence of HIV and (ii) alcohol's impact on worsening the disease course.
  
  
  RESULTS
  In terms of incidence of HIV, although we found a consistent and strong association with consumption, there was not enough evidence for a causal connection. In particular, it is not clear whether personality traits such as sensation seeking or sexual compulsivity and psychiatric disorders such as antisocial personality disorder impact both alcohol consumption and risky sex, subsequently creating an association between both behaviors. In terms of worsening the disease course of HIV/AIDS, we found enough evidence for a causal impact of alcohol. Alcohol affects the immune system, thus contributing to a worsened course of HIV/AIDS. In addition, alcohol negatively impacts on behaviors that include support seeking and medication adherence.
  
  
  CONCLUSIONS
  A randomized controlled clinical trial targeted toward at-risk HIV-negative individuals who live in areas with high HIV prevalence is suggested to test the effects of proven effective alcohol interventions on HIV incidence.
authors.affiliation: Centre for Addiction and Mental Health, 33 Russell Street, Room T-518, Toronto, Ontario, Canada M5S 2S1. paul.shuper@uconn.edu
authors.forename: Paul A
authors.initials: PA
authors.lastname: Shuper
authors.forename: Manuela
authors.initials: M
authors.lastname: Neuman
authors.forename: Fotis
authors.initials: F
authors.lastname: Kanteres
authors.forename: Dolly
authors.initials: D
authors.lastname: Baliunas
authors.forename: Narges
authors.initials: N
authors.lastname: Joharchi
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000523:psychology / Q000635:transmission; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology; D015984:Causality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D017831:Diagnosis, Dual (Psychiatry); D018450:Disease Progression; D005106:Exploratory Behavior; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology / Q000635:transmission; D006801:Humans; D015994:Incidence; D055118:Medication Adherence / Q000523:psychology; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology; D012307:Risk Factors; D012944:Social Support; D047568:Unsafe Sex