A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization.
BACKGROUND
Alcohol use disorders (AUDs) are highly prevalent and associated with non-adherence to antiretroviral therapy, decreased health care utilization and poor HIV treatment outcomes among HIV-infected individuals.


OBJECTIVE
To systematically review studies assessing the impact of AUDs on: (1) medication adherence, (2) health care utilization and (3) biological treatment outcomes among people living with HIV/AIDS (PLWHA).


METHODS
Six electronic databases and Google Scholar were queried for articles published in English, French and Spanish from 1988 to 2010. Selected references from primary articles were also examined.


METHODS
Selection criteria included: (1) AUD and adherence (N=20); (2) AUD and health services utilization (N=11); or (3) AUD with CD4 count or HIV-1 RNA treatment outcomes (N=10). Reviews, animal studies, non-peer reviewed documents and ongoing studies with unpublished data were excluded. Studies that did not differentiate HIV+ from HIV- status and those that did not distinguish between drug and alcohol use were also excluded. Data were extracted, appraised and summarized.


CONCLUSIONS
Our findings consistently support an association between AUDs and decreased adherence to antiretroviral therapy and poor HIV treatment outcomes among HIV-infected individuals. Their effect on health care utilization, however, was variable.
Azar
Marwan M
MM
Yale University School of Medicine, Department of Medicine, Section of Infectious Diseases, AIDS Program, 135 College Street, Suite 323, New Haven 06511, CT, USA.
Springer
Sandra A
SA
Meyer
Jaimie P
JP
Altice
Frederick L
FL
D000428:Alcohol Drinking; D019973:Alcohol-Related Disorders / Q000150:complications* / Q000378:metabolism; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002986:Clinical Trials as Topic; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006679:HIV Seropositivity / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D055118:Medication Adherence; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents