title: Alcohol consumption and CD4 T-cell count response among persons initiating antiretroviral therapy.
abstract: BACKGROUND
  We evaluated the longitudinal association of alcohol use with immunologic response to combination antiretroviral therapy (ART) among HIV-infected individuals.
  
  
  METHODS
  This was a prospective cohort study of individuals initiating ART. Participants underwent an Audio Computer-Assisted Self-interview querying drug and alcohol use within 6 months of treatment. Immunologic response to ART was defined by CD4 T-cell count (CD4). Primary independent variables were self-reported number of drinks consumed per drinking day (quantity) and days of alcohol consumption in a typical week (frequency). We used linear mixed effects models to quantify the association between CD4 T-cell count and alcohol quantity and frequency and Cox proportional hazards models to estimate the relative hazard of an increase in 100, 150, and 200 CD4 cells per cubic millimeter per additional drink per drinking day. Analyses were stratified by sex. Viral suppression was examined as a time-varying covariate.
  
  
  RESULTS
  Between 2000 and 2008, 1107 individuals were eligible for inclusion in this study. There was no statistically significant difference in CD4 T-cell count by average drinks per drinking day at any frequency of alcohol use irrespective of sex or viral suppression. Similarly, we found no difference in the hazard ratio for drinks per drinking day within the categories of drinking frequency for time to CD4 T-cell count increase of 100, 150, and 200 cells per cubic millimeter, respectively.
  
  
  CONCLUSIONS
  Among individuals initiating ART, the benefits of therapy and viral suppression on the immune system outweigh detrimental effects of alcohol, reinforcing the importance of initiating ART and ensuring adequate adherence to therapy.
authors.affiliation: Department of Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21287, USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kowalski
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Colantuoni
authors.forename: Bryan
authors.initials: B
authors.lastname: Lau
authors.forename: Jeanne
authors.initials: J
authors.lastname: Keruly
authors.forename: Mary E
authors.initials: ME
authors.lastname: McCaul
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Hutton
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Chander
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents