title: Alcohol Use and Human Immunodeficiency Virus (HIV) Infection: Current Knowledge, Implications, and Future Directions.
abstract: Alcohol use is common among people living with human immunodeficiency virus (HIV). In this narrative review, we describe literature regarding alcohol's impact on transmission, care, coinfections, and comorbidities that are common among people living with HIV (PLWH), as well as literature regarding interventions to address alcohol use and its influences among PLWH. This narrative review identifies alcohol use as a risk factor for HIV transmission, as well as a factor impacting the clinical manifestations and management of HIV. Alcohol use appears to have additive and potentially synergistic effects on common HIV-related comorbidities. We find that interventions to modify drinking and improve HIV-related risks and outcomes have had limited success to date, and we recommend research in several areas. Consistent with Office of AIDS Research/National Institutes of Health priorities, we suggest research to better understand how and at what levels alcohol influences comorbid conditions among PLWH, to elucidate the mechanisms by which alcohol use is impacting comorbidities, and to understand whether decreases in alcohol use improve HIV-relevant outcomes. This should include studies regarding whether state-of-the-art medications used to treat common coinfections are safe for PLWH who drink alcohol. We recommend that future research among PLWH include validated self-report measures of alcohol use and/or biological measurements, ideally both. Additionally, subgroup variation in associations should be identified to ensure that the risks of particularly vulnerable populations are understood. This body of research should serve as a foundation for a next generation of intervention studies to address alcohol use from transmission to treatment of HIV. Intervention studies should inform implementation efforts to improve provision of alcohol-related interventions and treatments for PLWH in healthcare settings. By making further progress on understanding how alcohol use affects PLWH in the era of HIV as a chronic condition, this research should inform how we can mitigate transmission, achieve viral suppression, and avoid exacerbating common comorbidities of HIV and alcohol use and make progress toward the 90-90-90 goals for engagement in the HIV treatment cascade.
authors.affiliation: Veterans Health Administration (VA) Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.|Department of Health Services, University of Washington, Seattle, Washington.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.affiliation: Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Hahn
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.|Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.affiliation: Consortiums for HIV/AIDS and Alcohol Research Translation (CHAART) National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland.
authors.forename: Kendall
authors.initials: K
authors.lastname: Bryant
authors.affiliation: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Marlene C
authors.initials: MC
authors.lastname: Lira
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts. jsamet@bu.edu.|Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts. jsamet@bu.edu.
authors.forename: Jeffrey H
authors.identifier: 0000-0002-0897-3400
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects*; D060085:Coinfection / Q000453:epidemiology*; D015897:Comorbidity; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D006801:Humans; D012106:Research / Q000639:trends*
keywords: 
  HIV
  ; Alcohol; Alcohol Use; HIV-Related Comorbidities; Substance Use