Low CD4 counts among alcohol-dependent people on antiretroviral therapy – not due to poor adherence

Alcohol dependence and CD4 cell count: is there a relationship?

Malbergier A, Amaral RA, Cardoso LD. AIDS Care. 2014 Sep 1:1-5. [Epub ahead of print]

Alcohol and other drugs use seem to be common among people infected with HIV on antiretroviral treatment (ART). Their effects on HIV progression is still in debate. This study aimed to assess the association between alcohol and drug use and an HIV disease progression biomarker (CD4 cell count) among patients on ART. A cross-sectional study was carried out at an HIV treatment center affiliated with Medical School of the University of Sao Paulo, Brazil. Four hundred and thirty-eight HIV-positive patients on ART were interviewed by trained psychiatrists and psychologists using the following instruments: Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Alcohol Use Disorders Identification Test (AUDIT), 17-item Hamilton Rating Scale for Depression, and the Simplified Medication Adherence Questionnaire (SMAQ). In the previous month, 219 (50%) and 41 (9.3%) patients reported use of alcohol and illicit drugs, respectively. Fifty patients (12.6%) were classified as having harmful alcohol use by AUDIT. According to SCID-I, 80 patients (18.3%) were alcohol abusers, 24 (5.5%) alcohol dependents, and 21 (4.2%) had a current depressive disorder. Almost 73% (n = 319-72.8%) of the patients were adherent to ART. Alcohol dependents were nine times (p < 0.01) more likely to have CD4 cell count ≤200/mm3, and this association was independent of ART adherence. In conclusion, alcohol dependence seems to be associated with low CD4 cell count in HIV-positive patients. Based on these data, HIV health care workers should always assess alcohol consumption in the treatment setting, and patients should be advised that alcohol dependence may be linked to low CD4.

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Editor’s notes: The prognosis for people living with HIV who initiate antiretroviral therapy (ART) depends not only on their adherence to ART, but also the presence of co-morbid health conditions. There is now increasing focus on the role mental health disorders have on HIV-related outcomes. In this study of 438 HIV positive people on ART in Brazil, nearly 20% of individuals were found to be abusing alcohol, and five percent were diagnosed as being alcohol dependent. The people who were alcohol dependent were nine times more likely to have CD4 count <200/mm3, an association which was independent of ART adherence, HIV viral load and illicit substance use. As the availability of mental health care in low- and middle-income countries continues to expand, people living with HIV will comprise a key population for these services. Future research must confirm whether the relationship between alcohol dependence and CD4 count persists over time, and how alcohol dependence services can be integrated with HIV care services.

Latin America
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