Alcohol use is common among people living with HIV (PLWH) and associated with poor antiretroviral treatment (ART) adherence and detectable viral load (VL). Interventions for hazardous alcohol use exists; however, many PLWH may moderate their use but not abstain. We conducted this study to examine the potential impact of decreasing alcohol use on VL without abstinence and how this differs based on alcohol use patterns.
We used data from 7 U.S. sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. Eligible PLWH completed the CNICS clinical assessment including alcohol use on the AUDIT-C on or after 2010, reported alcohol use, and had 2 VL measures collected as part of clinical care. We examined frequency of alcohol use, frequency of binge drinking, and alcohol use severity (AUDIT-C score). Linear mixed models with time-updated alcohol use and VL were used to examine associations between changes in alcohol use and VL (log10 transformed) adjusting for age, sex, race, frequency of illicit substance use by individual drug category, and calendar year. Models were repeated, stratified by Hepatitis C virus (HCV) status.
Among 7137 PLWH who drank alcohol there were 61,315 VL measures, mean baseline VL was 22,709 copies/mL (geometric mean 118) and 71% were undetectable (<100 copies/mL). Stopping alcohol use was associated with decreased VL for all alcohol measures (p values<0.05). Decreased alcohol use among those who continued to drink (not abstinent) was associated with lower VL for all 3 alcohol measures. Compared to those who did not decrease alcohol, those who decreased alcohol frequency had a mean 18% lower VL (95% confidence interval (CI) 11%-24%, p <0.001), those who decreased their binge drinking frequency had 26% lower VL (95% CI 15%-36%, p <0.001), and those who decreased their AUDIT-C score had 26% lower VL (95% CI 21%-31%, p <0.001). Even a 1-point AUDIT-C score decrease was significant. Impacts were attenuated among PLWH with HCV.
We demonstrated alcohol cessation was associated with decreased VL. In addition, decreasing alcohol use without abstinence was associated with a lower VL, which could lead to improved health outcomes and public health benefits in terms of decreased transmissibility. The decreased VL could be via improved ART adherence or more direct biological effects of alcohol. This suggests that supporting decreased alcohol use could help patients achieve VL goals regardless of achieving abstinence.