Alcohol Use Does Not Affect CD4 T-cell Count Response after Antiretroviral Therapy Initiation

Alcohol can cause immune suppression in individuals with HIV. Among HIV-infected individuals not receiving antiretroviral therapy (ART), heavy alcohol use lowers CD4 T-cell counts compared with no alcohol use. Using data from the Johns Hopkins Clinical Cohort, the authors sought to determine the longitudinal effect of quantity and frequency of alcohol use on CD4 T-cell response to ART, the differential effect of alcohol on CD4 T-cell count response in people who achieved viral suppression compared with those who did not, and the effect of alcohol on immune function, stratified by sex. Out of roughly 6000 patients enrolled in the cohort, 1107 participants reported alcohol use via computer-assisted self-interview within 6 months of ART initiation, had their CD4 T-cells measured, and were not virologically suppressed at the time of the interview. Sixty percent had a baseline CD4 T-cell count <200 cells/mm3. Among patients who used alcohol (n=440), the median number of drinks per day was 2 (interquartile range, 1–4).

• No differences were noted in CD4 T-cell counts among patients who used alcohol, irrespective of drinking quantity or frequency, gender, or virologic suppression.

• Among those without suppressed viral load, there was no change in CD4 T-cell count by quantity or frequency of alcohol use.

Comments:

These data suggest the benefits of ART initiation outweigh potential risks of ongoing alcohol use in HIV-infected men and women who meet criteria for HIV treatment. Validation of these findings in other patient samples will lend further support to ART treatment initiation despite alcohol use.

Jeanette M. Tetrault, MD

Reference:

Kowalski S, Colantuoni E, Lau B, et al. Alcohol consumption and CD4 T-cell count response among persons initiating antiretroviral therapy. JAIDS. 2012;61(4):455–461.