Brief Intervention May Reduce Consumption in some HIV-Infected Women with Hazardous Alcohol Use
Hazardous alcohol use occurs in as many as a quarter of HIV-infected women, and is associated with suboptimal antiretroviral therapy (ART) adherence and high-risk sexual behaviors. Researchers enrolled 148 women with hazardous alcohol use* from an HIV primary care clinic. Participants were randomized to receive either 2 sessions of alcohol brief intervention (BI) 1 month apart, or usual clinic care.
- Over the prior 90 days, the BI group had an average of 34 drinking days, 25 days of heavy episodic drinking, and a mean number of 10 drinks per drinking day. Numbers for the control group were similar.
- BI was associated with a decrease in the number of drinking days, but only for women whose number of drinking days fell between the 28th and 90th percentiles. Similar results were seen for the number of heavy drinking days. BI was also associated with a decrease in unprotected vaginal sex, compared with controls.
- The BI group did not experience a reduction in the mean number of drinks per drinking day, or in secondary outcomes including liver enzymes, ART adherence, virologic suppression, and appointment attendance.
* Defined as an average of ≥ 8 drinks in a week or ≥ 4 drinks on an occasion at least twice in the last 6 months, or a TWEAK score of ≥ 2 (5-question tool: Tolerance, Worried, Eye-opener, Amnesia, Cut down).
Comments:
This intervention was not effective for the participants who drank the most, for those who drank least, or for clinical outcomes (e.g. virological suppression) despite the fact that it was adapted from a previously-published intervention and included content specific to HIV-infected women, adherence, and sexual risk. It did appear, however to reduce unprotected sex. This study is limited, as are many, by the reliance on self-report to determine alcohol consumption—participants in the intervention may have been more likely than those in the control group to report a reduction in alcohol consumption. Clearly we need to know more about how best to address unhealthy alcohol use in women with HIV infection.
Jessica S. Merlin, MD, MBA
Reference:
Chander G, Hutton HE, Lau B, et al. Brief intervention decreases drinking frequency in HIV-infected, heavy drinking women: results of a randomized controlled trial. J Acquir Immune Defic Syndr. 2015 [Epub ahead of print]. PMID: 25967270.