Unhealthy Alcohol Use Is Not Associated With CD4 Count Change Among People With HIV Who Are Not Receiving Antiretroviral Therapy

Unhealthy alcohol use has been associated with poor HIV outcomes, at least partially due to its effect on HIV treatment adherence. Less is known about its impact on individuals who are not receiving antiretroviral treatment (ART); it is possible that alcohol may have direct effects on immune function. Researchers investigated the association between CD4 count changes and unhealthy alcohol use* among individuals with HIV in Uganda who did not meet WHO or local eligibility criteria for ART.

• The study included 446 participants, of whom 43% met criteria for unhealthy alcohol use. The median CD4 cell count at baseline was 550 cells/mm³ and the median duration of follow-up was 12.4 months.
• Unhealthy alcohol use was not associated with an increased rate of CD4 cell count decline in unadjusted or adjusted analyses.

* Defined as 3-month Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) score of ≥3 for women and ≥4 for men, or phosphatidylethanol (an alcohol biomarker) ≥50 ng/ml.

Comments: This study suggests that unhealthy alcohol use does not have a direct impact on short-term CD4 cell count changes; however, it has been shown to be associated with other harms, including decreased ART adherence, increased HIV transmission, and poor clinical outcomes.

Darius A. Rastegar, MD

Reference: Hahn JA, Cheng DM, Emenyonu NI, et al. Alcohol use and disease progression in an antiretroviral naïve cohort. J Acquir Immune Defic Syndr. 2018;77(5):492–501.