An under-recognized phenomenon may affect medication adherence among individuals with HIV -- problem drinking, according to a study.
“The results of this study emphasize the importance of screening for alcohol problems among persons with HIV infection,” said lead author Robert L. Cook, MD, MPH, of the Center for Research on Health Care at the University of Pittsburgh School of Medicine, in Pennsylvania.
Few previous studies have looked at the relationship between excessive drinking and medication adherence in those with HIV -- an important issue since viral resistance can result from even a few missed doses or from taking HIV medications off schedule, according to the study.
Alcohol consumption, including excessive drinking, is common in the HIV population. “Problem drinking is a significant issue among persons with HIV infection, affecting at least one in five people in our clinics,” noted Cook.
Cook and colleagues surveyed over 200 individuals with HIV about how often they missed medication doses or took doses off schedule and about their drinking habits. The researchers categorized problem drinkers in three ways: women who had five and men who had six alcoholic drinks at one sitting at least once a month, women who had more than 12 and men who had more than 16 drinks weekly; and women and men with high scores on a test called the Alcohol Use Disorders Identification Test.
Problem drinkers were more likely to take their HIV medications off schedule, the researchers found. Nearly half of the problem drinkers reported taking medication off schedule during the previous week, compared to 26 percent of those without problem drinking behaviors. The study results appear in the February issue of the Journal of General Internal Medicine.
The researchers cautioned that clinicians should not assume that problem drinkers will not be able to follow complex medical regimens based on these study findings. More than half of the problem drinkers in the study did not report any problems with medication adherence.
The researchers recommend that clinicians should instead work with patients individually to develop strategies to help them adhere to their HIV medications. “Clinicians should monitor outcomes in both alcohol consumption and HIV medication adherence to most effectively assist their patients in achieving their optimal long-term health,” said Cook.
The researchers noted that more research is needed to explain their findings. Some problem drinkers may forget to take their medications on time because they are drunk or distracted by social functions at bars or parties. Underlying personality traits, or conditions like depression, may lead to both problem drinking and difficulty with medication adherence, according to the study.
The study was funded by the University of Pittsburgh Center for Research on Health Care.
The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care. For information about the journal, contact Renee F. Wilson at (410) 955-9868.
Posted by the Center for the Advancement of Health Journal of General Internal Medicine
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