Depression and Alcohol Misuse Lower Odds of Achieving Viral Suppression in HIV

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The association between heavy alcohol use and consistent virologic suppression during the subsequent year depended on concurrent symptoms of depression.
The association between heavy alcohol use and consistent virologic suppression during the subsequent year depended on concurrent symptoms of depression.

Symptoms of depression and heavy alcohol use interact to lower the chances of achieving virologic suppression in people with HIV; therefore, interventions that target both depression and alcohol misuse may benefit those who are at high risk for poor outcomes, according to a study published in AIDS and Behavior.

Although people living with HIV (PLWHIV) who consistently adhere to antiretroviral therapy and have achieved sustained virologic suppression can have an comparatively normal lifespan,2,3 a substantial percentage of PLWHIV are not retained in care and fail to achieve or maintain virologic suppression.4-7 Depression and misuse of substances such as alcohol are highly prevalent in PLWHIV and are associated with decreased adherence to therapy and retention in HIV care.8-16 

Because depression and alcohol abuse are modifiable risk factors for poor HIV outcomes, researchers examined how they interact to affect HIV control in 14,380 PLWHIV from 8 clinical sites across the United States.1 They found that among PLWHIV with no or mild depression, heavy alcohol use had no association with virologic suppression; however, reduced viral suppression was noted among PLWHIV who had moderate or severe depression symptoms. These data indicate that the interaction between symptoms of depression and heavy alcohol use were present only in PLWHIV who were not taking antidepressants.

"These results underscore the importance of recognizing and treating depression in [PLWHIV], particularly among persons with heavy alcohol use, and suggest that deploying integrated, multifaceted interventions that target both depression and alcohol misuse could greatly benefit a subset of PLWHIV at high risk for poor outcomes," concluded the study authors.1

References

  1. Fojo AT, Lesko CR, Calkins KL, et al. Do symptoms of depression interact with substance use to affect HIV continuum of care outcomes? [published online September 29, 2018]. AIDS Behav. doi: 10.1007/s10461-018-2269-0.
  2. Smith CJ, Ryom L, Weber R, et al. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet. 2014;384(9939):241-248.
  3. Okulicz JF, Samji H, Cescon A, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS ONE. 2013;8(12):e81355.
  4. Ghiam MK, Rebeiro PF, Turner M, et al. Trends in HIV continuum of care outcomes over ten years of follow-up at a large HIV primary medical home in the Southeastern United States. AIDS Res Hum Retrovir. 2017;33:1027-1034.
  5. Colasanti J, Kelly J, Pennisi E, et al. Continuous retention and viral suppression provide further insights into the HIV care continuum compared to the cross-sectional HIV care cascade. Clin Infect Dis. 2016;62(5):648-654.
  6. Yehia BR, Stephens-Shields AJ, Fleishman JA, et al. The HIV care continuum: changes over time in retention in care and viral suppression. PLoS ONE. 2015;10(6):e0129376.
  7. Rebeiro P, Althoff KN, Buchacz K, et al. Retention among North American HIV-infected persons in clinical care, 2000–2008. JAIDS. 2013;62(3):356-362.
  8. Zuniga JA, Yoo-Jeong M, Dai T, Guo Y, Waldrop-Valverde D. The role of depression in retention in care for persons living with HIV . AIDS Patient Care STDS. 2016;30(1):34-38.
  9. Krumme AA, Kaigamba F, Binagwaho A, Murray MB, Rich ML, Franke MF. Depression, adherence and attrition from care in HIV-infected adults receiving antiretroviral therapy. J Epidemiol Community Health. 2015;69(3):284-289.
  10. Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr. 2011;58(2):181-187.
  11. Horberg MA, Silverberg MJ, Hurley LB, et al. Effects of depression and selective serotonin reuptake inhibitor use on adherence to highly active antiretroviral therapy and on clinical outcomes in HIV-infected patients. J Acquir Immune Defic Syndr. 2008;47(3):384-390.
  12. Monroe AK, Lau B, Mugavero MJ, et al. Heavy alcohol use is associated with worse retention in HIV care. JAIDS. 2016;73(4):419-425.
  13. Chander G, Lau B, Moore RD. Hazardous alcohol use: a risk factor for non-adherence and lack of suppression in HIV infection. J Acquir Immune Defic Syndr. 2006;43(4):411-417.
  14. Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr. 2009;52(2):180-202.
  15. Braithwaite RS, McGinnis KA, Conigliaro J, et al. A temporal and dose-response association between alcohol consumption and medication adherence among veterans in care. Alcohol Clin Exp Res. 2005;29(7):1190-1197.
  16. Gonzalez A, Barinas J, O'Cleirigh C. Substance use: impact on adherence and HIV medical treatment. Curr HIV/AIDS Rep. 2011;8(4):223-234.
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