Alcohol Use in HIV Not Associated With Short-Term CD4 Cell Count Decline

HIV virus
HIV virus
Unhealthy alcohol use does not appear to have a short-term direct biological effect on CD4 cell count.

Unhealthy alcohol use did not affect the short-term rate of CD4 cell count decline in HIV-infected, antiretroviral treatment (ART)-naive individuals in Uganda, according to research published in the Journal of Acquired Immune Deficiency Syndromes.

A prospective cohort study conducted from September 2011 to August 2014 investigated the effect of unhealthy alcohol use on CD4 cell count among patients with HIV not yet eligible for ART. Baseline measures of unhealthy alcohol use, CD4 cell count, and HIV viral load were taken from 446 adults and repeated at follow-up visits every 6 months.

Unhealthy alcohol use was determined by self-report, using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and phosphatidylethanol, an alcohol biomarker, providing an objective measure of alcohol intake. AUDIT-C ≥3 for women and ≥4 for men and/or a cutoff of phosphatidylethanol ≥50 ng/mL indicated unhealthy drinking.

At baseline, 43% of participants fit the unhealthy drinking criteria, with a median CD4 cell count of 550 cells/mm3 (interquartile range, 416-685). There was no significant difference in CD4 cell count decline per year between unhealthy drinkers and those refraining from unhealthy drinking: −14.5 cells/mm3 (95% CI, −38.6 to 9.5 cells/mm3) and −24.0 cells/mm3 (95% CI, −43.6 to −4.5 cells/mm3), respectively (P =.54).

Analysis of subgroups, such as alternative alcohol measures, participant subgroups, and time-dependent confounders, as well as adjustments for demographic factors, produced similar results.

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Investigators concluded there is no evidence for an effect of unhealthy alcohol consumption on CD4 cell counts. There do remain several known negative effects of alcohol on HIV patient health, including decrease in ART adherence and increases in HIV transmission, as well as some evidence that alcohol negatively affects inflammation. Therefore, patients with HIV are still strongly discouraged from unhealthy alcohol consumption.


Hahn JA, Cheng DM, Emenyonu NI, et al. Alcohol use and HIV disease progression in an antiretroviral naïve cohort [published online January 4, 2018]. J Acquir Immune Defic Syndr. doi: 10.1097/QAI.0000000000001624