Many women with HIV report hazardous drinking

Hazardous alcohol use is common among HIV-positive women, for whom excessive drinking poses special health risks, according to a new study out in the American Journal of Epidemiology.

“At least 1 in 10 HIV-infected women continue to drink at a level which may be hazardous,” Dr. Robert L. Cook of the University of Florida in Gainesville, the lead researcher on the study, told Reuters Health. “We in public health could do more to help them reduce that harmful drinking.”

Thanks to the effectiveness of antiretroviral drugs, HIV has become a chronic disease that many people live with, like diabetes or high blood pressure, Cook noted. But alcohol use can be especially dangerous to HIV-positive people.

For one, people who drink heavily are less likely to take their medications as prescribed. Also, many people with HIV are infected with hepatitis C, which harms the liver and makes the organ more vulnerable to the effects of alcohol, and HIV drugs themselves can damage the liver. Women who drink to excess may also be more prone to have unsafe sex. And studies have suggested that heavy alcohol use in and of itself may contribute to disease progression.

To investigate how common hazardous alcohol use is among HIV-positive women, Cook and his colleagues followed 2,770 women for 11 years. They defined hazardous drinking as having had four or more drinks daily, or more than seven drinks a week, in the past year.

Over the course of the study, the percentage of women who reported hazardous drinking ranged from 14 percent to 24 percent. Risky drinking was more common among women who were jobless, had less than a high school education, were depressed, or had hepatitis C. The women who had enrolled in the study at its outset in 1994-1995 were also more likely to be hazardous drinkers, as were those with CD4 cell counts of 200 to 500 cells/mL.

In the general population, the researchers note, about 22 percent of women report hazardous drinking.

While there are many barriers to addressing hazardous alcohol in the primary care setting, Cook noted, there is some good news. An approach called brief intervention or motivational interviewing has been shown to help people cut down on their drinking, while there are also medications that can help people reduce their alcohol consumption.

Just a single 30- to 60-minute session of motivational interviewing has been shown to help people drink less, the researcher added, but the intervention must be delivered by a trained professional. He and his colleagues are now planning a study in which they will test whether delivering the intervention via a computer using graphic characters will be effective. They are also planning to investigate whether medications will be helpful to HIV-positive women who want to reduce their alcohol use.

“Right now we don’t know even if women are interested in taking any treatment,” Cook pointed out. “They may be very happy with the way they drink and not necessarily be motivated to change.”

SOURCE: American Journal of Epidemiology, April 15, 2009.

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