Whether heavy alcohol consumption accelerates HIV disease progression is a fundamental unanswered question with far-reaching public health implications. Alcohol is one of the most commonly used drugs in the world, and heavy alcohol consumption is very common among those infected with HIV. Animal studies suggest that heavy alcohol consumption early in infection has the potential to accelerate HIV disease progression. However, the results of human observational studies of alcohol consumption on HIV disease progression, beyond the effect on antiretroviral therapy (ART) adherence, have been much less consistent due to several methodological limitations. We propose a 650-person prospective cohort study to examine the effect of heavy alcohol consumption on HIV disease progression prior to ART. We will conduct this research in Uganda, which has very high levels of alcohol consumption, high prevalence of HIV infection, and many HIV-infected persons not yet on ART. Participants, studied prospectively, will be recruited from an 8,000 patient HIV treatment program in Uganda as an expansion of a newly initiated 210 person prospective cohort study. The main goal is to determine the impact of heavy alcohol consumption on HIV disease progression, as measured by CD4 cell count decline among those not yet on ART. We will overcome previous methodological limitations by limiting our study to those not on ART, by using a biomarker of alcohol consumption, phosphatidylethanol (PEth), to correctly assess alcohol consumption, and by conducting the study in Uganda, where other substance use is rare. We will conduct exploratory analyses of several biological and behavioral pathways by which heavy alcohol consumption may accelerate HIV disease progression. In conducting this study, we will gain critical evidence of the impact of heavy alcohol use on the clinical course of HIV infection among persons not on ART that will provide clinicians and patients with clear information and may provide motivation to reduce alcohol consumption earlier than previously thought necessary, both in the US and around the world. In addition, better understanding of the mechanisms by which alcohol-induced damage occurs will inform the development of effective interventions.

Public Health Relevance

A high percentage of HIV infected persons consume alcohol, yet due to the limitations of previous research, it is still unknown whether heavy alcohol consumption accelerates HIV disease progression prior to the start of ART. This study will provide clear evidence about the value of decreasing alcohol consumption early in HIV infection, rather than waiting until ART is initiated, as is the current practice.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZAA1)
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Wang, Joe
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Woolf-King, Sarah E; Fatch, Robin; Cheng, Debbie M et al. (2018) Alcohol Use and Unprotected Sex Among HIV-Infected Ugandan Adults: Findings from an Event-Level Study. Arch Sex Behav 47:1937-1948
Freiman, J Morgan; Jacobson, Karen R; Muyindike, Winnie R et al. (2018) Isoniazid Preventive Therapy for People With HIV Who Are Heavy Alcohol Drinkers in High TB-/HIV-Burden Countries: A Risk-Benefit Analysis. J Acquir Immune Defic Syndr 77:405-412
Adong, Julian; Lindan, Christina; Fatch, Robin et al. (2018) The Relationship Between Spirituality/Religiousness and Unhealthy Alcohol Use Among HIV-Infected Adults in Southwestern Uganda. AIDS Behav 22:1802-1813
Coleman, Sharon M; Gnatienko, Natalia; Lloyd-Travaglini, Christine A et al. (2018) False-positive HIV diagnoses: lessons from Ugandan and Russian research cohorts. HIV Clin Trials 19:15-22
Hahn, Judith A; Cheng, Debbie M; Emenyonu, Nneka I et al. (2018) Alcohol Use and HIV Disease Progression in an Antiretroviral Naive Cohort. J Acquir Immune Defic Syndr 77:492-501
Fatch, Robin; Emenyonu, Nneka I; Muyindike, Winnie et al. (2017) Alcohol Interactive Toxicity Beliefs and ART Non-adherence Among HIV-Infected Current Drinkers in Mbarara, Uganda. AIDS Behav 21:1812-1824
Asiimwe, Stephen B; Fatch, Robin; Patts, Gregory et al. (2017) Alcohol Types and HIV Disease Progression Among HIV-Infected Drinkers Not Yet on Antiretroviral Therapy in Russia and Uganda. AIDS Behav 21:204-215
Muyindike, Winnie R; Lloyd-Travaglini, Christine; Fatch, Robin et al. (2017) Phosphatidylethanol confirmed alcohol use among ART-naïve HIV-infected persons who denied consumption in rural Uganda. AIDS Care 29:1442-1447
Patts, Gregory J; Cheng, Debbie M; Emenyonu, Nneka et al. (2017) Alcohol Use and Food Insecurity Among People Living with HIV in Mbarara, Uganda and St. Petersburg, Russia. AIDS Behav 21:724-733
Woolf-King, Sarah E; Muyindike, Winnie; Hobbs, Marcia M et al. (2017) Vaginal Prostate Specific Antigen (PSA) Is a Useful Biomarker of Semen Exposure Among HIV-Infected Ugandan Women. AIDS Behav 21:2141-2146

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