Long-Term HIV Viral Suppression Not Affected by Alcohol Reduction

Viral suppression was unchanged after a year when patients with HIV (PWH) were engaged in a 6-month alcohol reduction intervention or isoniazid (INH) adherence incentives for HIV, according to a study published in eClinicalMedicine.1 Viral suppression remained high throughout the year of observation.

Many PWH have an unhealthy relationship to alcohol use, which is associated with poor outcomes in HIV.2 Unhealthy alcohol use can also lead to tuberculosis (TB) in areas where the prevalence is high. Interventions and incentives to promote healthy lifestyles have been effective in the past. This study aimed to assess how incentives to reduce the use of alcohol and promote adherence to INH could affect viral suppression 6 months after the incentives were discontinued.

Data from the Drinkers’ Intervention to Prevent Tuberculosis trial was used for this study. All participants were aged 18 years or older, were living with HIV, had a positive Alcohol Use Disorder Identification Test—Consumption score for the previous 3 months, and had a positive urine ethyl glucuronide point of care test. Participants also had to have no history of active TB or medication for TB and had to be currently using antiretroviral therapy (ART). Participants who were pregnant or were using ART based in nevirapine were excluded from the study.

Participating in alcohol reduction interventions did not change the high viral suppression of the participants | Image credit: maeching - stock.adobe.com

All participants were randomized 1:1:1:1 into intervention and non-intervention groups, with groups 2 and 4 being intervention groups. Incentives were given to participants based on their recent abstinence from alcohol. Surveys were given at baseline and after 3, 6, and 12 months. All participants had alcohol reduction counseling at their baseline visit, whereas the follow-up visits based further counseling on risk of severe alcohol use disorder.

Viral suppression of less than 200 copies/mL at 12 months and no or low-risk of alcohol use was the primary outcome of this study.

There were 680 participants included in the study who were randomized 169:169:170:172 into the 4 arms. There were 619 participants who had alcohol use data and/or viral load measurement after 12 months, of which 70% were men with a median (IQR) age of 40 (32-47) years; 60% were married. A total of 95% of the participants had a suppressed HIV viral load. All participants had very-high-risk, high-risk, or medium-risk alcohol use.

A total of 97.2% of the participants with HIV and viral load results after 12 months were virally suppressed, with 96.7% of the alcohol reduction incentive group and 97.6% of the no alcohol reduction incentive group reporting viral suppression (adjusted risk difference [aRD], –0.9%; 95% CI, –3.6% to 1.7%). The INH adherence group had 98.3% viral suppression and the no INH adherence incentive group had 96.0% viral suppression (aRD, 2.2%; 95% CI, –0.4% to 4.9%). A total of 71% of the participants who had no or low risk of drinking after 3 and 6 months also had no or low risk of alcohol use after 12 months; 6% of those who did not have no or low risk of alcohol use after 3 and 6 months had no or low risk of alcohol use after 12 months.

There were some limitations to this study. There were participants who did not participate in the primary viral load or alcohol use outcomes at the 12-month mark. The use of ART and alcohol was self-reported and could affect the accuracy of the results due to social desirability bias or recall bias. The differential impact of those with or without alcohol use disorder was not studied. All participants who were enrolled had high baseline HIV viral suppression and the efficacy of the interventions on long-term viral suppression was limited.

The researchers concluded that they “found sustained lower levels of alcohol use at 12 months in the alcohol reduction intervention versus no alcohol intervention arms, suggesting that intervention effects persist after incentives are no longer provided.” PWH had sustained viral load suppression with the decreased use of alcohol, which helped to bolster the health of those who participated.

References

1. Muyindike WR, Fatch R, Lodi S, et al. Alcohol use and HIV suppression after completion of financial incentives for alcohol abstinence and isoniazid adherence: a randomized controlled trial. eClinicalMedicine. 2025;80:103045. doi:10.1016/j.eclinm.2024.103045
2. Bolt A. HIV and alcohol: consumption, tolerance, safety, and more. WebMD. April 3, 2022. Accessed January 27, 2025. https://www.webmd.com/hiv-aids/hiv-alcohol