In the past 35 years, HIV infection has transformed from an illness that was almost invariably fatal to a chronic disease that can be managed. HIV medications have made it possible to control the HIV, which has led to dramatically increased survival and longer lives for people with HIV.

While scientists continue the search for a cure, research is also being conducted to understand how people with HIV can achieve maintain health as they age, and to identify barriers to successful self-management.

One such barrier is the use (and misuse) of alcohol.

Alcohol is the most widely abused substance in the United States, and estimates as high as 50 percent of people with HIV in the U.S. have histories of alcohol problems. Alcohol use has been associated with new infections, increased hospitalizations, causing inflammation that increases the amount of HIV in the body, and progression to illicit drug use.

Gender also plays a major role in the overall impact of alcohol consumption. Men and women process alcohol differently, with women naturally absorbing more alcohol and having slower alcohol metabolism regardless of the amount they drink.

Women with HIV are a group that is at particularly high risk for health complications related to alcohol use, as a smaller quantity of alcohol can interfere with HIV treatment compared to men. Furthermore, alcohol has been linked to liver dysfunction, cardiovascular disease, and interference with HIV medications.

In addition to the many physiological affects of alcohol in people with HIV, studies are also showing that higher levels of alcohol use are related to decreased self-management of HIV.

In a recent study, we examined the relationship between drinking and important self-management behaviors in 52 men and 39 women. Our data showed that women in the study were less likely to engage in self-management behaviors as drinking behaviors increased. This finding illustrates that drinking can adversely affect the health of people with HIV.

Where do we go from here?

Addressing substance misuse of any sort is challenging, but perhaps even more so in the case of alcohol. The impact of alcohol may be obscured by the fact that it is legal, considered generally harmless in moderation, and less stigmatized than illicit drugs (e.g., injection drugs, methamphetamine, crack cocaine).

It may also not appear to be a problem that would affect people with HIV any differently than people who do not have HIV. However, the National Institute on Alcohol Abuse and Alcoholism has called for more research on alcohol use in people with HIV.

We need to further our understanding the precursors, causes, and conditions that lead to harmful drinking behaviors that can derail even the best efforts to achieve and maintain health in people with HIV. In doing so, we will be adding one more solution to the question of how to best promote health in people living with HIV.