HIV update - 17th February 2016

Moderate alcohol consumption may be more harmful for people with HIV

Safe drinking limits for people living with HIV may need to be lower than the recommendations for the rest of the population, according to a large American study. The drinking habits and health outcomes of over 18,000 men living with HIV were compared with those of over 42,000 men who didn’t have HIV. Most participants were in their forties, fifties and sixties.

Alcohol contributes to a wide range of cancers, liver disease, stroke and heart disease.

Looking at deaths from any cause, the researchers found a strong relationship between the amount people with HIV drank and their risk of death. After adjusting for other factors that could influence the results, men who had 30 to 70 alcoholic drinks a month (i.e. one or two a day) had a 30% higher risk of death than men who hardly drank at all. Men who drank more than this (70 or more drinks a month) had a 50% greater risk.

In contrast, only the higher level of drinking (70 or more a month) made a difference to deaths in HIV-negative men.

There were similar results when looking at results of blood tests, liver function tests and other markers of poorer health – there wasn’t any level of alcohol consumption which was ‘safe’ for men with HIV.

One limitation of the study is that it only includes data on men. Nonetheless, the greater harm caused by a unit of alcohol in women is well established. The overall findings probably apply to women, but at lower levels of alcohol consumption.

Some other studies suggest that a person living with HIV who consumes the same amount of alcohol as an HIV-negative person would have higher levels of alcohol in their blood than the person without HIV. This effect may be especially pronounced in people who aren’t taking HIV treatment.

The researchers concluded that people with HIV who drink more than 30 alcoholic drinks a month are at increased risk of health problems. This was an American study, using American standard drinks – for example, one drink is a small can of beer, a small glass of wine or a shot of whisky. No more than 30 drinks a month would amount to no more than one drink a day.

UK health authorities calculate alcohol quantities differently, but recently released advice from the Chief Medical Officer is consistent with the recommendations of the American study. One “unit” of alcohol in the UK is roughly half of a standard drink in the US. The UK government now recommends alcohol consumption below 14 units a week, which is the same as 8 American standard drinks a week – i.e. roughly one drink a day. 

However very few people in the general population and even fewer people with HIV drink this little. But this is the first major study to show that there are particular advantages for people living with HIV to cut back on alcohol.

There’s more information about the UK’s official alcohol advice here.

Women under-represented in HIV clinical trials

Less than a quarter of people taking part in clinical trials for new HIV treatments are women, a study has found. Limited participation of women in medical research is a concern in a wide range of disease areas, but the problem appears to be particularly acute in HIV.

It’s possible that gender differences in the way drugs are absorbed and distributed in the body and in the effect of drugs on the body can result in differences in side-effects and response to treatment for men and women. If few women are recruited to clinical trials, these issues may not be picked up.

Family and caregiving responsibilities can make the time commitment of trial participation more challenging for women, but some researchers have found practical ways to help women participate. Other issues limiting women’s participation are concerns about the safety of new medicines for an unborn child and requirements to use contraceptives while taking part in a study.

You can find out more about what’s involved in taking part in a study in our factsheets on Clinical trials and Thinking about joining a clinical trial?

Kidney and liver transplants

If a person living with HIV has kidney failure or end-stage liver disease, could a kidney or liver transplant be effective? While some experts have said that transplants are too risky, American doctors have recently reported good results.

Those receiving transplants were carefully assessed as suitable for transplantation. A total of 150 HIV-positive people received kidney transplants and had similar results to HIV-negative people. A total of 125 HIV-positive people received a new liver and this improved their chances of survival, compared to a comparable group of HIV-positive people who did not have a transplant. Nonetheless outcomes were not quite as good as in HIV-negative people.