Last reviewed, October 2008

Next due for review, October 2009

Alcohol is a drug and comes in many forms, including beer, cider, wine, ‘alcopops,’ and spirits such as whisky, gin and vodka.

Alcohol is legally available in the UK from licensed outlets to people aged over 18 years and is enjoyed and used safely by many people. However, alcohol is a major cause of health and social problems, and, after tobacco, causes more deaths in the UK than any other drug.  This has led to new legislation which means that Alcoholic drinks will carry health warning labels by the end of 2008.

Short-term effects of alcohol

Alcohol relaxes the brain and body which some people find pleasurable. Many people find that moderate drinking (a unit or two of alcohol a day - a unit is a small glass of wine, or a half pint of normal strenght beer or lager, or a pub measure of spirits) helps relieve stress, encourages relaxation and acts as an appetite stimulant. However, its affects can also alter mood and lead to physical, psychological and social problems.

UK Chief Medical Officers recommends that men should not drink more than 3 to 4 units of alcohol per day. For women, the daily limit is 2 to 3 units.  Drinking your entire weekly limit in one session (often called binge drinking) is not recommended as it can lead to poor coordination, vomiting, exaggerated emotional reactions (including sadness, tearfulness, anger and aggression) and can lead to unconsciousness. Women who are pregnant or planning to become so, are advised to avoid alcohol.

A hangover – headache, dry mouth, feeling sick and tired – is a very common consequence of heavy drinking the night before. These effects are caused by dehydration and toxicities, so if you drink alcohol, you should drink plenty of water as well.

As even small amounts of alcohol can have an effect on your coordination, reactions and judgments. You should never drink even small amounts of alcohol and drive, or operate machinery.

Extremely heavy drinking can lead to coma and even death.

Longer-term effects of alcohol

Long-term heavy alcohol consumption (10 or more units a day in a man or 6 or more in a woman) can cause ill health, effecting the liver, heart and brain. Drinking every day can also lead to physical and psychological dependence on alcohol.

People who drink heavily often don’t eat well and this can cause further health problems. Alcohol is a depressive drug and can cause or make worse mental, psychological or emotional problems. Used in conjunction with other drugs, such as over the counter pain-killers like paracetamol, alcohol can have more serious effects.

Alcohol and HIV

There is no evidence that moderate drinking does any harm to people with HIV. However, if you have hepatitis or high levels of blood fats, then you may have to stop drinking alcohol or cut down alcohol consumption.

However, alcohol dependency is common amongst those with HIV and heavy drinking may affect your immune system and slow down recovery from infections. Studies conducted in both animals and in test tubes suggest that alcohol can interfere with the normal functions of various components of our immune system, impairing our body’s immune response to infection.

HIV-positive people who drink heavily and are not on anti-HIV drugs tend to have lower CD4 counts (a measure of immune system function) than moderate drinkers.

While, the same difference in CD4 count isn’t true for heavy drinkers who are taking anti-HIV drugs, they are more likely to be miss doses of their treatment than those who don’t drink. Alcohol can also damage the liver and a healthy liver is important for the body to process some antiretroviral medicines effectively. The blood fat increases caused by some anti-HIV drugs can be made worse by heavy drinking.

People who have hepatitis as well as HIV are advised not to drink alcohol at all, or to keep alcohol consumption to a minimum. People whose liver has been damaged by drinking too much alcohol (especially if they have hepatitis) are more likely to experience side-effects from anti-HIV drugs, particularly protease inhibitors.

There are no significant interactions between any of the currently available anti-HIV drugs and alcohol but alcohol can react badly with certain medicines (e.g. rifampicin, rifabutin, metronidazole). It is important to check with your pharmacist that alcohol is safe to drink with any medicines you are prescribed.

Alcohol can cause vomiting. If you vomit within an hour of taking a dose of your anti-HIV drugs, or any other medicine you have been told to take, then you should retake the dose.

Help with alcohol problems

If you are concerned about your alcohol use, speak to a member of your health care team. Alcohol Concern, one of the UK’s largest alcohol charities, can be contacted via http://www.alcoholconcern.org.uk/  , or phone Drinkline on 020 7264 0510. More information on Scottish support services is online at http://www.alcohol-focus-scotland.org.uk/, or phone 0141 572 6700.