Key points
- Long-term alcohol use can increase the risk of serious health conditions.
- Alcohol can damage the liver which plays an important role in how the body processes anti-HIV drugs.
- Drinking alcohol may be more harmful for people with HIV than for HIV-negative people.
- Alcohol does not stop anti-HIV drugs from working properly.
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 also a major cause of health and social problems, and, after tobacco, causes more deaths in the UK than any other drug.
What are the UK guidelines on alcohol?
New UK guidelines on alcohol were published in 2016. The UK Chief Medical Officer’s recommendation is that people should not regularly drink more than 14 units of alcohol a week. This applies to both men and women.
A unit of alcohol is around:
- a third of a pint of beer, lager or cider (at 5 to 6% alcohol)
- half a standard glass of wine (a standard glass is 175ml)
- a single measure of spirits (25ml)
- a small glass of sherry or port (50ml).
It is also recommended that you spread your alcohol intake over the week rather than saving up your units for one session – often called binge drinking. At the same time, it’s best to have some alcohol-free days each week.
Binge drinking can lead to poor co-ordination, vomiting, exaggerated emotional reactions (including sadness, tearfulness, anger and aggression) and loss of memory. It can also lead to heart problems, alcohol poisoning, and unconsciousness.
Alcohol can contain a lot of calories and sugar, so it’s worth being mindful of this too.
There is a good tool to help you calculate how many units of alcohol (and calories) there are in your drinks on the Drinkaware website.
Drinking alcohol during pregnancy can harm an unborn baby, so people who are pregnant or planning to become pregnant are advised to avoid alcohol.
Short-term effects of alcohol
Alcohol relaxes the brain and body which some people find enjoyable. Many people find that drinking helps relieve stress, encourages relaxation, and acts as an appetite stimulant. However, its effects can also alter mood and lead to physical, psychological, and social problems.
A hangover – headache, dry mouth, feeling sick and tired – is a very common consequence of heavy drinking. These effects are caused by dehydration as well as toxicities. So, if you drink alcohol, you should drink plenty of water as well. Alternating between alcoholic and non-alcoholic drinks, drinking more slowly, not drinking on an empty stomach and eating something while you’re drinking can also help to reduce a hangover and the short-term effects of alcohol.
Even small amounts of alcohol can have an effect on your co-ordination, reactions, and judgments, including influencing decisions you make about sex. The safest approach is to avoid alcohol completely if you plan to drive, or operate machinery.
Extremely heavy drinking can lead to coma and even death.
Longer-term effects of alcohol
Long-term heavy alcohol consumption can increase the risk of serious health conditions. These include a wide range of cancers, heart disease, high blood pressure, stroke, liver disease, pancreatitis, dementia, sexual problems, and infertility. People who drink heavily also often don’t eat well and this can cause further health problems.
In addition, alcohol is a depressive drug that can cause, or make worse, mental, psychological, or emotional problems, such as depression.
Excessive drinking can lead to physical and psychological dependence on alcohol. You might be dependent on alcohol if you feel like you don’t have control over how much you’re drinking, or you find you’re having very strong desires to drink alcohol.
Alcohol and HIV
There is some evidence that drinking alcohol is more harmful for people with HIV than people who don’t have HIV. For this reason, sticking to the recommendations of no more than 14 units per week is particularly important.
Some studies have shown that people with HIV, who drink the same amount as HIV-negative people, have higher blood alcohol levels than those who don’t have HIV. People who aren’t on anti-HIV drugs have been found to have even higher levels of alcohol in their blood.
Drinking even a small amount of alcohol can speed up liver damage in people who have hepatitis B or C. Heavy drinking can worsen the increases in blood fats (such as cholesterol) caused by some anti-HIV drugs. There’s also evidence that heavy drinking increases the risk of heart disease in people living with HIV more than in people without HIV.
Alcohol and HIV medication
Drinking too much can make it harder for you to take your drugs in the right way and at the right time. Studies have shown that people with HIV who drink alcohol are more likely to miss doses of their treatment than those who don’t, especially when they drink a lot on one occasion (binge drink).
Being dependant on alcohol has also been linked to unsuppressed viral load.
Alcohol can also cause vomiting. If you’re sick (vomit) after taking your HIV treatment, you usually don’t need to take another dose because the medication will already have been absorbed into your body. But you might need to take another dose if:
- it’s been less than 2 hours since you took your pills
- you are taking rilpivirine and it’s been less than 4 hours since you took your pills
- you see the pills, or bits of them, in the vomit.
Alcohol can damage the liver. Heavy drinking can cause hepatitis (inflammation of the liver). It is particularly important that people with HIV take care of their liver – it plays a vital role in how the body processes anti-HIV drugs. If your liver has been damaged by drinking too much alcohol, you are more likely to experience side-effects from some anti-HIV drugs.
It’s sometimes said that alcohol and HIV medications “do not mix”. But as long as you don’t have hepatitis or liver disease, this is a myth. There are no interactions between alcohol and HIV medications, and alcohol does not stop the medications from working.
However, alcohol can react badly with certain other medicines. These include the antibiotics metronidazole, tinidazole and the anti-TB drugs rifampicin and rifabutin.
Alcohol should be avoided if you are taking antidepressants and sedatives (such as Valium) and can interact with some other long-term medications. It is important to check with your pharmacist that alcohol is safe to drink with any medicines you are prescribed. It can also be dangerous to mix alcohol with illegal drugs.
Help with alcohol problems
Alcohol dependency is common in people living with HIV in the UK. If you are concerned about your alcohol use, speak to a member of your healthcare team. There are also lots of organisations who can give you advice and support.
The charity Alcohol Change UK can be contacted via its website, or phone Drinkline on 0300 123 1110.
The website Drinkaware provides a list of support services that may be helpful.