Magazine
On ARVs? Then quit drinking
Doctors recommend two units of beer for men and one for women a day. File Photo
When John Adiwa lost his job because of excessive and irresponsible drinking, he, ironically sought solace in alcohol and suffered frequent illnesses.
His doctor advised him to take an HIV test, which turned out positive.
He blames his irresponsible drinking. “I am sure were it not for alcohol, I would not have contracted HIV.
My binge drinking led me to having unprotected,” he says. He has since quit drinking and has been clean for three years.
His doctor advised him to quit drinking if he’s on antiretroviral drugs (ARVs) because the two are a dangerous combination and compromise the immune system. “My health has greatly improved since I quit drinking and my CD4 count is improving gradually,” he said.
According to experts, alcohol is not recommended for people living with HIV and on antiretroviral treatment, and medics have raised an alarm over the same.
According to Dr David Bukusi, a psychiatrist and head of the voluntary counselling and testing at Kenyatta National Hospital, the liver which undertakes overall metabolism in the body, would choose to process alcohol first, then the ARVs if taken at the same time.
“This is because alcohol is a simple sugar and less complex than the regimen of antiretrovirals. This means that if you are on ARVs and drinking, the medication will not stay at meaningful levels in the blood in order to fight the immune-wrecking virus,” he explains.
He further adds that chronic drinking does not only reduce the efficacy of ARVs but also leads to fast progression of the disease since excessive alcohol intake in itself wrecks the immune system.
This fact is further echoed by a new study published recently by Aids Research and Human Retroviruses, a peer-reviewed journal in the US which found out that the progression from HIV to Aids tends to progress at a faster rate in infected individuals who consume two or more alcoholic drinks in a day.
Dr. William Sinkele who heads support for addictions, prevention and treatment in Africa, draws the line between alcohol use and abuse.
“It should be two units of 300 millilitres of lager beer for a man in a day and one can for a woman. Regarding this, it is easy to tell that a majority who take alcohol actually abuse it,” he says, adding that other types of alcohol vary in content and purity.
He says that this variation is primarily because men have more muscle fat and water is distributed evenly in their bodies compared with women who have more body fat and thus alcohol gets more directly into their blood stream than men.
Alcohol has also been found to react negatively with ARVs. For example, someone on antiretrovirals such as stavudine or zidovudine should avoid alcohol all together because of the serious side effects that can occur.
Besides causing liver damage making it impossible to metabolise ARVS, alcohol also speeds up their breakdown, increasing the side effects and hindering the body’s adherence to ART.
It is widely believed that alcohol increases risk taking, a habit that can lead to infection.
Dr Nduku Kilonzi of Liverpool VCT and Care n Nairobi argues that alcohol affects your sensory and mortal control thus influencing your ability to judge collectly and make the right decisions.
She relates the severity of alcoholism to TB which is the most common and serious opportunistic infection for those with HIV. “HIV and alcohol are a dangerous combination too since both kill the immune system.
This is despite the fact that those who abuse alcohol practice poor diet and are less likely to adhere to the drugs.
There have also been reported cases of patients who wash down their ARVs with alcohol. Doctors warn that this could cause serious side effects.
Those who drink excessively also run a high risk of foregoing treatment thus causing a drop in the CD4.
Without effective treatment, the average decline per year in CD4 count is 60 to 80 cells per ml although this varies from one patient to the other and over different times.
Despite the recognition of the role that alcohol plays in fuelling the HIV pandemic, researchers are facing many challenges on how to respond to alcohol use in HIV prevention and adherence to anti retroviral drugs.
In East Africa, few HIV prevention programmes, including VCT programmes have directly addressed the issue of HIV risk behaviour as a result of alcohol use.
This is partly because service providers offering HIV prevention programmes are not formally required to ask their clients about whether they use alcohol hence missing a great opportunity to address the risk factor.
