Alcohol use and immune reconstitution among HIV-infected patients on antiretroviral therapy in Nairobi, Kenya

ABSTRACT

Studies on the effects of alcohol use on HIV disease progression have been contradictory, with at least one study finding a positive effect of low alcohol consumption on CD4 count. In addition, most such studies have taken place in the developed West. We investigated the association between alcohol use and immune reconstitution through CD4 count response among HIV-infected individuals on antiretroviral therapy (ART) at an urban sub-Saharan African clinic. This was a retrospective cohort study of treatment-naïve HIV-infected adults initiating ART in Nairobi, Kenya and followed for 12 months between January 2009 and December 2012. At enrollment, a standardized questionnaire was used to collect data on sociodemographic variables and alcohol consumption. CD4 count was measured every six months. Linear regression models assessed the association between CD4 count and alcohol consumption, categorized as abstinent, moderate, or hazardous. Overall, 854 participants were included, 522 of which were women, with 85 (25.6%) men and 50 (9.6%) women reporting any alcohol use, and 8 (2.4%) men and 7 (1.3%) women reporting hazardous drinking. At baseline, alcohol use was associated with higher education and socioeconomic status. Median CD4 count was higher among alcohol users compared to those who abstained at baseline and at 6 and 12 months post-ART initiation, although this was only significant at 6 months. There were no differences in adherence between abstainers and drinkers. While overall alcohol use was significantly associated with higher CD4 counts, moderate and hazardous use treated separately were not. We conclude that, while alcohol use was associated with higher CD4 counts at 12 months post-ART, the mechanism for this association is unclear but may reflect unmeasured socioeconomic or nutritional differences. Additional research is required on the specific drinking patterns of this population and the types of alcoholic beverages consumed to clarify this relationship.

KEYWORDS:

• HIV
• alcohol
• CD4 count
• antiretroviral therapy
• Africa

Acknowledgements

A. Cagle implemented and designed the study, and participated in all data analysis. M. Chung, G. John-Stewart, and C. McGrath helped to design the study, interpret the data, and write the paper. B. Richardson assisted with statistical analyses and helped to design the study and write the paper. D. Donovan assisted on issues of substance abuse and helped write the paper. S. Sakr, N. Yatich, and R. Ngomoa helped to conduct the study in the field. Agnes Chepngeno Langat provided CDC guidance and editorial support. We would like to acknowledge the contributions of the research personnel and data management teams in Nairobi, Kenya, and Seattle, WA, USA; and the staff and clinicians at the Coptic Hope Center in Nairobi, Kenya, for providing a conducive environment for HIV care and research. The findings and conclusions in this paper are those of the author(s) and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention/Government of Kenya.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The Coptic Hope Center for Infectious Diseases is supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through a cooperative agreement [U62/CCU024512] from the Centers for Disease Control and Prevention. During development of this manuscript, Dr. McGrath was supported by the University of Washington STD/AIDS Research Training Fellowship [NIH NRSA T32AI007140] and a research career development award [K12HD052023: Building Interdisciplinary Research Careers in Women’s Health Program-BIRCWH] supported by ORWH, NIAID, and NICHD of the National Institutes of Health.