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Alcohol and HIV: Your Guide

Posted on November 23, 2021
Medically reviewed by
Barry S. Zingman, M.D.
Article written by
Nyaka Mwanza

If you’ve been diagnosed with HIV, you may wonder how drinking could affect your health or treatment. People with HIV tend to drink more than the general population, but some studies indicate that even moderate drinking (an average of one drink per day) could be more harmful for people with HIV than for people without HIV.

There are several reasons you may want to reduce or eliminate your alcohol intake if you are living with HIV or are at higher risk of HIV infection. Drinking may impact your risk of transmitting or contracting HIV, and drinking may affect adherence to and outcomes of HIV treatment.

This article provides information about HIV and alcohol that can help you make an informed decision about whether you’d like to drink — and, if so, how much and how often. Your HIV treatment team and other health care providers are best qualified to help you determine whether consuming alcohol is a relatively safe and healthy option for you. Speak to your doctors and clinicians honestly about how you use alcohol and how it may impact your health.

Alcohol and Risk of HIV

Drinking alcohol is a known risk factor for HIV. That’s because when you drink, your judgment may be impaired, making you more likely to engage in risky behaviors such as having unprotected sex or using recreational drugs — both of which can increase the risk of HIV.

These behaviors also increase your risk of exposure to other sexually transmitted infections (STIs). Having another STI may make it easier to transmit or contract HIV.

People who regularly drink alcohol in excess are less likely to take their HIV medications consistently and more likely to delay seeking health care and regular HIV testing, which also contribute to the spread of HIV.

Alcohol and HIV Treatment

Alcohol and HIV medications do not interact in a way that impacts the medications’ effectiveness, and the effect of the combination is not toxic unless you have liver damage. While there’s no drug interaction between alcohol and HIV medications specifically, alcohol can interfere with your ability to take your medication as prescribed. Plus, alcohol may interact with other medications you may need to take.

Alcohol and Liver Damage

Alcohol can cause or contribute to liver damage. Liver damage or liver disease is especially problematic for people living with HIV because most HIV medications are processed through the liver. Liver damage from drinking or hepatitis can affect how effective these medications are. If you have liver damage, you may also be more likely to experience side effects from your medications.

Treatment Adherence

Treatment adherence refers to taking medication exactly as prescribed. Research has found that drinking too much can interfere with adherence to antiretroviral therapy. In one study, over 50 percent of people with HIV reported having skipped or stopped taking their medication while drinking. Missing doses can lead to increases in your viral load and may also contribute to faster disease progression.

Drug Interactions

Always check with your doctor or pharmacist about whether alcohol is safe to drink with the medications prescribed to you. While alcohol does not interact with HIV drugs directly, alcohol may interact dangerously with other medications you may be taking, including:

  • Antibiotics, such as metronidazole and tinidazole
  • Antituberculosis drugs, such as rifampicin and rifabutin
  • Antidepressants and sedatives, such as diazepam
  • Pain medications, especially opiates

Alcohol and Immune Function

Chronic or excessive alcohol use can weaken the immune system, which is already compromised by HIV. This effect means that alcohol can make it even harder for the body to prevent, fight off, and recover from HIV and secondary infections.

One study found that heavy drinking, in particular, impacted the way the immune system functions. In this study, heavy drinking was defined as three drinks or more per day for women and four drinks or more per day for men. The findings of this study suggest that alcohol may contribute to an increased risk of death by disrupting immune function in people with HIV.

Studies have also shown that in people living with HIV, antiretroviral therapy may be able to counteract some of the negative effects of alcohol on T cell counts. It is critical that people with HIV who drink alcohol take their HIV medications and adhere to their treatment plan.

Alcohol and Mental Health

Between 10 percent and 28 percent of people with HIV have at least one diagnosed mental health disorder, such as anxiety or depression. Because alcohol is a depressant, drinking alcohol may make mental health issues worse. Worsening mental health is especially problematic for people with HIV, as mood disorders may prevent a person from adhering to their treatment plan.

Mood disorders may also sometimes contribute to substance use disorders. Substance abuse, particularly intravenous drug use or use of alcohol, methamphetamine, cocaine, or inhalants, plays a large role in the spread of HIV.

Should You Drink if You Have HIV?

With proper and consistent HIV treatment and regular access to health care, people with HIV who live a generally healthy lifestyle can expect to live about as long as people who do not have HIV. A healthy lifestyle includes a balanced diet, regular exercise, and moderate to no alcohol consumption.

Ultimately, the decision of whether to drink is yours to make. But for those who do drink alcohol, drinking less alcohol and drinking less frequently may be better for your health. It is important to discuss alcohol consumption with your doctor to make sure you are approaching it safely.

When Could Drinking Be Problematic?

Some people struggle to drink moderately, drink more frequently than they should, or experience problems drinking such as binge drinking, alcohol use disorders, and alcohol dependence.

If this sounds like you, don’t be afraid to be honest with your doctor about your habits and preferences — remember, your doctor wants to work with you to make your life as manageable as possible, not to judge or shame you. Monitor how you feel when you drink alcohol, and be willing to have open and honest conversations about drinking with your doctor and other important people in your life.

If you are concerned about the alcohol use of yourself or a loved one, know that there are many support groups, substance abuse treatment programs, and other tools that can help. Your doctor should be able to offer you referrals or recommendations for where to get help.

Find Your Team

On myHIVteam, the social network for people with HIV and their loved ones, more than 32,200 members come together to ask questions, give advice, and share their experiences with others who understand life with HIV.

How does alcohol affect your life with HIV? Share your thoughts in the comments below, or by posting on myHIVteam.

References
  1. HIV and Substance Use — Centers for Disease Control and Prevention
  2. Alcohol Use and Your Health — Centers for Disease Control and Prevention
  3. Association Between Alcohol Use and Inflammatory Biomarkers Over Time Among Younger Adults With HIV — The Russia ARCH Observational Study — PLOS ONE
  4. Alcohol and HIV Risk — HIV.gov
  5. Alcohol Consumption and HIV Disease Progression — Journal of Acquired Immune Deficiency Syndromes
  6. Alcohol and HIV — NAM
  7. Risk of Mortality and Physiologic Injury Evident With Lower Alcohol Exposure Among HIV Infected Compared With Uninfected Men — Drug and Alcohol Dependence
  8. Avoiding Drugs and Alcohol — UC San Diego Health
  9. Rethinking Drinking — National Institute on Alcohol Abuse and Alcoholism
  10. Substance Use and HIV Risk — HIV.gov
  11. Co-Occurring Disorders and Other Health Conditions — Substance Abuse and Mental Health Services Administration
  12. Alcohol Consumption and CD4 T-cell Count Response Among Persons Initiating Antiretroviral Therapy — Journal of Acquired Immune Deficiency Syndromes
  13. Prevention and Treatment of HIV Among People Living With Substance Use and/or Mental Disorders — Substance Abuse and Mental Health Services Administration
  14. Intentional Non-Adherence to Medications Among HIV Positive Alcohol Drinkers: Prospective Study of Interactive Toxicity Beliefs — Journal of General Internal Medicine
  15. Substance Abuse Treatment for Persons With HIV/AIDS — Substance Abuse and Mental Health Services Administration
  16. Focus on the Liver: Alcohol Use, Highly Active Antiretroviral Therapy, and Liver Disease in HIV-Infected Patients — National Institute on Alcohol Abuse and Alcoholism
  17. ​​Focus on the Heart: Alcohol Consumption, HIV Infection, and Cardiovascular Disease — National Institute on Alcohol Abuse and Alcoholism
  18. Alcohol’s Role in HIV Transmission and Disease Progression — National Institute on Alcohol Abuse and Alcoholism
  19. Focus on the Brain: HIV Infection and Alcoholism — National Institute on Alcohol Abuse and Alcoholism
  20. A Recent Perspective on Alcohol, Immunity, and Host Defense — Alcoholism: Clinical and Experimental Research
All updates must be accompanied by text or a picture.
Barry S. Zingman, M.D. specializes in HIV/AIDS medicine and general infectious disease. Review provided by VeriMed Healthcare Network. Learn more about him here.
Nyaka Mwanza has worked with large global health nonprofits focused on improving health outcomes for women and children. Learn more about her here.

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