Researchers Advise Taking HIV Meds, Even When Drinking

A new study found that a number of people taking HIV meds intentionally skip doses when drinking, a practice that for most is more dangerous than mixing the two.

Researchers at the University of Connecticut followed the habits of 178 primarily African-American participants in Atlanta, Georgia, who were on HIV meds and regularly drank. Two-thirds were men, most of whom were gay, or men who have sex with men (MSM).

The researchers found that while being intoxicated played a role in missing doses, half of the participants actually purposefully skipped for fear of mixing.

"It's very common for people to believe it's harmful to mix medications in with alcohol, and often it's true," said UConn psychology professor and study author Seth Kalichman. "With certain antidepressant, psychiatric and pain medications, it's very harmful, but with antiretrovirals, it's only harmful if they have liver disease."

If you don't have liver disease, skipping HIV meds when you know you'll be drinking, or waiting for the alcohol to leave your system, is actually a bad idea, especially if you make a habit of it.

"With a missed dose here and there, the meds are more forgiving, but when people miss a succession over time or a few days, that's when you really start to get worried," Kalichman said.

That's because missing a series of doses puts patients at risk of developing treatment-resistant virus. Higher viral loads also mean greater risk of transmission.

So why do so many patients hold onto these misbeliefs and intentionally skip? Kalichman suspects it is part common misassumption, part doctors not thoroughly discussing it with them.

"It's common in general for doctors to tell patients not to drink when they take medications and we think the message may get garbled and HIV patients may hear that as, 'I shouldn't be mixing things,'" he said. "Also, doctors may be assuming patients will stop drinking when they go on medications. Communication needs to be much more specific and clearer."

Alcohol suppresses the immune system, but it doesn't make HIV meds ineffective.

Kalichman did acknowledge that some of the participants didn't have the best track record of remembering to take their meds every day, even on days when they didn't drink. And people are of course more likely to forget to take their meds when they're hammered. Still, he said, half of the study participants reported skipping intentionally when drinking, and that speaks to their beliefs and misconceptions.

The two-year project, funded by the Recovery Act and published in the Journal of General Internal Medicine, was born out of similar studies Kalichman conducted on alcohol use and non-adherence to HIV medication regimens. They too, were based in Atlanta.

In Los Angeles, Gay & Lesbian Center Medical Director Dr. Robert Bolan said he's rarely had patients ask him about drinking while on antiretrovirals.

"I wouldn't say most of our patients have that belief, but I don't know," he said. "We don't really track that kind of information."

He said people with HIV are more likely to struggle with depression, to abuse alcohol and that MSM are more likely to use drugs like crystal meth.

"I think we can ask patients whether they have beliefs around HIV medication and drugs and alcohol, and if they do, we can certainly correct them. People shouldn't think that a weekend or two of drinking and taking their meds will cause liver failure. But when it comes to crystal meth and amphetamine, there are real interactions," said Bolan.

While the study findings are interesting, he said, they are reflective of one part of the country.

"People's health beliefs vary by racial and ethnic groups, by region, age and so forth. Whenever a study comes out showing a particularly dramatic association like this one, most experts will call for more research in other populations to see if the results are reproduced," Bolan said. "In the meantime, doctors should incorporate education about HIV medications into their general counseling about alcohol use."