Summer arrives, and with it comes more daylight hours, warmer temperatures, outdoor parties, and summer drinks. But before you think of an icy margarita or mojito as carefree or even therapeutic beyond its refreshing taste and social enjoyment, it is important to know the possible downsides of alcohol consumption.
It is unlikely that much prospective clinical research about chronic alcohol ingestion in HIV-infected people will happen. Thus, most of this type of research has been conducted on simians with immunodeficiency virus infection. Simian research suggests that chronic and excessive alcohol consumption is an all-around hazard because it can lead to increased viral replication and disease progression. One study on the effects of alcohol on metabolism in simians with immunodeficiency virus infection showed that aside from viral load increases and immune cell derangements, cytokine levels in skeletal muscle were elevated. This inflammatory process sets the stage for muscle wasting. In addition, the simians changed food habits and reduced calorie intake early in the study, which could exacerbate muscle wasting.
Moving away from simianville, we can look at published human research. Chronic and binge alcohol consumption appears to lead to metabolic changes that accelerate cardiovascular disease risk, liver impairment, glucose intolerance, and other changes that are associated with lipodystrophy. Higher levels of LDL (bad) cholesterol and triglycerides (blood fats) are associated with higher levels of alcohol consumption. If someone has hyperlipidemia, treatment includes a reduction or abstinence of alcohol use along with diet and exercise changes. (If you like just the flavor of a cocktail, try the accompanying recipe for a mojito virginal.) In patients treated with antiretrovirals, alcohol use has been associated with body shape changes, though this finding remains controversial. Excessive alcohol consumption is also associated with accelerated loss of bone, leading to weakened bones and bone death, which is already a problem in chronic HIV infection. Ramping up, routine consumption of 50 grams of alcohol per day'the equivalent of four to five drinks'can increase the risk of liver disease progression in people with hepatitis C coinfection.
Alcohol is processed through the liver and can therefore interfere with many medications. Chronic alcohol intake can interact with antiretrovirals, especially protease inhibitors and nonnucleoside reverse transcriptase inhibitors, decreasing antiretroviral drug levels in the blood and consequently their effectiveness. Alcohol consumption could increase the risk for pancreatitis associated with medications such as didanosine, stavudine, and others. In the case of abacavir, antiretroviral drug levels can be increased by up to 60%'exacerbating any associated side effects'when alcohol levels reach 0.1% in the blood (which can be achieved with as little as two drinks). Some medications already contain alcohol. For instance, Kaletra contains 42% alcohol in its oral solution.
Alcohol use is also associated with a lower rate of antiretroviral medication adherence, which is crucial to drug effectiveness. Other research has found that alcohol in moderation'two drinks or fewer per day'might have some beneficial effects. You may have heard that a glass or two of wine or beer can slightly reduce cardiovascular disease risk, even for HIVers. At this level of moderation, alcohol might help to increase 'good' HDL cholesterol. Some clinicians have even suggested mild alcohol consumption as a way to reduce anxiety, although that's only a short-lived solution to a more complex problem.
So what is the bottom line for most HIVers? Low levels of consumption might not cause a problem for many people living who do not have other reasons to avoid alcohol. However, passing that two-drink mark on a routine basis could cause problems, including increasing the risk for nonadherence and medication interactions, chronic diseases, and body changes, such as muscle wasting and altered body shape. If you drink alcohol, moderation and balance are key, just as with other diet and exercise choices. Make your own best choices'somewhere in the middle of the road.
1/2 a fresh lime (or a whole key lime)
2 fresh mint leaves
8 ounces lemon-lime soda (diet or regular)
Crushed or cubed ice
Squeeze lime juice into a small bowl or cup, add one of the mint leaves, mash them together, and transfer to a mesh strainer. Hold the strainer over a tall glass of ice and pour in the soda, transferring the fresh mint and lime flavors. Garnish with the remaining mint leaf and lime rind.