PROVIDENCE – A Brown University team has been awarded $7.5 million to study a question that scientists are only beginning to answer: why alcohol seems to do particular harm to people with HIV, and what doctors with HIV-positive patients should do about it.
The study, financed by a five-year National Institutes of Health grant, is part of a growing body of research that examines life with HIV in an era when antiretroviral medications can keep people alive and relatively healthy for many decades.
HIV still affects the body, however, and scientists are learning more and more about the long-term effects of living with the virus – and of taking drugs that keep it in check.
One such lesson has been that alcohol can produce unique complications and risks for people with HIV. Peter Monti, director of the new Brown Alcohol Research Center on HIV, which will run the study, said both alcohol and HIV can weaken the brain and the liver, for example.
Drinking could also make a patient less careful about taking his medications, Monti said, or about remaining abstinent or engaging only in safe sex.
The purpose of this study, for which the center is recruiting healthy individuals living with HIV, is to help determine whether people with the virus need to stop drinking entirely or whether they just have to drink less, he said.
At least among some major groups of HIV-positive people, alcohol use is more prevalent than in the general population, said Monti, who also directs the Center for Alcohol and Addiction Studies at Brown’s Warren Alpert Medical School.
The new project will involve two major studies and four pilot studies, looking at both the physiological and the behavioral aspects of HIV and alcohol.
One study, based at The Miriam Hospital, will examine changes in the brain structure, metabolism and cognitive functioning of heavier and lighter drinkers with HIV over three years. Another, based at Fenway Health in Boston, will adapt an emergency room alcohol intervention Monti developed for a trial with chronic heavy drinkers with HIV.
The latter involves “motivational interviews” in which patients are given facts and feedback about how their drinking compares with that of peers and about the health effects. “You ask them whether they’d be interested in changing,” Monti said, “and if the answer is yes, you give them some thumbnail sketches about how they might want to go about that.”
The pilot studies will investigate the role of occult hepatitis C in the HIV and alcohol mix, the effects of HIV and drinking during pregnancy on newborns, the brain response that HIV-positive drinkers have to various stimuli, and the effects of drinking and HIV among fishermen and commercial sex workers in Uganda.
Additional pilot studies will be jointly funded by the new center and Brown’s Center for AIDS Research, based at The Miriam Hospital. Two researchers will also work to educate post-doctoral trainees and doctors in the specialty of alcohol and HIV.
Throughout the project, the team will share its findings with colleagues, clinicians and patients, aiming to start providing answers to many unanswered questions.
“Doctors often ask me what they should tell their HIV-positive patients who have no other risk factors than being HIV-positive about whether they can safely take a glass or two of wine with dinner,” said Monti. “We simply do not know.”
Don’t we already know the answers to these questions? Does anyone even question that alcohol has a detrimental effect on the liver and brain? Does the fact that these symptons are more acute with individuals with HIV surprise anyone?
If a person with HIV asks his/her doctor about whether they should quit drinking, wouldn’t the appropriate response be – “If you do not want any risk stop drinking, if drinking is that important to you then drink – in moderation – but accept the consequences”. Why do we need to spend $7.5 million for this. Couldn’t this money be better well spent for, let me think, a cure of HIV or cancer, etc. or not spent at all.
Richard, your answer is extremely short sighted. The purpose of the study come about because folks with HIV are living longer. These questions were never asked because no one expected to live very long. I know someone close to me that is living with HIV and is doing very well on these new drugs. There are many complications with them, but being alive is the main goal. Heavy drinking is not the question trying to be answered here. Since drinking alcohol is a normal activity in daily life for many, you have to look at the question from its entirity, which includes heavy drinkers. This study and its findings will be used with the many other studies conducted to help build a body of knowledge on HIV. The goal is to ultimately find a cure. Remember, penicillin was found by complete accident.