Alcohol consumption and infectious diseases in South Africa

Abstract

In The Lancet's Series on health in South Africa, although alcohol misuse figured prominently in relation to violence,1Seedat M Niekerk AV Jewkes R Suffla S Ratele K Violence and injuries in South Africa: prioritising an agenda for prevention.Lancet. 2009; 374: 1011-1022Summary Full Text Full Text PDF PubMed Scopus (419) Google Scholar there was no mention of its link to infectious diseases.Heavy alcohol use has been causally linked to tuberculosis incidence.2Parry CDH Rehm JR Poznyak V Room R Alcohol and infectious diseases: are there causal linkages?.Addiction. 2009; 104: 331-332Crossref PubMed Scopus (61) Google Scholar Two pathways are involved: one biological via weakening of the immune system, and one social via social exclusion and drift, resulting in about a threefold increased risk of tuberculosis. There are also clear and consistent associations between alcohol use and HIV/AIDS, with a relative risk of 1·6–2·0 for problem drinkers versus non-drinkers.3Fisher JC Bang H Kapiga SH The association between HIV infection and alcohol use: a systematic review and meta-analysis of African studies.Sex Transm Dis. 2007; 34: 856-863Crossref PubMed Scopus (245) Google Scholar The causality is not clear, however, since personality variables could affect both alcohol consumption and unsafe sex. Additionally, a meta-analysis showed that alcohol use was associated with substantially lower adherence to antiretroviral therapy, in a dose-dependent manner.4Hendershot CS Stoner SA Pantalone DW Simoni JM Alcohol use and antiretroviral adherence: review and meta-analysis.J Acquir Immune Defic Syndr. 2009; 52: 180-202Crossref PubMed Scopus (357) Google Scholar Since such treatment is key for survival, alcohol thus seriously affects HIV mortality.Alcohol use was estimated to have been responsible for 939 000 disability-adjusted life-years lost in South Africa for tuberculosis and HIV/AIDS alone in 2004 (253 000 for women, 687 000 for men).5Rehm J Anderson P Kanteres F Parry CD Samokhvalov AV Patra J Alcohol, social development and infectious disease. Centre for Addiction and Mental Health, Toronto2009Google Scholar This figure corresponds to 4·6% of the overall disease burden in South Africa (2·5% for women, 6·6% for men).These numbers show the potential for reducing alcohol-attributable infectious disease burden in South Africa, since cost-effective measures for reducing alcohol-attributable harm in developing societies exist and could be applied.We declare that we have no conflicts of interest. In The Lancet's Series on health in South Africa, although alcohol misuse figured prominently in relation to violence,1Seedat M Niekerk AV Jewkes R Suffla S Ratele K Violence and injuries in South Africa: prioritising an agenda for prevention.Lancet. 2009; 374: 1011-1022Summary Full Text Full Text PDF PubMed Scopus (419) Google Scholar there was no mention of its link to infectious diseases. Heavy alcohol use has been causally linked to tuberculosis incidence.2Parry CDH Rehm JR Poznyak V Room R Alcohol and infectious diseases: are there causal linkages?.Addiction. 2009; 104: 331-332Crossref PubMed Scopus (61) Google Scholar Two pathways are involved: one biological via weakening of the immune system, and one social via social exclusion and drift, resulting in about a threefold increased risk of tuberculosis. There are also clear and consistent associations between alcohol use and HIV/AIDS, with a relative risk of 1·6–2·0 for problem drinkers versus non-drinkers.3Fisher JC Bang H Kapiga SH The association between HIV infection and alcohol use: a systematic review and meta-analysis of African studies.Sex Transm Dis. 2007; 34: 856-863Crossref PubMed Scopus (245) Google Scholar The causality is not clear, however, since personality variables could affect both alcohol consumption and unsafe sex. Additionally, a meta-analysis showed that alcohol use was associated with substantially lower adherence to antiretroviral therapy, in a dose-dependent manner.4Hendershot CS Stoner SA Pantalone DW Simoni JM Alcohol use and antiretroviral adherence: review and meta-analysis.J Acquir Immune Defic Syndr. 2009; 52: 180-202Crossref PubMed Scopus (357) Google Scholar Since such treatment is key for survival, alcohol thus seriously affects HIV mortality. Alcohol use was estimated to have been responsible for 939 000 disability-adjusted life-years lost in South Africa for tuberculosis and HIV/AIDS alone in 2004 (253 000 for women, 687 000 for men).5Rehm J Anderson P Kanteres F Parry CD Samokhvalov AV Patra J Alcohol, social development and infectious disease. Centre for Addiction and Mental Health, Toronto2009Google Scholar This figure corresponds to 4·6% of the overall disease burden in South Africa (2·5% for women, 6·6% for men). These numbers show the potential for reducing alcohol-attributable infectious disease burden in South Africa, since cost-effective measures for reducing alcohol-attributable harm in developing societies exist and could be applied. We declare that we have no conflicts of interest.