Abstract
Sustained heavy ethanol drinking is a common problem globally and ethanol is one of the most abused drugs among individuals of different socio-economic status including the HIV-infected patients on antiretroviral drugs. Ethanol is reward drug and a CNS depressant especially at high doses. The study determined the effect of sustained heavy ethanol drinking by HIV-infected patients on d4T/3TC/NVP regimen on CD4+ cell counts in Uganda using WHO AUDIT tool and chronic alcohol-use biomarkers. A case control study using repeated measures design with serial measurements model was used. The patients on stavudine (d4T) 30 mg, lamivudine (3TC) 150 mg and nevirapine (NVP) 200 mg and chronic alcohol use were recruited. A total of 41 patients (20 in alcohol group and 21 in control group) were screened for chronic alcohol use by WHO AUDIT tool and chronic alcohol use biomarkers. They were followed up for 9 months with blood sampling done at 3 months intervals. CD4+ cell count was determined using Facscalibur Flow Cytometer system. Results were then sorted by alcohol-use biomarkers (GGT, MCV and AST/ ALT ratio). Data were analysed using SAS 2003 version 9.1 statistical package with repeated measures fixed model and the means were compared using student t-test. The mean CD4+ cell counts in all the groups were lower than the reference ranges at baseline and gradually increased at 3, 6 and 9 months of follow-up. The mean CD4+ cell counts were higher in the control group as compared to the chronic alcohol use group in both WHO AUDIT tool group and chronic alcohol-use biomarkers group though there was no significant difference (p > 0.05). Chronic alcohol use slightly lowers CD4+ cell count in HIV-infected patients on d4T/3TC/NVP treatment regimen.
Highlights
Sustained heavy ethanol drinking is a common problem globally including among the HIV-infected patients on ARV treatment regimens
The study determined the effect of chronic alcohol consumption on the CD4+ cell count in the HIV-infected patients on d4T/3TC/NVP drug regimen using the chronic alcohol-use self reporting World Health Organization (WHO) alcohol-use disorders identification test (AUDIT) tool and the chronic alcohol-use biomarkers
The results show that the mean CD4+ cell count in the chronic alcohol use group in the 3 and 9 months and in the control group in the 6 and 9 months for the chronic alcohol-use self reporting WHO AUDIT tool group were within the normal reference ranges of 410 - 1590 cells/μL (Table 1)
Summary
Sustained heavy ethanol drinking is a common problem globally including among the HIV-infected patients on ARV treatment regimens. The World Health Organization (WHO) estimates that there are about 2 billion people globally that consume alcoholic beverages and it is the leading risk factor to various disease burdens like HIV infection especially in developing countries like Uganda. It is the third risk factor in developed OPEN ACCESS. Especially in the liver and the gastrointestinal tract (GIT), ethanol is broken down by a number of metabolizing enzyme systems by both the oxidative and non-oxidative pathways to generate a number of potentially harmful byproducts which causes deleterious effects to the body tissues and organs [11,12]. The ethanol metabolism leads to the generation of free radicals in tissues and from lipid peroxidation depleting the body antioxidants such as the glutathione which is important in the mediation of the immune body responses and leading to severe pathological body changes [21,22,23,24,25,26,27]
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