HIV This Week

Fisher 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(11):856-63.

Fisher and colleagues amied to summarize the association between alcohol use and human immunodeficiency virus (HIV) infection based on studies conducted in Africa. EMBASE and PubMed were searched for African studies that related alcohol use to HIV infection. Meta-analyses were conducted to obtain pooled univariate and multivariate relative risk estimates. Subgroup analyses were performed for studies having different sample types: males or females and population-based or high-risk, and ones that differentiated between problem and asymptomatic drinkers. Alcohol drinkers were more apt to be HIV+ than nondrinkers. The pooled unadjusted odds ratio (OR) from 20 studies was 1.70 (95% confidence interval, CI = 1.45-1.99). Results from 11 studies that adjusted for other risk factors produced a pooled risk estimate of 1.57 (95% CI = 1.42-1.72). Males and females had similar risk estimates, while studies involving high-risk samples tended to report larger pooled odds ratios than studies of the general population. When compared with nondrinkers, the pooled estimates of HIV risk were 1.57 (95% CI = 1.33-1.86) for non-problem drinkers versus 2.04 (95% CI = 1.61-2.58 ) for problem drinkers, a statistically significant difference (z = 2.08, P <0.04). Alcohol use was associated with HIV infection in Africa and alcohol-related interventions might help reduce further expansion of the epidemic.

Editors’ note: This systematic review and meta-analysis found alcohol drinkers to have a 57% increased risk of HIV infection after controlling for potential confounders, with the heaviest and symptomatic drinkers at greatest risk, suggesting a dose-response relationship. Beyond its direct immune suppressive effects, alcohol increases risk indirectly through other factors such as high-risk behaviour, gender violence, and presence of other sexually transmitted infections. With low alcohol content traditional home brews increasingly being replaced by high alcohol content commercial brews, alcohol consumption in Africa is on the rise. Prevention programming with a focus on responsible drinking and safer sex could create a more favourable social context in small bars and other informal alcohol serving establishments to avert alcohol-induced amplification of HIV transmission.