Alcohol is one of the most commonly used and abused drugs in the United States. The Substance Abuse and Mental Health Services Administration (SAMHSA) reported that in 2015, over 14 million Americans met the diagnostic criteria for an alcohol use disorder, and over 100 million Americans reported using alcohol at least once. SAMHSA also reports that alcohol is one of the most common drugs that is abused in conjunction with other drugs, including opiate drugs, stimulants, benzodiazepines, etc.
Individuals who develop HIV come from many different backgrounds. HIV use is associated with intravenous drug abuse, unsafe sexual practices, and other detrimental behaviors. Many of these individuals are prone to using and abusing alcohol, and may also have a co-occurring mental health disorder, such as major depression (which can also result from the development of AIDS), anxiety disorders, personality disorders, etc. Individuals with HIV are very likely to be using and abusing alcohol and other drugs.
Heavy alcohol use and abuse is associated with the development of numerous detrimental health conditions, including liver damage, increased susceptibility to infectious conditions, increased susceptibility to cancer, etc. Individuals with the HIV virus who abuse alcohol increase the risk of developing harmful conditions, and the use of alcohol can exacerbate the progression and symptoms associated with their HIV.
How Alcohol and HIV Interact
Heavy alcohol use weakens an individual’s ability to fight disease because alcohol is a toxic substance that destroys and alters healthy cells in the body, even cells in the immune system. Because the HIV virus attacks the immune system, an individual who has an alcohol use disorder and comorbid (co-occurring) HIV is experiencing two issues that seriously affect their ability to fight off infections.
According to numerous sources, including research articles like the one published in the journal AIDS Research and Human Retroviruses, alcohol use exacerbates the effects of the HIV virus by:
- Decreasing the effect of medications used to treat the HIV virus
- Causing dehydration, which makes one more susceptible to infections
- Decreasing the immune system’s ability to fight disease by destroying important cells in the immune system
- Decreasing the number of CD4+ cells: The major cell affected by the HIV virus is an immune cell called CD4+ or the T-helper cell. The cell plays an important role in defense against disease producing pathogens. When HIV affects the cells, a new virus forms, and the cells eventually die. This leads the person to be more susceptible to infections and cancers.
- Decreasing cells in the brain: The HIV virus can cross the blood-brain barrier and enter the brain. This can result in the development of neurotoxins that can damage neurons in the brain. Using alcohol speeds up this process because alcohol also destroys brain cells.
- Affecting the functions of the liver, which results in an increased susceptibility to infections and other problems
- Increasing the potential to develop forms of hepatitis, which will further damage the liver, and result in further issues with health and susceptibility to infectious diseases and other conditions
- Increasing ability to serious and long-term liver damage, such as cirrhosis, which may not be reversible
- Exacerbating issues with depression, anxiety, and other psychological symptoms that can result in an increased potential to develop numerous infectious diseases and other disorders
- Interfering with one’s ability to adhere to their treatment program for HIV, which can result in even more complications
- Resulting in poor decision-making abilities, which can interfere with treatment and result in risky behaviors that can exacerbate the potential to develop numerous disorders, such as infectious diseases and other physical and mental disorders and diseases
- Increasing the risk that one will spread the HIV virus due to engaging in risky behaviors
Many of these findings are associated with even mild to moderate use of alcohol in individuals diagnosed with HIV. Obviously, heavy use of alcohol exacerbates these conditions even further.
Symptoms of HIV/AIDS
The human immunodeficiency virus (HIV) attacks the immune system of the body. This infection often leads to the acquired immune deficiency syndrome (AIDS) that results in an individual being unable to fight off even mild infections. As a result, HIV/AIDS can lead to fatal consequences.
In 2015, the Centers for Disease Control and Prevention (CDC) reported that nearly 40,000 people in the United States were diagnosed with an HIV infection, and more than 1 million people were living with HIV in the United States. It was hypothesized that one out of every eight people with HIV did not know they had the disease.
Individuals affected with the HIV virus cannot tell from the symptoms alone if they actually have HIV. The only way to tell if a person has HIV is to get tested. High-risk individuals, such as intravenous drug users, people who engage in sexual activity with multiple partners without protection, etc., should consider getting checked regularly. Knowing one’s status regarding an HIV infection can help to treat the disease, slow its progression, and reduce the risk of transmitting the disease to others.
Even though someone cannot ascertain whether or not they have HIV based on symptoms, there are common symptoms that people experience over three stages of the infection. Not everyone will experience all of these symptoms, and in the early stages, they are often interpreted as being due to other conditions.
Many people experience flu like symptoms within 2-4 weeks of being infected; estimates range between 40% and 90%. Others may not have any symptoms at all. Typical early stage HIV symptoms include:
- Night sweats
- Sore throat
- Muscle aches
- Swelling in the lymph nodes
- Ulcers or sores in the mouth
In the acute stages, the disease can be highly infectious, and people can spread the infection to others, but some people who are infected with the HIV virus may not express any symptoms for many years. In addition, having any or all of the symptoms is not a sure sign that a person has the HIV virus because the symptoms can occur with other types of illnesses, conditions, or infections.
Following the early stages of infection, the disease moves into a latency stage where people have no symptoms at all or very mild symptoms that can be mistaken for mild cases of a cold, influenza, or just fatigue associated with everyday living.
If the person gets no treatment for the disease, it can progress, and the person may develop late-stage HIV infection or AIDS. The symptoms of AIDS include some or all of the following:
- Rapid reduction in body weight
- Extreme fatigue
- Extreme and prolonged swelling of the lymph nodes
- Recurrent fever
- Recurring night sweats
- Sores on the body, particularly in the mouth, genitals, and anus
- Extended periods of diarrhea (for longer than a week)
- Blotches under the skin or inside of the mouth, eyelids, or nose
- Neurological and psychological symptoms that can include issues with memory, attention, judgment, problem-solving, depression, movement, etc.
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Individuals diagnosed with the HIV virus would be best to abstain from alcohol use altogether. People who suffer from an alcohol use disorder may not be able to abstain from drinking alcohol without getting professional help. In addition, when individuals develop AIDS as a result of an HIV infection, they often experience cognitive and emotional issues, such as problems with learning and memory, judgment, and mood. These individuals often become very depressed and can potentially be diagnosed with a form of dementia related to HIV/AIDS.
Because the use of alcohol, especially heavy alcohol use, can exacerbate the effects of HIV, it is imperative that individuals abstain from alcohol use, and that those who need help, seek it out. There are several considerations in finding a treatment or support program for an alcohol use disorder.
- Treatment needs vary, depending on the level of one’s alcohol use disorder. Individuals who use alcohol occasionally or have mild alcohol use disorders may not require formal medical interventions, but can benefit from professional help.
- People who have moderate to severe alcohol use disorders may require formal medical interventions to deal with withdrawal symptoms or cravings for alcohol.
- Everyone can benefit from alcohol abuse and substance use disorder counseling to help them develop a plan recovery.
- Everyone can benefit from peer-based support groups (e.g., 12-Step groups) despite the severity of their alcohol use disorder.
These findings mean that individuals with HIV who use alcohol on a regular basis should first undergo a professional assessment to determine if they have an alcohol use disorder and the severity of the disorder. If the individual is deemed to have an alcohol use disorder, medical intervention is crucial for those who have moderate to severe disorders, and would be strongly recommended for individuals with mild disorders. Only complete abstinence from alcohol can ensure that the person will not experience further damage due to the combination of the HIV virus and alcohol. Those who experience even mild withdrawal effects as they begin to stay away from alcohol should immediately be placed in an inpatient physician-assisted withdrawal management program (a medical detox program) to ensure their safety and to reduce the risk of relapse in the early stages of recovery.
- Get therapy in either individual or group sessions (or a combination of both) to address issues related to alcohol abuse, develop a proactive plan of recovery, and deal with any complications that occur in recovery
- Participate in social support groups, such as Alcoholics Anonymous
- Have any co-occurring mental health disorders treated at the same time
- Get medical treatment for their HIV/AIDS
- Become involved in support groups for individuals with HIV
- Engage in any other interventions that are needed in the individual case
According to the American Society of Addiction Medicine, in order for any form of substance use disorder treatment to be effective, the person must remain abstinent and involved in treatment for years before they can consider their recovery to be relatively successful. However, individuals who develop any form of substance use disorder, including an alcohol use disorder, are always at an increased risk for relapse. This is why many individuals remain involved in some form of treatment-related activity, such as participation in 12-Step groups, for decades after initially becoming abstinent.