Alcohol y VIH
Alcohol and HIV
María José Míguez, M.D. Ph.D., Universidad de Miami, EE.UU.
Gail Shor-Posner, PhD., Universidad de Miami, EE.UU.
Kendall Bryant, M.D., Institutos Nacionales de Salud (NIH), EE.UU.
Clinical and experimental studies have demonstrated that excessive alcohol consumption can result in impairment of the immune system, and can impact several functions including immune tolerance and host defense against opportunistic infections. In patients infected with the human immunodeficiency virus (HIV) who are alcohol abusers, two immunocompromising conditions that frequently coexist, pulmonary infections are a significant cause of morbidity and mortality. Moreover, our studies in HIV infected individuals indicate that alcohol use significantly increases the risk of hospitalization with a respiratory disease and particularly with community-acquired pneumonia. Of importance, pneumonia now represents the most frequent cause of hospitalization among HIV infected subjects, and is a principal cause of death worldwide. In animal models, the combined effects of in vivo lentiviral infection and in vitro alcohol exposure, have been demonstrated to reduce the production of tumor necrosis factor- alpha (TNF-alpha), a proinflammatory cytokine that is critical to normal pulmonary host defense, by approximately 50%, as compared to non-exposed animals.
Alcohol consumption in HIV-infected individuals is an important medical management issue with significant implications for the effectiveness of antiretroviral therapy. Adherence to medication is critical in HIV infected patients not only to reduce viral burden to its lowest level, but also to prevent resistance. Alcohol and drug use have been shown to reduce adherence to antiretroviral regimens. But even among adherent to their antiretroviral regimen, our data demonstrate that antiretroviral-treated HIV infected subjects, using alcohol, are less likely to achieve viral suppression and show a CD4 increase above 500. The mechanism involved, while still undetermined, may be related to reduction in IL2 as well as interference with the metabolism and absorption of antiretroviral medications.
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