142nd APHA Annual Meeting and Exposition

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Heavy alcohol consumption and vaginal shedding of HIV-1

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Danielle Fastring, MS, MPH, PhD , Department of Public Health, University of Southern Mississippi, Hattiesburg, MS
Angela Amedee, PhD , Department of Microbiology, Immunology, and Parasitology, Louisiana State University, New Orleans, LA
Megan Gatski, PhD , Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
Rebecca Clark, MD, PhD , Department of Internal Medicine, Louisiana State University, New Orleans, LA
Leandro Mena, MD , University of Mississippi Medical Center, Jackson, MS
Judy Levison, MD, MPH , Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
Norine Schmidt, MPH , Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
Jeanette Gustat, PhD , Department of Epidemiology; Prevention Research Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
Susan Hassig, PhD , Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
Patricia Kissinger, BSN, MPH, PhD , Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
Background: Vaginal shedding of HIV-1 may lead to increased risk for HIV transmission. Alcohol use is more prevalent among HIV+ women (6-54%) than the general population (4-12%) and has been associated with lack of adherence to antiretroviral therapy (ART) which could increase HIV shedding.  The purpose of this study is to explore the relationship between heavy drinking and vaginal shedding of HIV-1.

Methods:  HIV-positive women attending outpatient clinics in three urban southern cities underwent a clinical examination, received screening for sexually transmitted infections and bacterial vaginosis, and completed a survey which quantified alcohol consumption patterns.  Levels of cell-free HIV-1 RNA in plasma and vaginal fluids were determined by RT-PCR. Heavy drinking was defined as consuming more than three drinks per day and more than seven drinks per week, or consuming more than four drinks in two hours on any day in the previous week. Heavy drinkers were compared to abstainers to determine the association between heavy drinking and vaginal shedding of HIV.

Results: In this sample of HIV-positive women (n=219), 15.12% were classified as heavy drinkers, and 33.3% were shedding HIV vaginally.  Heavy drinkers were 2.25 times more likely to be shedding HIV vaginally (95% CI 1.10 – 4.60) than abstainers when the model was controlled for ART adherence and plasma virus levels (PVL). 

Conclusion: Heavy alcohol consumption was positively associated with vaginal shedding of HIV after adjusting for ART adherence and PVL. It is possible that a direct link exists between heavy alcohol consumption and vaginal shedding of HIV-1.

Learning Areas:

Epidemiology

Learning Objectives:
Describe determinants of vaginal shedding in HIV-positive women. Define heavy drinking. Differentiate between vaginal shedding of HIV-1 among heavy drinkers and abstainers.

Keyword(s): HIV/AIDS, Alcohol Use

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have presented at the International AIDS conference in Washington DC (2012) and published articles relating to vaginal shedding of HIV-1 RNA. I have a PhD in epidemiology from Tulane School of Public Health and Tropical Medicine. Among my scientific interests are HIV, infectious disease epidemiology, health disparities, and GIS.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4285.0: HIV, Infectious Diseases, and Co-Morbidities