Hi Pozziepinoy.
I wish you can help me with my situation. I don't do planning and keeping records. I've been taking ARV's for 3 months. I really don't find it comfortable in talking to my doctors in SLH.
When I started taking meds, I stopped drinking alcohol for a month but continued smoking cigarettes. Come second month, I go back and finishing a bottle of up to three for once of beer every week (sometimes brandy) . Come Christmas break, events invited me to do so. I know it will do worse in me. My friends are telling me not to do so but I insist that I really want to drink. Yeah, you called it addiction and I might be needing a psychiatrist. I can't have a positive outlook in life although I'm about to graduate this coming March.
Please comprehend to my concern by your blogging skills. BTW Happy New Year.
XXX
CONTRIBUTOR'S RESPONSE
Hi XXX,
Thank you for your email and reading this blog.
Thank you also for clarifying the situation. I understand now that the three bottles of alcohol you're drinking are beer and you are also consuming some spirits.
You have mentioned two forms of recreational drug use. Alcohol and cigarettes. They are popular drugs and they certainly need to be addressed in an HIV context.
Alcohol: An alcoholic beverage is any drink containing ethanol. The 3 general classes, in descending order of strength, are spirits, wines and beers. One unit of alcohol may be defined as being 25ml spirits, 87.5ml wine/champagne, 189ml 5% strength beer and 284ml 4% strength beer. Working with this definition, the UK Chief Medical Offer's recommendations are that men should not drink more than three to four units of alcohol per day and women should only drink two to three. However, the health benefits are maximized when men consume no more than 2-3units and women 1-2units. Studies have found that people who consume alcohol within this range tend to have better health and live longer than those who are either abstainers or heavy drinkers. In addition to having fewer heart attacks and strokes, moderate consumers of alcoholic beverages are generally less likely to suffer diabetes, arthritis, enlarged prostate, dementia (including Alzheimer's disease), and several major cancers.
Do these recommendations hold true if you're HIV+?
The answer is, it depends on 1) what ARV's (Anti-RetroVirals) you're on, and 2) what other, if any opportunistic infections or coinfections you might have and what medications you are taking for them..
1) The total amount of Abacavir absorbed is increased by up to 41% in men. This hasn't been studied in women as of yet but it would be best to err on the safe side and avoid alcohol altogether if this is one or your ARV's. The unwanted potential side effects of Efavirenz, such as dizziness, trouble sleeping or concentrating, drowsiness, and/or unusual dreams are often increased if mood altering recreational drugs, including alcohol, are consumed soon after it's use.
2) If you are coinfected with any form of hepatitis then you may need to cease drinking alcohol. Most antibiotics are rendered less effective in the presence of alcohol and some that are used to treat tuberculosis, meningitis, mycobacterium avium complex, Chlamydia, vaginitis, and a range of other infections that often occur in HIV+ patients, react very badly with alcohol. It is important to check with your HIV Medical Specialist that alcohol is safe to drink with any medication you are prescribed to treat any coinfections.
What if I drink more than the recommended amount of alcohol?
Drinking more than the recommended amount effects the immune system and slows down recovery from infections. HIV+ people who are not on ARV and drink more than the recommended amount tend to have lower CD4 counts. This is especially true of people who indulge in binge drinking. Binge drinking is defined as drinking your entire weekly recommended limit in one session. If you are consuming 3 bottles of beer and some spirits in one session, then you are binge drinking. When binge drinking all of the health benefits of moderate amounts of alcohol consumption are lost. People who do this often run the risk of liver, heart and brain damage. People who drink heavily often don't eat well leading to further health problems which can be exacerbated in HIV+ people.
Alcohol is metabolized by the liver. Excess alcohol can damage the liver possibly leading to a life threatening condition called cirrhosis. Most ARV's are processed by the liver so a healthy liver is necessary to effectively metabolize them. People with liver damage may also experience an increase in the severity of any unwanted ARV side effects. This is especially true of Aluvia (Kaletra) and other Protease Inhibitors. Some pain killers such as paracetamol are also metabolized by the liver. Excess alcohol consumption can interact with their metabolism to cause potentially fatal liver failure.
Binge drinking can also lead to missed doses of ARV's and other medications. This can lead to the development of strains of HIV that are resistant to the ARV's rendering them ineffective. Binge drinking can also lead to vomiting. If you vomit within an hour of taking your ARV's, or any other prescribed medicine, you should retake the dose. Eating food of almost any type and drinking water while consuming alcohol speeds up its metabolism and reduces the incidence of vomiting and lessens the severity of any hangover.
Alcohol is a psychoactive drug that has a depressant effect. Thus binge drinking can cause, or make worse existing mental, psychological or emotional problems.
Smoking: Unlike alcohol consumption, there is no level of smoking which produces health benefits that outweigh any risks. This is especially true in HIV+ people. Smoking weakens the immune system and the lining of the lungs making them more prone to potentially fatal opportunistic infections such as TB, Pneumocystis jiroveci pneumonia (formerly called Pneumocystis carinii pneumonia or PCP), Mycobacterium avium complex (MAC). A study done in Copenhagen found that HIV-positive smokers experienced a five-fold elevation in non-AIDS related deaths, with marked increases in cardiovascular disease and cancer. It concluded that people with HIV who smoked lost 12.3 years of life compared with nonsmoking people with HIV.
The general symptoms of opportunistic infections and cancers of the lungs are:
- Cough (either dry or productive of sputum)
- Sputum (clear or streaked with pus or blood)
- Difficulty breathing
- Chest pain
Associated symptoms can include fever, night sweats, chills, fatigue, lack of appetite, headache and weight loss. Any HIV-positive person with these symptoms should have them promptly checked out by a HIV Medical Specialist.
Overcoming any addiction that people may develop to any drug can be incredibly difficult. Asking for help is not a sign of weakness but of strength. It demonstrates self awareness and a determination to live a happy and productive life irrespective of your HIV status. You will be graduating in March and have everything to look forward to. HIV need not be an impediment to your life in any way if you decide it isn't. It hasn't stopped me or others like me from being happy and living well. If you seek assistance in over coming these potential addictions now, you will never regret it. Giving up alcohol, or reducing alcohol intake and giving up cigarettes are two of the most beneficial decisions that a HIV+ person can make for their health.
I hope you have found this answer helpful.
American Journal of Respiratory and Critical Care Medicine
AIDS Project Los Angeles Nancy Wongvipat, M.P.H.
HIV-Related Lung Diseases by R. Morgan Griffin
Stay healthy, stay compliant with your ARV regimen,
Malcolm Brown
International Contributor
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