Alcohol consumption and HIV-1 vaginal RNA shedding among women.

Objective: The purpose of this study was to examine the association between alcohol consumption and HIV-1 vaginal shedding.

Method: HIV-1 infected women attending a large urban HIV primary care clinic in New Orleans, LA, between June 2002 and October 2004 who underwent a gynecological exam, were 18 years of age or older, and provided informed consent were included. Subjects underwent exams and were interviewed using a computer-assisted survey at baseline, 1 month, and 3 months.

Results: Most of the women were black (86.4%), with a median age of 38 (range: 19-61 years). Most (56.7%) also were on antiretroviral therapy (ART; with 89.6% self-reported adherence) and had a median CD4 of 404 copies/ml and a plasma viral load of 13,400 copies/ml at baseline. The overall period prevalence of vaginal shedding (>50 copies/swab) was 24.5%, with a baseline prevalence of 27.3%. At baseline, 30% reported any alcohol consumption, 32.6% were weekly drinkers, 25.5% were heavy episodic drinkers, and 10.0% had recent moderate to heavy alcohol consumption (two or more drinks the day before the interview). Recent moderate to heavy alcohol consumption and heavy episodic drinking were both strongly and positively associated with vaginal shedding but only among women on ART. After adjusting for plasma viral load, immunosuppression, and ART adherence, recent moderate to heavy alcohol consumption was significantly associated with vaginal shedding (adjusted prevalence odds ratio=2.29, 95% confidence interval: 1.18-14.43). No association was observed for plasma viral load and alcohol consumption.

Conclusions: Recent alcohol consumption was associated with expression of HIV-1 RNA in vaginal fluids of women on ART. Future research is needed to support this observation and to determine the mechanisms behind it.