The primary goal of ART is to increase disease-free survival through suppression of viral replication and improvement in immunological function. The optimal time to initiate treatment is influenced by these known benefits and the risk of drug toxicity, potential emergence of viral drug resistance, and the need for lifetime therapy. The complexities of adherence-resistance relationships are related to characteristics of the virus, the medication, misuse of alcohol, and their interactions. Nevertheless, the effectiveness of ART can be limited by lack of access to therapy. Additionally, a set of acquired behaviour, such as alcohol misuse and poor adherence and/or intolerance, can lead to ART resistance. Therefore, especially in low-income populations, the education of individuals who live with HIV and alcohol abuse is relevant.
Knowledge of class-specific adherence-resistance relationships may help clinicians and patients tailor therapy to match individual patterns of adherence in order to minimize the development of resistance and treatment failure. In addition, in low-income settings, this information may guide the selection of optimal drug combinations and regimen sequences to improve the durability of ART. Moreover, alcohol use and alcohol dependence are widespread in the general population. Many people suffering from alcohol use disorders also suffer from other psychiatric disorders including drug abuse disorders. Importantly, persons living with HIV should be assessed not only for their immunologic and virologic statuses, but also for comorbidities.
This is particularly important but rarely assessed or/and reported in the literature. Modeling or condition simulation may introduce these interactions in the context of the corresponding topic leading to possible interventions.
An important objective of our study is to bring awareness of these complex interactions in the medical and education fields. Awareness should lead to cooperation between patients living with HIV, their caregivers, and researchers looking into the mechanism of relationship between the virus, disease progression, alcohol, and its comorbidities. Multiple substances of misuse, such as combined alcohol and cocaine, might be associated with behaviour and metabolic consequences not measured or not considered in these analyses. These drug-induced biological phenomena may promote disease progression and CD4+ cell loss, as well as poor adherence with prescribed medication and/or inadequate micronutrient and macronutrient intake. Because the patterns of substance abuse observed in these HIV positive cohorts might not be common or typical of other HIV populations, these findings can be generalized only to other infected populations with similar patterns of substance abuse. Further studies targeting HIV heavy alcohol users, that control for other confounding behavioural and metabolic variables, need to be conducted to confirm and extend the knowledge in this area. Moreover, a network of direct discussion is needed between people living with HIV/AIDS, medical personnel treating HIV and/or addictions, epidemiology researchers, as well as policy makers and treatment planners.