AIDS RESEARCH AND HUMAN RETROVIRUSES Volume 18, Number 11, 2002, pp. 757–770 © Mary Ann Liebert, Inc. Alcohol Use and HIV Pharmacotherapy THOMAS F. KRESINA, 1 CHARLES W. FLEXNER, 2 JACQUELINE SINCLAIR, 3 MARIA ALMIRA CORREIA, 4 JACK T. STAPLETON, 5 SAMUEL ADENIYI-JONES, 6 VICTORIA CARGILL, 7 and LAURA W. CHEEVER 8 ABSTRACT Alcohol consumption by individuals infected with HIV is an important medical management issue with sig- nificant implications for the effectiveness of antiretroviral therapy as well as an important evolving field of HIV research. Alcohol consumption is a risk factor for poor medication adherence and can modify liver drug metabolism, both of which can lead to the emergence of drug-resistant virus. Research indicates that alcohol consumption greater than 50 g/day (four or five drinks) is a risk factor for liver disease progression among patients with HIV/HCV coinfection. In addition, alcohol-induced cirrhosis can result in changes in drug me- tabolism in the liver through compromised liver function. More research studies are needed to elucidate the biological and molecular basis of the clinical changes induced by alcohol consumption in HIV-infected indi- viduals and on the relationship of these changes to the effectiveness of HIV pharmacotherapy. Specifically, research areas that are of particular importance are (1) determining alcohol consumption levels and patterns and its impact on antiretroviral medication adherence, efficacy, and physician prescribing practices; (2) iden- tifying behavioral interventions to enhance adherence to HIV medications and reduce alcohol consumption; (3) clarifying the relationships and interactions among alcohol metabolism, HIV drug metabolism, and phar- macogenetics; (4) elucidating the extent of liver toxicity due to antiretroviral therapy and drug–drug inter- actions in individuals who consume alcohol; and (5) delineating the contribution of alcohol consumption to end-stage organ damage, particularly in HIV/HCV coinfection. 757 INTRODUCTION A REVIEW AND UPDATE of the data presented at “Alcohol Use and HIV Pharmacotherapy,”a conferencesponsoredby the National Institute on Alcohol Abuse and Alcoholism, and Of- fice of AIDS Research, NIH; and HIV/AIDS Bureau, Health Resources and Services Administration is summarized in the following sections:Scope and Treatment of Alcohol Use in HIV Infection, Implications of Liver Function in Alcohol Use and HIV Infection, and Consequences of Alcohol Use in HIV In- fection. SCOPE AND TREATMENT OF ALCOHOL USE IN HIV INFECTION: EPIDEMIOLOGY, MEDICATION ADHERENCE, AND MEDICAL MANAGEMENT Alcohol use and high-risk behaviors Abstinencerates, drinking patterns,and drinking quantity for individuals as well as populations in the United States are de- scribed in national sampling data. 1–3 Trend data show increas- ing rates of abstinence by African Americans and Hispanics, 1 National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland 20892. 2 Johns Hopkins University School of Medicine, Baltimore, Maryland 21205. 3 Veterans Affairs Medical Center and Dartmouth Medical School, Hanover, New Hampshire 03755. 4 University of California, San Francisco School of Medicine, San Francisco, California 94143. 5 Veterans Affairs Medical Center and University of Iowa, Iowa City, Iowa 52246. 6 National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892. 7 Office of AIDS Research, National Institutes of Health, Bethesda, Maryland 20892. 8 HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland 20857.