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Chronic Alcohol Use Impacts Immune System Activation and Inflammation in People Living with HIV

January 4, 2022
Meg Brunner, MLIS
Underwood ML, et al. Chronic alcohol exposure among people living with HIV is associated with innate immune activation and alterations in monocyte phenotype and plasma cytokine profile. Frontiers in Immunology 2022 (in press). 
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Addiction Science Made Easy
April 2022
CTN Dissemination Library


Key points:

  • Alcohol use compromises several of the body’s defense mechanisms, impacting both immune system activation and inflammation
  • People living with HIV are particularly vulnerable to these effects
  • A 1-month intervention for alcohol use in people living with HIV did not markedly improve observed immune system and inflammation effects, but studies looking at longer interventions should be prioritized 

At chest level white female wearing white shirt sitting at table one hand covering top of whiskey glass while other hand held out in the halt position.Chronic alcohol use resulting in alcohol use disorder (AUD) impacts millions of American adults and teens. People living with HIV (PLWH) are particularly vulnerable to negative impacts of alcohol use, as heavy drinking is associated with reductions in HIV treatment compliance and poor virologic control. 

Acute and chronic alcohol exposure compromises a variety of defense mechanisms in the body, putting PLWH at increased risk for both acute infection and chronic inflammation. Both alcohol and HIV also have long-term effects on the lining of the intestines that impact immunity and inflammation and make it easier for bacterial microbes and their byproducts to move from the intestines into the bloodstream. This latter issue is a major driver of chronic immune activation, which is associated with non-AIDS-related illnesses and death among PLWH. 

While we may not be able to eradicate someone’s HIV, we can potentially help them reduce their alcohol use, which could then reduce these harmful immune system- and inflammation-related risks. This study looked at a 1-month medication-based intervention for AUD to see what, if any, impact reducing alcohol use had on these physical defenses.

The study used data from CTN-0055 (the CHOICES trial), an open-label randomized pilot trial of extended-release naltrexone (XR-NTX) versus treatment-as-usual (TAU) for treatment of opioid use disorder (OUD), alcohol use disorder (AUD), and mixed OUD/AUD in PLWH. Twenty-three PLWH with AUD and 29 PLWH without AUD were included in this secondary analysis, which looked at blood samples taken at the beginning of the original trial and at the 4-week mark.

Researchers found that alcohol use disorder in PLWH was clearly associated with advanced immune system activation and other physiological changes, and that this was more pronounced among those who also had hepatitis C co-infection. This means that chronic alcohol exposure is a major risk factor for chronic immune activation among people living with HIV. The 1-month alcohol use disorder invention did not appear to have much of an impact on these changes, but 1 month isn’t much time, and a longer period of treatment might be more effective.

Conclusions: Among people living with HIV, chronic alcohol exposure appears to be a risk factor for chronic immune system activation that is known to lead to health impacts like heart disease, stroke, and dementia. Long-term studies examining the impact of reduction in alcohol use should be prioritized among this group of people.


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