Alcohol and Sedatives

The lifetime prevalence of alcohol dependence in the United States is in the range of 14.1% (Kessler et al., 1997), while binge alcohol use and heavy alcohol use within the past month have been reported as 22.8% and 6.9%, respectively (SAMSHA, 2005). Even higher rates are seen among gay men, regardless of their serostatus (Ferrando et al., 1998; Stall et al., 2001).

Alcohol is rapidly absorbed from the duodenum with blood alcohol concentrations of 100-200 mg%, causing impaired motor function and judgment; concentrations of200-400 mg% lead to stupor and coma. Alcohol activates GABA receptors, inhibits NMDA receptors, and has additional effects on 5-HT3, nico-tinic, and opioid receptors. It is metabolized by alcohol dehyrogenase at a constant rate of 100 mg/kg/ hour. Medical complications of alcohol dependence are listed in Table 8.3. Problems such as anemia, peripheral neuropathy, and dementia are of particular concern in HIV patients, who are already predisposed to these complications. More importantly, alcohol-induced liver disease may be worse in those coinfected

tabLe 8.3. Medical Complications of Alcohol Abuse and Dependence

Gastritis/peptic ulcer

Pancreatitis

Cirrhosis/hepatic failure

Anemia

Pneumonia

Malnutrition

Trauma

Peripheral neuropathy

Subdural hematoma

Dementia

Cardiomyopathy

Wernicke-Korsakoff syndrome

with HCV, as alcoholism doubles the risk of cirrhosis (Maillard and Sorrell, 2005).

Among HIV-positive persons, alcohol abuse leads to additional medical complications because of reduced adherence to treatment. Studies among veterans in care for HIV showed that binge drinkers missed many more doses of medications on drinking days, compared with non-binge drinkers. The study demonstrated that this trend was especially strong for HIVpositive individuals as compared with HIV-negative individuals. The investigators concluded that HIVpositive persons may be particularly sensitive to the negative effects of alcohol consumption (Brathwaite et al., 2005). Additionally, alcohol use is associated with risky sexual behaviors and intravenous drug use, both of which lead to higher rates of HIV transmission (Petry, 1999; Szerlip etal., 2005). Studies abroad have also demonstrated that alcohol intoxication is associated with sexual risk behaviors. A study in China concluded that HIV/AIDS prevention and intervention efforts should include components of alcohol use and abuse prevention for an effective reduction in sexual risk-taking behaviors (Lin et al., 2005).

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