Health> Vol.6 No.5, February 2014

Sustained heavy ethanol drinking affects CD4+ cell counts in HIV-infected patients on stavudine (d4T), lamivudine (3TC) and nevirapine (NVP) treatment regimen during 9 months follow-up period

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ABSTRACT

Sustained heavy ethanol drinking is a common problem globally and ethanol is one of the most abused drugs among individuals of different socio-economic status including the HIV-infected patients on antiretroviral drugs. Ethanol is reward drug and a CNS depressant especially at high doses. The study determined the effect of sustained heavy ethanol drinking by HIV-infected patients on d4T/3TC/NVP regimen on CD4+ cell counts in Uganda using WHO AUDIT tool and chronic alcohol-use biomarkers. A case control study using repeated measures design with serial measurements model was used. The patients on stavudine (d4T) 30 mg, lamivudine (3TC) 150 mg and nevirapine (NVP) 200 mg and chronic alcohol use were recruited. A total of 41 patients (20 in alcohol group and 21 in control group) were screened for chronic alcohol use by WHO AUDIT tool and chronic alcohol use biomarkers. They were followed up for 9 months with blood sampling done at 3 months intervals. CD4+ cell count was determined using Facscalibur Flow Cytometer system. Results were then sorted by alcohol-use biomarkers (GGT, MCV and AST/ ALT ratio). Data were analysed using SAS 2003 version 9.1 statistical package with repeated measures fixed model and the means were compared using student t-test. The mean CD4+ cell counts in all the groups were lower than the reference ranges at baseline and gradually increased at 3, 6 and 9 months of follow-up. The mean CD4+ cell counts were higher in the control group as compared to the chronic alcohol use group in both WHO AUDIT tool group and chronic alcohol-use biomarkers group though there was no significant difference (p > 0.05). Chronic alcohol use slightly lowers CD4+ cell count in HIV-infected patients on d4T/3TC/NVP treatment regimen.

Cite this paper

Bbosa, G. , Kyegombe, D. , Anokbonggo, W. , Mugisha, A. and Ogwal-Okeng, J. (2014) Sustained heavy ethanol drinking affects CD4+ cell counts in HIV-infected patients on stavudine (d4T), lamivudine (3TC) and nevirapine (NVP) treatment regimen during 9 months follow-up period. Health, 6, 432-441. doi: 10.4236/health.2014.65061.

References

[1] Heath, D.B. (1987) Anthropology and alcohol studies: Current issues. Annual Reviews Anthropology, 16, 99-120. arjournals.annualreviews.org
http://dx.doi.org/10.1146/annurev.an.16.100187.000531
[2] Micheal, G. (1996) Alcohol health issues related to alcohol consumption. The place of alcohol in human culture, 1-22.
[3] Wikipedia (2009) Alcoholic beverage. Wikimedia Foundation Inc.
http://en.wikipedia.org/wiki/Alcoholic_beverage
[4] WHO (2004) Global Status Report on Alcohol 2004. Geneva.
[5] WHO (2007) Alcohol and injury in Emergency Department: Summary of the Report from the WHO Collaborative Study on Alcohol and Injuries. WHO Library Cataloguing-in-Publication Data, 1-11.
[6] GENACIS (2005) Alcohol, gender and drinking problems: Perspectives from low and middle income countries. Geneva, 2-241.
[7] Kafuko, A. and Bukuluki, P. (2008) Qualitative research in Uganda on knowledge, attitude and practices concerning alcohol. Health Communication, YEAH and Afford, Corporate Agreement Number 617-A-00-07-00005-00.
[8] Obot, I.S. (2006) Alcohol use and related problems in Sub-Saharan Africa. African Journal of Drug and Alcohol Studies, 5, 17-25.
[9] YEAH (2007) Alcohol Consumption in Uganda: Literature Review.
http://www.yeahuganda.org/research/AlcoholConsumption.pdf
[10] Jernigan, D.H. and Obot, I.S. (2006) Thirsting for the African market. African Journal of Drug and Alcohol Studies, 5, 57-68.
[11] Kinoshita, H., Jessop, D.S., Finn, D.P., Coventry, T.L., Roberts, D.J., Ameno, K., Jiri, I. and Harbuz, M.S. (2001) Acetaldehyde, a metabolite of ethanol activates the hypothalmic-pituitary-adrenal axis in the rat. Alcohol & Alcoholism, 36, 59-64.
http://dx.doi.org/10.1093/alcalc/36.1.59
[12] Zakhari, S. (2006) Overview: How is alcohol metabolised by the body? The Journal of the National Institute on Alcohol Abuse and Alcoholism, 29, 245-252.
[13] Fleming, M., Mihic, S.J. and Harris, R.A. (2001) Ethanol. Goodman Gilman’s, the pharmacological basis of therapeutics. 10th Edition, McGraw-Hill Medical Publishing Division, New York, 429-442.
[14] SAMHSA (2006) The role of Biomarkers in the treatment of alcohol use disorders. Substance Abuse and Mental Health Service Administration (SAMHSA): US Center for Substance Abuse Treatment, 5.
[15] Sumida, K.D., Hill, J.M. and Matveyenko, A.V. (2007) Sex differences in hepatic gluconeogenic capacity after chronic alcohol consumption. Clinical Medicine and Research, 5, 193-202.
http://dx.doi.org/10.3121/cmr.2007.729
[16] Szabo, G., Kornyei, L., Keller, E., Lengyel, G. and Feher, J. (2009) Levels of carbohydrate-deficient transferrin according to gender and age in a small town in Hungary. CEMED, 3, 319-325.
[17] Whitfield, J.B., Zhu, G., Heath, A.C., Powell, L.W. and Martin, N.G. (2001) Effects of alcohol consumption on indices of iron stores and of iron stores on alcohol intake markers. Alcohol Clinical Experimental Research, 25, 1037-1045. http://dx.doi.org/10.1111/j.1530-0277.2001.tb02314.x
[18] Edith, L., Bernard, H., Pascal, P., Yves, C., Josiane, A., Nadine, M., Francois, P., Gerard, S. and Yves, A. (1994) Effect of alcohol consumption on blood antioxidant nutrients and oxidative stress indicators. American Journal of Clinical Nutrition, 60, 255-261.
[19] Haile, H.E. (1998) Booze and blood: The effect of acute and chronic alcohol abuse on the hematopoietic system. Clinical Laboratory Science, 11, 229.
[20] Jones, A.J. (2010) The relationship between Blood Alcohol Concentration (BAC) and Breath Alcohol Concentration (BrAC): A review of the evidence. Department for Transport (DfT), London, 1-43.
http://assets.dft.gov.uk/publications/research-and-statistical-reports/report15.pdf
[21] Braude, M.C. and Chao, H.M. (1996) Genetic and biological markers in drug abuse and alcoholism. National Institute on Drug Abuse (NIDA) Research Monograph 66 Department of Health and Human Service. Alcohol, Drug Abuse, and Mental Health Administration, Maryland, 1-50.
[22] Conigrave, K.M., Degenhardt, L.J., Whitfield, J.B., Saunders, J.B., Helander, A. and Tabakoff, B. (2002) CDT, GGT, and AST as markers of alcohol use: The WHO/ISBRA collaborative project. Alcoholism: Clinical and Experimental Research, 26, 332-338.
http://dx.doi.org/10.1111/j.1530-0277.2002.tb02542.x
[23] Figlie, N.B., Benedito-Silva, A.A., Monteiro, M.G. and Souza-Formigoni, M.L.O. (2002) Biological markers of alcohol consumption in nondrinkers, drinkers, and alcohol-dependent brazilian patients. WHO/ISBRA study on state and trait markers of alcohol use and dependence investigators. Alcoholism: Clinical and Experimental Research, 26, 1062-1069.
http://dx.doi.org/10.1111/j.1530-0277.2002.tb02640.x
[24] Helander, A., Tabakoff, B. and WHO/ISBRA (1997) Biochemical Markers of alcohol use and abuse: Experience from the pilot study of the WHO/ISBRA Collaborative Project on State and Trait Markers of alcohol. Alcohol and Alcoholism, 32, 133-144.
http://dx.doi.org/10.1093/oxfordjournals.alcalc.a008247
[25] Kipnis, S. (2006) The assessment of alcohol use utilizing biomarkers: Knowledge workbook IV. OASAS. Addiction Medicine Unit. New York State Office of Alcoholism and Substance Abuse Services, 1-14.
[26] Sommers, M.S., Savage, C., Wray, J. and Dyehouse, J.M. (2003) Laboratory measures of alcohol (Ethanol) consumption: Strategies to assess drinking patterns with biochemical measures. Biological Research for Nursing, 4, 203-217.
http://dx.doi.org/10.1177/1099800402239624
[27] Tiemersma, E.W., Wark, P.A., Ocke′, M.C., Bunschoten, A., Otten, M.H., Kok, F.J. and Kampman, E. (2003) Alcohol consumption, alcohol dehydrogenase 3 polymorphism, and colorectal adenomas. Cancer Epidemiology, Biomarkers & Prevention, 12, 419-425.
[28] Edenberg, H.J. (2007) The role of alcohol dehydrogenase and aldehyde dehydrogenase variants: The genetics of alcohol metabolism. The Journal of the National Institute on Alcohol Abuse and Alcoholism, 30, 5-12.
[29] Ehlers, C.L. (2007) Variations in ADH and ALDH in Southwest California Indians. The Journal of the National Institute on Alcohol Abuse and Alcoholism, 30, 14-16.
[30] Quintanilla, M.E., Tampier, L., Sapag, A., Gerdtzen, Z. and Israel, Y. (2007) Sex differences, alcohol dehydrogenase, acetaldehyde burst, and aversion to ethanol in the rat: A systems perspective. University of Chile, Santiago, FONDECYT Nos. 1050480 and 1040555, NIAAA R01 015421, and the Millennium Scientific Initiative ICM P05-001F.
[31] Kovacs, E.J. and Messingham, K.A.N. (2003) Influence of alcohol and gender on immune response. National Institute on Alcohol Abuse and Alcoholism (NIAAA), Fishers Lane, 1-13.
[32] Balkaya, M., Unsal, H., Ünsal, C., Kiral, F. and Dabanoglu, I. (2005) Effects of Alcohol and Passive Smoking on Some Hematological Variables of Swiss Albino Mice. Turkish Journal of Veterinary Animal Science, 29, 241-250.
[33] Chu, Y.C. (1989) Haematological ef-fects of alcohol. Journal of the Hong Kong Medical Association, 41, 41-42.
[34] Cook, R.T. (1998) Alcohol abuse, alcoholism, and damage to the immune system—A review. Alcoholism: Clinical Experimental Research, 22, 1927-1942.
[35] Latvala, J. (2004) Effect of alcohol consumption and acetaldehyde on blood cells and molecules. Thesis, Acta University of Tampere.
http://acta.uta.fi/pdf/951-44-6095-2.pdf
[36] Dunlap, M.P. (2005) Biological impacts of alcohol use: An overview.
www.oregoncounseling.org/ArticlesPapers/Documents/ETOHBIOFx.htm
[37] El-Sayed, M.S., Ali, N. and Ali, E. (2005) Interaction between alcohol and exercise: Physiological and hematological implications. Sports Medicine, 35, 257-269.
http://dx.doi.org/10.2165/00007256-200535030-00005
[38] Broyles, B.M. (2008) Alcohol use HIV infection and anti-retroviral adherence. Ph.D. Reseach Dissertation, School of Nursing, University of Pittsburgh, Pittsburgh, 1-27.
[39] Lima, V.D., Fink, V., Yip, B., Hogg, R.S., Harrigan, P.R. and Montaner, J.S.G. (2009) Association between HIV-1 RNA level and CD4 cell count among untreated HIV-infected individuals. American Journal of Public Health, 99, S193-S196.
http://dx.doi.org/10.2105/AJPH.2008.137901
[40] Pernick, N. (2009) Navigational links to CD markers. PathologyOutlines.com, Inc.
http://www.pathologyoutlines.com/cdmarkers.html
[41] Susaengrat, W., Krissadarak, K., Mitchai, J. and Leeratanapetch, N. (2008) Evaluation of a manual CD4+ count kit for determination of absolute CD4+ T-lymphocyte counts. Journal of the Medical Association of Thailand, 91, 1495-1498.
[42] WHO. (2007) Laboratory guidelines for the enumerating CD4 T lymphocytes in the context of HIV/AIDS. World Health Organization. Regional Office for South-East Asia, New Delhi, 1-68.
[43] Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B. and Monteiro, M.G. (2001) The Alcohol Use Disorders Identification Test (AUDIT) manual: Guidelines for use in primary care. 2nd Edition, Department of Mental Health and Substance Dependence. World Health Organization, Geneva, WHO/MSD/MSB/01.6a, 4-32.
http://whqlibdoc.who.int/hq/2001/who_msd_msb_01.6a.pdf
[44] SAMHSA (2012) The role of biomarkers in the treatment of alcohol use disorders. Substance Abuse and Mental Health Service Administration (SAMHSA): US Center for Substance Abuse Treatment, 11, 1-8.
http://store.samhsa.gov/shin/content/SMA12-4686/SMA12-4686.pdf.
[45] Bianchi, V., Raspagni, A. and Arfini, C. (2013) Emerging biomarkers of alcohol consumption: Clinical and forensic application. The Open Toxicology Journal, 6, 27-33.
http://www.benthamscience.com/open/totoxij/articles/V006/SI0011TOTOXIJ/27TOTOXIJ.pdf
[46] Allen, J.P., Sillanaukee, P., Strid, N. and Litten, R.Z. (2013) Biomarkers of heavy drinking. Assessing alcohol problems: A guide for clinicians and researchers. National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, 37-53.
http://pubs.niaaa.nih.gov/publications/AssessingAlcohol/allen.pdf
[47] Mbopi-Kéou, F.X., Sagnia, B., Ngogang, J., Angwafo III, F.F., Colizzi, V., Montagnier, L. and Bélec, L. (2012) Validation of a single-platform, volumetric, flow cytometry for CD4 T cell count monitoring in therapeutic mobile unit. Journal of Translational Medicine, 10, 22.
http://www.translational-medicine.com/content/pdf/1479-5876-10-22.pdf
[48] Nantakomol, D., Chanprasert, S., Soogarun, S., Imwong, M., Ohashi, J. and Nuchnoi, P. (2010) Affordable technology for enumeration of the absolute CD4 T-lymphocyte count by cell bead assay. Science: Lab Medicine, 41, 423-428.
http://labmed.ascpjournals.org/content/41/7/423.full.pdf.
[49] Hoffmann, C., Rockstroh, J.K. and Kamps, B.S. (2007) HIV medicine 2007. 15th Edition, Flying Publisher, 23-29.
www.HIVMedicine.com
[50] UNAIDS/WHO (2008) AIDS epidemic update/Sub-Saharan Africa. Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO) 2007, 11.
[51] Foisy, M. and Tseng, A. (2008) Interactions between opioids, protease inhibitors and the non-nucleoside reverse transcriptase inhibitors. Toronto General Hospital, 1-10.
[52] Ferreira, M.P. and Willoughby, D. (2007) Alcohol consumption: The good, the bad and the indifferent. Applied Physiology, Nutrition and Metabolism, 33, 12-20.
[53] Triplit, C. (2006) Drug interactions of medications commonly used in diabetes. Diabetes Spectrum, 19, 202-211.
http://dx.doi.org/10.2337/diaspect.19.4.202
[54] Bartlett, J.G. and Gallant, J.E. (2006) Medical management of HIV infection. Johns Hopkins University School of Medicine. Johns Hopkins Medicine Health Publishing Business Group, Baltimore, 2005-2006, 1-181.
[55] Dobrinas, M. and Eap, C.B. (2007) Cytochrome P4503A pharmacogenetics. HIV PGX 2:2, 1-3.
[56] Orrick, J.J. (2002) Antiretroviral drug interactions. Infectious diseases: HIV/AIDS primary care guide. Florida Aids Education and Training Centre, University of Florida, 7, 69-81.

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