Alcohol consumption and HIV disease prognosis among virally unsuppressed in Rural KwaZulu Natal, South Africa

Background The effect of alcohol consumption and human immunodeficiency virus (HIV) disease prognosis has been examined in several studies with inconsistent findings. We sought to determine the effect of alcohol consumption on HIV disease prognosis by examining CD4+ T cell count/µL (CD4+ count) and HIV RNA concentration [HIV viral load (VL)] independent of anti-retroviral therapy (ART). Methods A secondary analysis was performed on a cross-sectional survey data of 1120 participants between 2018 and 2020. Questionnaires were used to obtain the participants' history of alcohol consumption. Blood samples were assayed for CD4+ T cell count/µL (CD4+ count) and HIV RNA concentration (HIV viral load). The history of alcohol consumption was categorized into non-alcohol consumers, non-heavy alcohol consumers, and heavy-alcohol consumers. Age, cigarette smoking, gender, and ART use were considered potential confounders. Participants were categorized into two cohorts for the analysis and a multivariate logistic regression was used to establish relationships among virally unsuppressed participants who were ART-experienced and ART-naïve. Results A total of 1120 participants were considered for analysis. The majority were females (65.9%) between 15–39 years (72.4%). The majority were non-smokers and non-alcohol consumers (88% and 79%, respectively). ART-experienced females had an increased risk of having a higher VL (VL > 1000). This finding was statistically significant [RR, 0.425, 95% CI, (0.192–0.944), p-value, 0.036]. However, ART-experienced participants aged above 64 years had an increased risk of having a lower VL (VL < 1000 copies/mL) and a lower risk of having a higher VL (VL > 1000). However, ART-naïve participants aged between 40–64 years had a significantly lower risk of having higher CD4 count (CD4+ > 500 cells) and an increased risk of having a lower CD4 count [OR, 0.566 95% CI, (0.386–0.829), p-value, 0.004]. History of alcohol consumption did not have a significant effect on CD4+ cell count and VL in neither the ART-experienced nor the naïve cohort. Conclusions Female middle-aged people living with HIV (PLWH) are more likely to have a poorer HIV disease state, independent of alcohol consumption. Alcohol consumption may not have a direct effect on CD4+ cell count and VL in either ART-naïve or experienced patients.