Alcohol use disorder, antiretroviral therapyBivariate associations of AIDS risk (measured via CD4 count) and mean adherence, and oral health in Peruvian MSM living with HIV.

BACKGROUND

In Peru, the HIV epidemic is primarily concentrated among men who have sex with men (MSM), with an estimated prevalence exceeding 10%. This study aimed to assess the interaction between alcohol use and suboptimal adherence to antiretroviral therapy (ART) on AIDS risk and oral health among Peruvian MSM living with HIV.

METHODS

We recruited 398 MSM living with HIV from two urban HIV treatment clinics in Lima. Alcohol use disorder (AUD) was assessed using the standard Alcohol Use Disorders Identification Test (AUDIT). ART adherence was self-reported. AIDS risk was defined as a history of having a CD4 count below 200 cells/mm ³ . A joint model was used to estimate the association between AIDS risk and oral conditions. Independent variables included alcohol consumption (binge drink and heavy use), suboptimal ART adherence (not 100% use), and their interaction, controlling for age and education.

RESULTS

Almost 53% of MSM reported that they had ever had a CD4 count lower than 200 cells/mm ³ , and 38% reported that they were not 100% adherent to ART in the past month. Additionally, 42% reported being at a hazardous or harmful level of AUD risk, with 78% being binge drinkers and 12% heavy drinkers. The interactions in the joint model indicated that suboptimal ART adherence and binge drinking are associated with an increased risk of developing AIDS (p = 0.0287), while suboptimal ART adherence and heavy drinking are associated with an increased number of self-reported oral diseases (p = 0.0231). This association also holds when modeling the two outcomes separately.

CONCLUSIONS

Interaction of suboptimal ART adherence and AUD is strongly associated with increased risk of AIDS and poor oral health among Peruvian MSM with HIV. Our findings support the need for longitudinal studies to better understand the complexity of alcohol consumption, ART adherence, AIDS risk, and oral diseases in this vulnerable population.