Global burden of HIV/AIDS in 2004 resulting from alcohol attributable non-adherence to medication regimes

Kevin David Shield, Paul A Shuper, Gerrit Gmel, Jürgen Rehm


Shield, K. D., Shuper, P. A., Gmel, G. & Rehm, J. (2013). Global burden of HIV/AIDS in 2004 resulting from non-adherence to medication regimes and alcohol-attributable non-adherence to medication regimes. International Journal of Alcohol and Drug Research, 2(1), 19-44.    doi: 10.7895/ijadr.v2i1.52 (

Aims: Using novel methodology, this article aims to quantify the number of HIV/AIDS-related deaths and the potential years of life lost (PYLL) in 2004 resulting from non-adherence to antiretroviral treatment (ART) and non-adherence to ART due to alcohol consumption.

Design: HIV/AIDS-related deaths and PYLL attributable to non-adherence to ART and attributable specifically to non-adherence due to alcohol consumption were calculated using attributable fractions.  These fractions were based on new risk modeling methodology, which combines estimates of the mortality of those people currently adhering to ART, the mortality attributable to non-adherence to ART, and the proportion of those people not adhering to ART because of alcohol consumption.

Measurements: Data on alcohol indicators were obtained from the Comparative Risk Assessment study, data on deaths and PYLL were obtained from the World Health Organization, and ART indicators were obtained from UNAIDS.

Findings: In 2004, for people 15 years of age and older, 67,000 (95% CI: 62,000–72,000) deaths and 1,608,000 (95% CI: 1,491,000–1,725,000) PYLL were caused by non-adherence to ART, of which 8,000 (95% CI: 3,000–13,000) HIV/AIDS-related deaths and 187,000 (95% CI: 70,000–304,000) HIV/AIDS-related PYLL were attributable to alcohol consumption.

Conclusions: As the burden of disease for HIV/AIDS-related deaths attributable to non-adherence to ART and attributable to alcohol consumption is non-trivial, additional research is required to examine the effectiveness of different interventions aimed at reducing alcohol consumption among people with HIV/AIDS and at increasing adherence to ART among both drinkers and non- drinkers.


alcohol consumption; HIV; antiretroviral therapy; adherence; mortality; potential years of life lost

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