%0 Journal Article
%T Developing a method to derive alcohol-attributable fractions for HIV/AIDS mortality based on alcohol's impact on adherence to antiretroviral medication
%A Gerrit Gmel
%A Kevin D Shield
%A Jščrgen Rehm
%J Population Health Metrics
%D 2011
%I BioMed Central
%R 10.1186/1478-7954-9-5
%X By combining information on risk relations from a number of published sources, we estimated alcohol-attributable fractions (AAFs) of HIV/AIDS in a stepwise procedure. First, we estimated the effect of alcohol consumption on adherence to antiretroviral treatment, and then we combined this estimate with the impact of nonadherence on death. The 95% uncertainty intervals were computed by estimating the variance of the AAFs using Taylor series expansions of one and multiple variables. AAFs were determined for each of the five Global Burden of Disease regions of Africa, based on country-specific treatment and alcohol consumption data from 2005.The effects of alcohol on HIV/AIDS in the African Global Burden of Disease regions range from 0.03% to 0.34% for men and from 0% to 0.17% for women, depending on region and age category. The detrimental effect of alcohol consumption was statistically significant in every region and age category except for the North Africa/Middle East region.Although the method has its limitations, it was shown to be feasible and provided estimates of the impact of alcohol use on the mortality outcome of HIV/AIDS.Alcohol has been identified as a major risk factor for mortality and burden of disease in past comparative risk assessments within Global Burden of Disease studies [1,2]. In past iterations of comparative risk assessments, infectious diseases have not been included. However, evidence has been accumulating that alcohol has a causal impact on infectious disease categories [3,4].Evidence indicates a strong association between alcohol and HIV/AIDS [5,6], but personality variables such as risk-taking or impulsive behavior cannot be excluded as potential alternative explanations [6]. There is sufficient evidence, however, that alcohol worsens the course of the disease, especially by impacting adherence to antiretroviral treatment. Globally, HIV/AIDS led to about 2 million deaths and 58.5 million lost disability-adjusted life years (DALYs) in 2004
%U http://www.pophealthmetrics.com/content/9/1/5