Thanks to effective antiretroviral medications like pre-exposure prophylaxis (PrEP), many of those living with HIV can effectively manage their illness. Nonetheless, certain behaviors can stymie the effectiveness of medication. One prominent risk factor, which Health Systems and Population Health (HSPop) professor Emily Williams has studied extensively, is unhealthy alcohol use. Her research has demonstrated that alcohol use lowers “helper T” cell counts while exacerbating HIV viral loads.
“If people reduce their alcohol consumption, at follow up screenings they actually look healthier with regard to HIV measures. My work has contributed to our understanding whether changes in drinking behaviors are actually going to improve people’s health,” Williams explained.
Unfortunately, most people with HIV don’t receive the evidence-based care for unhealthy alcohol use those screening positive acutely need. To fill that gap, Williams has spearheaded or contributed to multiple studies investigating how to synthesize HIV- and alcohol-related care. As part of her involvement with the Veterans Health Administration, Williams leads the alcohol and behavior intervention arm of the Veterans Aging Cohort Study (VACS), the largest clinical epidemiological study of people living with HIV in the U.S. The VACS study has followed over 40,000 HIV-positive veterans alongside more than 80,000 non-infected control participants in order to generate usable clinical insights for providers.
She is also on the front lines of implementing these findings. One current study, co-led with UW internal medicine faculty member Geetanjali Chander, will assess the impact of practice facilitation on alcoholism interventions at three clinics across the country. Another involves integrating PrEP into substance use care for veterans. As Wiliams explained, targeting unhealthy alcohol use could be a game-changer in combating the HIV epidemic.
“When people’s viral loads are managed, disease spread is prevented. This could mean the end of the HIV epidemic in the United States, if we continue to work on these modifiable behaviors,” said Williams.