Alcohol use among patients with HIV infection

Ann Hepatol. Oct-Dec 2011;10(4):502-7.

Abstract

Objective: To evaluate alcohol use in patients with HIV infection, assess ethnic and social associations, and describe outcomes.

Material and methods: design: cohort study. setting: Academic HIV-Liver Clinic. patients: 431 HIV-infected patients (371 men, 60 women); 249 patients with HIV/HCV coinfection, 115 HIV alone, and 67 with HIV/HBV.

Intervention: alcohol use was estimated at first interview and reported as the estimated average lifetime consumption in grams/day. outcome measures: laboratory values, liver fibrosis, decompensation and mortality.

Results: Twenty-two percent of patients in the entire cohort had high risk lifetime average alcohol consumption, defined as ≥ 50 mg/day. Fifty-six percent of patients had quit all alcohol when first evaluated, but follow-up showed that 26% continued high risk consumption. By univariate analysis high alcohol consumption was associated with Latino ethnicity, injection drug use (IDU) and hepatitis C (HCV) coinfection. Multivariable analysis showed only IDU to be independently associated with high alcohol consumption (RR = 4.1, p = 0.0005). There were no significant differences in laboratory values, including CD4 cell counts, except for a trend towards higher transaminases and liver fibrosis scores, between high and low alcohol users. All-cause mortality was statistically higher in the high (37%) vs. low (25%, p = 0.03) alcohol use group, and was associated with both IDU (RR = 2.2, p = 0.04) and the amount of alcohol consumed (RR = 1.1, p = 0.04). Liver decompensation and mortality were both higher in the high use group but of borderline significance. Using an ordinal grouping, we found a strong correlation (R =0.88) between alcohol consumption and the percentage of liver death over total deaths, with lowest mortality rates found in those use of 10 g/day or less.

Conclusions: Unsafe use of alcohol is prevalent in HIV-infected patients and stoppage is not universal. There is a significant impact on all-cause mortality and a trend towards higher liver morbidity and mortality. IDU is significantly and independently associated with high ethanol intake. Practitioners should strongly recommend that HIV patients minimize alcohol use.

MeSH terms

  • Adult
  • Aged
  • Alcohol Drinking / epidemiology*
  • Alcohol Drinking / ethnology
  • Alcohol Drinking / mortality
  • Alcohol Drinking / prevention & control
  • Chi-Square Distribution
  • Coinfection
  • Female
  • HIV Infections / epidemiology*
  • HIV Infections / ethnology
  • HIV Infections / mortality
  • Hepatitis C / epidemiology
  • Humans
  • Logistic Models
  • Los Angeles / epidemiology
  • Male
  • Middle Aged
  • Prevalence
  • Prognosis
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Temperance
  • Time Factors
  • Urban Population / statistics & numerical data
  • Young Adult