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Level of Alcohol Use and Advanced Hepatic Fibrosis in HIV-Infected and Uninfected Patients...."there may be no safe level of alcohol use among HIV+ & HCV+"
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Reported by Jules Levin
CROI 2014 March 3-6 Boston, MA
JP Tate1, JK Lim1, KJ Bryant2, CL Gibert3, D Rimland4, MB Goetz5, MB Klein6, DA Fiellin1, AC Justice1, V Lo Re, III7
1Yale University School of Medicine, New Haven, CT, 2National Institute on Alcohol Abuse and Alcoholism (NIAAA), Washington, DC, 3George Washington University School of Medicine, Washington, DC, 4Emory School of Medicine, Atlanta, GA, 5David Geffen School of Medicine, University of California, Los Angeles, CA, 6Department of Medicine, McGill University, Montreal, QC, CANADA, 7University of Pennsylvania School of Medicine, Philadelphia, PA.
......authors conclude: "There may be no "safe" level of alcohol consumption among HIV+ and HCV+.....Advanced hepatic fibrosis was present at low levels of alcohol consumption, increased with alcohol use categories, and was greater in HIV-infected than uninfected individuals."
for HCV mono infected advanced hepatic fibrosis was present in 13.8% of patients with an alcoholic abuse/dependence diagnosis, 9.5% "hazardous/binge" drinking, and 1.3% "non-hazardous' drinkers....Among HCV/HIV connected: 14.2% "non-hazardous" drinkers had advanced liver fibrosis, 18.9% of "hazardous/binge" drinkers & 25.2% with alcohol dependence/abuse.....for HIV+ only 2.5% of "non-hazardous" drinkers, 3.3% of "hazardous/binge" drinkers, and 7.8% of alcohol dependent/abuse drinkers had advanced fibrosis.
Reported by Jules Levin
CROI 2014 March 3-6 Boston, MA
JP Tate1, JK Lim1, KJ Bryant2, CL Gibert3, D Rimland4, MB Goetz5, MB Klein6, DA Fiellin1, AC Justice1, V Lo Re, III7
1Yale University School of Medicine, New Haven, CT, 2National Institute on Alcohol Abuse and Alcoholism (NIAAA), Washington, DC, 3George Washington University School of Medicine, Washington, DC, 4Emory School of Medicine, Atlanta, GA, 5David Geffen School of Medicine, University of California, Los Angeles, CA, 6Department of Medicine, McGill University, Montreal, QC, CANADA, 7University of Pennsylvania School of Medicine, Philadelphia, PA.
Program Abstract-
Conclusions: Advanced hepatic fibrosis was present at low levels of alcohol consumption, increased with alcohol use categories, and was greater in HIV-infected than uninfected individuals. For all categories of alcohol use, associations with advanced hepatic fibrosis were particularly strong in HIV/HCV-coinfected patients.
Results: In 1,454 HIV-infected and 2,111 uninfected, presence of advanced hepatic fibrosis increased with alcohol use category (p-trend <0.001 for both groups). HIV-infected had a higher prevalence of advanced hepatic fibrosis than uninfected (non-hazardous drinking: 6.7% versus 1.4%; hazardous/binge drinking: 9.5% versus 3.0%; abuse/dependence: 19.0% versus 8.6%; p<0.01). In HIV infected, as level of alcohol increased so did the proportion with CD4 count <200 cells/mm3 (non-hazardous: 20%; hazardous/binge: 23%; abuse/dependence: 29%; test for trend, p<0.001) and HIV RNA >400 copies/mL (non-hazardous: 52%; hazardous/binge: 56%; abuse/dependence: 60%; test for trend, p<0.001). Both HIV and HCV increased the strength of association between alcohol use and advanced hepatic fibrosis with strongest associations seen in HIV/HCV-coinfected patients with non-hazardous drinking (OR, 13.7 [5.7-33.3]), hazardous/binge drinking (OR, 19.1 [8.0-45.8]), and alcohol abuse/dependence (OR, 24.5 [10.3-58.5]) compared to uninfected nonhazardous drinkers (Figure).
Background: The risk of liver disease associated with level of alcohol consumption is unclear for HIV-infected patients. We evaluated the association
between alcohol use categories and advanced hepatic fibrosis by HIV and Hepatitis C virus (HCV) status.
Methodology: In HIV-infected and uninfected subjects reporting alcohol use at enrollment in the Veterans Aging Cohort Study, alcohol use was determined
by responses to Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire and alcohol-related diagnoses. Use was classified as non-hazardous, hazardous/binge, or abuse/dependence. Adjusted odds ratios (ORs) of advanced hepatic fibrosis (defined as FIB-4 >3.25) associated with alcohol use categories were determined, stratified by
HIV/HCV status.
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