2011, Number 4
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Ann Hepatol 2011; 10 (4)
Alcohol use among patients with HIV infection
Bonacini M
Language: English
References: 24
Page: 502-507
PDF size: 56.45 Kb.
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 HIVinfected
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.
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