Alcohol use among patients with HIV infection.

Department of Transplantation, California Pacific Medical Center, San Francisco CA 94115, USA.
Annals of hepatology: official journal of the Mexican Association of Hepatology (Impact Factor: 2.19). 10/2011; 10(4):502-7.
Source: PubMed

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

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