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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    • "Hypertension prevalence in HIV-infected individuals ranges from 5.9 to 56.4% [9] [10] [11] [12] and has been associated with alcohol abuse and other factors related to HIV infection [9] [10] [13]. In these individuals , the prevalence of alcohol abuse ranges from 8% [14] [15] to 50% [16] [17] [18], exceeding the rates in general populations of the United States [19], Europe [20], and Brazil [21], where the prevalence is between 2 and 41% in men and 0.1 and 21% in women [20]. The relationship between alcohol consumption and hypertension may be influenced by some characteristics, such as skin color [3] [22]. "
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    ABSTRACT: Introduction. Although alcohol abuse is associated with hypertension in whites and nonwhites, it has been scarcely investigated in HIV-infected patients. Objective. To investigate whether the association of alcohol abuse with hypertension is influenced by skin color in HIV-infected individuals. Methods. Cross-sectional study in HIV-infected individuals aged 18 years or older. Demographic characteristics, lifestyle, and HIV infection were investigated. Alcohol abuse was defined as ≥15 (women) and ≥30 g/alcohol/day (men), and binge drinking by the intake of ≥5 drinks on a single occasion. Hypertension was defined by blood pressure ≥140/90 mmHg or use of blood pressure-lowering agents. Results. We studied 1,240 individuals, with 39.1 ± 10 years, 51% males and 57% whites. Age and body mass index were associated with blood pressure, and there was an independent association of alcohol abuse with hypertension in whites (RR = 1.9, 95% CI 1.1-3.3) and nonwhites (RR = 2.4, 95% CI 1.4 to 4.0). Among nonwhite individuals who were alcohol abusers, systolic (9.3 ± 3.2; P = 0.001) and diastolic blood pressures (6.4 ± 2.1; P = 0.008) were higher than in nonabusers. Conclusion. Alcohol abuse is a risk factor for hypertension in white and nonwhite HIV-infected individuals. The association of ethanol consumption with blood pressure is not explained by AIDS-related conditions.
    The Scientific World Journal 10/2013; 2013:169825. DOI:10.1155/2013/169825 · 1.73 Impact Factor
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    • "Since dopamine receptors decline with age, cocaine abuse in HIV subjects could exacerbate their age-associated dopaminergic receptor loss (Chang et al. 2008a). Furthermore, a growing number of HIV patients are identified to have alcohol use problems (Bonacini 2011), which is well known to contribute to the aging process in the brain (Pfefferbaum et al. 2012). Alcohol abuse appears to contribute to additional brain changes in HIV patients who had greater brain atrophy with larger ventricular volumes (Pfefferbaum et al. 2006), decreased neuronal marker NAA (Pfefferbaum et al. 2005), and greater diffusion abnormalities with lower FA and higher MD (Pfefferbaum et al. 2007). "
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    ABSTRACT: Highly active antiretroviral therapy (HAART) has increased life expectancy among HIV-infected individuals, and by 2015, at least half of all HIV-infected individuals will be over 50 years of age. Neurodegenerative processes associated with aging may be facilitated by HIV-1 infection, resulting in premature brain aging. This review will highlight brain abnormalities in HIV patients in the setting of aging, focusing on recent neuroimaging studies of the structural, physiological, functional and neurochemical changes. Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy studies performed during the pre-HAART era or on antiretroviral-naive subjects suggest an accelerated aging process, while those on HAART-treated subjects suggest premature brain atrophy. Diffusion tensor imaging studies yielded conflicting findings on the relationship between HIV and age in neuroasymptomatic individuals. Functional MRI studies found evidence of premature or accelerated aging processes in the brains of HIV subjects. Lastly, many age-related illnesses such as diabetes, stroke, and depression, as well as comorbid substance abuse, may further exacerbate the aging process in the HIV-infected brain, leading to premature or accelerated age-related brain changes. Given the different pathologic or physiologic changes in the brain assessed by the different neuroimaging techniques, using a multimodal approach in longitudinal follow-up studies is recommended for future studies.
    Journal of NeuroVirology 06/2012; 18(4):291-302. DOI:10.1007/s13365-012-0114-1 · 3.32 Impact Factor
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    ABSTRACT: Human immunodeficiency virus (HIV) infection and alcoholism each carries liability for disruption of brain structure and function integrity. Despite considerable prevalence of HIV-alcoholism comorbidity, few studies examined the potentially heightened burden of disease comorbidity. Participants were 342 men and women: 110 alcoholics, 59 with HIV infection, 65 with HIV infection and alcoholism, and 108 healthy control subjects. This design enabled examination of independent and combined effects of HIV infection and alcoholism along with other factors (acquired immune deficiency syndrome [AIDS]-defining events, hepatitis C infection, age) on regional brain volumes derived from T1-weighted magnetic resonance images. Brain volumes, expressed as Z scores corrected for intracranial volume and age, were measured in 20 tissue and 5 ventricular and sulcal regions. The most profound and consistent volume deficits occurred with alcohol use disorders, notable in the cortical mantle, insular and anterior cingulate cortices, thalamus, corpus callosum, and frontal sulci. The HIV-only group had smaller thalamic and larger frontal sulcal volumes than control subjects. HIV disease-related factors associated with greater volume abnormalities included CD4 cell count nadir, clinical staging, history of AIDS-defining events, infection age, and current age. Longer sobriety and less lifetime alcohol consumption were predictive of attenuated brain volume abnormalities in both alcohol groups. Having HIV infection with alcoholism and AIDS had an especially poor outcome on brain structures. That longer periods of sobriety and less lifetime alcohol consumption were predictive of attenuated brain volume abnormalities encourages the inclusion of alcohol recovery efforts in HIV/AIDS therapeutic settings.
    Biological psychiatry 03/2012; 72(5):361-70. DOI:10.1016/j.biopsych.2012.02.018 · 9.47 Impact Factor
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