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: 2.07). 10/2011; 10(4):502-7.
Source: PubMed


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.
    Full-text · Article · Oct 2013 · The Scientific World Journal
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    • "First, it can result in negative health outcomes, either directly or because of interactions with antiretroviral medications. Among HIV-positive individuals , heavy alcohol use has been found to be associated with decreased cluster of differentiation 4 (CD4) cell counts or nonsuppression of HIV viral load (Baum et al., 2010; Hahn and Samet, 2010; Samet et al., 2007; Shacham et al., 2011), increased neurodegeneration or memory impairment (Fama et al., 2009, 2011; Persidsky et al., 2011), decreased health-related quality of life (Uphold et al., 2007), and increased mortality from various causes (Bonacini, 2011; Braithwaite et al., 2007; Katcher et al., 2010). Likewise, crystal methamphetamine use among HIV-positive individuals has been found to be associated with decreased CD4 cell counts or nonsuppression of HIV viral load (Fairbairn et al., 2011; King et al., 2009; Toussi et al., 2009), neurodegeneration or memory impairment (Scott et al., 2007), and resistance to antiretroviral medications (Cachay et al., 2007; Colfax et al., 2007). "
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    ABSTRACT: Objective: This study examined substance use (intended and actual), unprotected sex, and HIV disclosure practices (disclosure and questioning) among HIV-positive men who have sex with men (MSM) at two party-oriented vacations, where substance use and sexual risk may be heightened. Method: A random sample of 489 MSM attending one of two party-oriented vacations participated in PartyIntents, a short-term longitudinal survey. Nearly half (47%) completed a follow-up assessment at the event or online for up to 2 weeks after the event. We examined rates of baseline intentions to use substances, actual substance use, and unprotected intercourse among HIV-positive men in attendance.Rates among HIV-negative men were estimated for comparison. Multiple logistic regression was used to assess the impact of illegal drug use and HIV status on unprotected anal intercourse (UAI). Results: HIV-positive attendees (17%) were significantly more likely than HIV-negative attendees to use nitrite inhalants (or "poppers") (24.3% vs. 10.7%). HIV-positive attendees were also significantly more likely to have insertive UAI (64.3% vs. 34.1%) and receptive UAI (68.8% vs. 22.2%). Multivariate models showed associations between HIV status and illegal drug use with UAI (for HIV status, odds ratio [OR] = 4.5, p = .001; for any illegal drug use, OR = 16.4, p < .001). There was no evidence that the influence of drug use moderated risk by HIV status. Rates of HIV disclosure and questioning did not differ by HIV status. Conclusions: HIV-positive men attending these events engaged in higher rates of illegal drug use and sexual risk than HIV-negative men. Prevention campaigns targeting MSM at high-risk events should include messages geared toward HIV-positive men.
    Full-text · Article · Jan 2013 · Journal of studies on alcohol and drugs
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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.
    Full-text · Article · Jun 2012 · Journal of NeuroVirology
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