Bonacini M. , 2011; 10 (4): 502-507
Alcohol use among patients with HIV infection
* Department of Transplantation, California Pacific Medical Center, San Francisco CA, USA.
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 al-
cohol 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 hepa-
titis 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, in-
cluding 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 mor-
tality rates found in those use of 10 g/day or less. Conclusions. 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.
Key words. HIV infection. Ethanol. Drug users. Hepatitis C virus. Hepatitis B virus. Seroprevalence. Viral infections.
Correspondence and reprint request: Maurizio Bonacini, M.D.
Department of Transplantation. California Pacific Medical Center
2340 Clay Street, Room 308. San Francisco, CA 94115
Tel.: (415) 600-1026. Fax: (415) 600-1200
Manuscript received: May 03, 2011.
Manuscript accepted: May 26, 2011.
October-December, Vol. 10 No.4, 2011: 502-507
Alcohol use in HIV-infected patients has been as-
sociated with a number of medical and social issues,
including noncompliance with antiretroviral thera-
py,1 risky sexual and needle-sharing behavior,1-4 and
decreased cellular immunity to specific HIV anti-
gens.5 Safe alcohol drinking is difficult to define, but
there appears to be a threshold of alcohol con-
sumption (estimated in drinks or grams per unit
time) beyond which alcoholic liver disease or other
disorders can develop.6-9 Unsafe alcohol use has
been defined as ≥ 50 grams/day (g/d),8 > 30 g/d,7 but
even lower consumption (23 g/d for women) have
the potential for causing alcoholic liver disease
(ALD).9 There is little data about alcohol and hepa-
tic end-organ damage in HIV patients without viral
hepatitis, and few data regarding its relationship to
viral hepatitis B or C.10,11 In addition, the use of al-
cohol in minorities affected by HIV, particularly La-
tinos, has not been adequately addressed. In fact
only two studies on alcohol in HIV disease included
> 50% minorities.12,13
T o evaluate alcohol use in patients with HIV in-
fection, with or without viral hepatitis, seen in an
urban academic HIV-Liver Clinic.
Alcohol use among patients with HIV infection. , 2011; 10 (4): 502-507
bumin, AST , CD4 and liver fibrosis scores in diffe-
rent alcohol consumption groups, this data should
not be construed as evidence that alcohol con-
sumption is acceptable, as we did not measure its
impact on relationships, drug adherence, risky beha-
vior or social issues. In fact, there was a definite as-
sociation between high alcohol use and all-cause
mortality, as well as trend for greater liver morbidi-
ty and mortality. This relatively high prevalence of
potentially unsafe alcohol consumption in subgroups
of HIV patients warrants:
• Further study of immunological and hepatic out-
Alcohol counseling, particularly in women and
patients with polysubstance abuse.
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