alcohol consumption is associated with an increased risk of advanced liver
fibrosis for people living with HIV and hepatitis C virus (HCV) co-infection,
investigators from the United States report in Clinical Infectious Diseases.
For all categories of drinking – moderate, severe/binge and
alcohol-related disorders – prevalence of advanced liver fibrosis was also
higher among people living with HIV or HCV mono-infection compared to people who had neither infection.
“For each alcohol
use category, advanced fibrosis was more common among HIV-infected than -uninfected and chronic HCV-infected than -uninfected patients,” comment the
authors. “When we evaluated associations between alcohol use categories and
advanced fibrosis across groups stratified by HIV/HCV status, the strongest
associations were observed among those with HIV/HCV coinfection.”
believe their findings have important implications for patient care, and that individuals
with advanced fibrosis should be advised to abstain from alcohol use or reduce
consumption is highly prevalent among people living with HIV and/or HCV infection,
and heavy drinking has been associated with advanced liver disease in this group. However, the impact of different levels of alcohol consumption on the
severity of liver fibrosis in people living with HIV and/or HCV infection is
unclear. Investigators from the US Department of Veterans Affairs therefore
designed a cross-sectional study to evaluate the associations between different
levels of alcohol consumption and advanced liver fibrosis in patients according
to their HIV and/or HCV infection status.
recruited to the study between 2002 and 2010. The study population included 701
people with HIV and HCV-co-infection; 1410 people with HIV mono-infection; 296 people with HCV mono-infection and 1158 people with neither infection (controls). All reported
some level of alcohol consumption. Liver fibrosis was assessed non-invasively
using the FIB-4 index, a score above 3.5 indicating advanced fibrosis. Participants completed a short questionnaire about their alcohol consumption and were placed
into one of three categories: non-hazardous drinking; hazardous/binge drinking;
Overall, 8% of participants had advanced liver fibrosis. Prevalence was higher among people with HIV (10%) than people who did not have HIV (4%) and also among people with chronic
HCV infection (19%) compared to people who did not have HCV (4%).
For all patient
groups, the prevalence of severe fibrosis increased with alcohol use category.
Moreover, for each
alcohol use category, advanced fibrosis was more common in HIV-positive than
HIV-negative patients (non-hazardous: 7 vs 1%; hazardous/binge: 10 vs 3%;
alcohol-related disorders: 19 vs 9%; p < 0.01). Findings were similar when
the investigators compared HCV-infected and -uninfected patients (non-hazardous
14 vs 3%; hazardous/binge: 18 vs 3%; alcohol-related disorders: 22 vs 7%;
p < 0.01).
For each category
of alcohol use, the prevalence of advanced liver fibrosis was highest among people living with HIV and HCV co-infection.
In analysis that
controlled for potential confounders, the association between alcohol use category
and the risk of advanced liver fibrosis was strongest for people with HIV and HCV
co-infection: non-hazardous drinking, OR, 14.2; 95% CI, 5.91-34.0; hazardous/binge,
OR, 18.9; 95% CI, 7.98-44.8; alcohol-related
disorders, OR, 25.2; 95% CI, 10.6-59.7 (all comparisons with HIV/HCV-uninfected
provide new data that suggest there is a stepwise increased risk of advanced
liver fibrosis with greater severity of alcohol use,” write the investigators. “They
also demonstrate that all alcohol use categories are strongly associated with
advanced hepatitis fibrosis in HIV/HCV-coinfected patients.”
believe their findings have important implications for patient care. First, all
patients should have their alcohol consumption assessed; people living with HIV and HCV
co-infection should be counselled to reduce their alcohol consumption; and any
patient with advanced fibrosis should be advised “to reduce or avoid alcohol