Abstract
BackgroundAlcohol consumption is a known risk factor for liver disease in HIV-infected populations. Therefore, knowledge of alcohol consumption behaviour and risk of disease progression associated with hazardous drinking are important in the overall management of HIV disease. We aimed at assessing the usefulness of routine data collected on alcohol consumption in predicting risk of severe liver disease (SLD) among people living with HIV (PLWHIV) with or without hepatitis C infection seen for routine clinical care in Italy.MethodsWe included PLWHIV from two observational cohorts in Italy (ICONA and HepaICONA). Alcohol consumption was assessed by physician interview and categorized according to the National Institute for Food and Nutrition Italian guidelines into four categories: abstainer; moderate; hazardous and unknown. SLD was defined as presence of FIB4 > 3.25 or a clinical diagnosis of liver disease or liver-related death. Cox regression analysis was used to evaluate the association between level of alcohol consumption at baseline and risk of SLD.ResultsAmong 9542 included PLWHIV the distribution of alcohol consumption categories was: abstainers 3422 (36%), moderate drinkers 2279 (23%), hazardous drinkers 637 (7%) and unknown 3204 (34%). Compared to moderate drinkers, hazardous drinking was associated with higher risk of SLD (adjusted hazard ratio, aHR = 1.45; 95% CI: 1.03–2.03). After additionally controlling for mode of HIV transmission, HCV infection and smoking, the association was attenuated (aHR = 1.32; 95% CI: 0.94–1.85). There was no evidence that the association was stronger when restricting to the HIV/HCV co-infected population.ConclusionsUsing a brief physician interview, we found evidence for an association between hazardous alcohol consumption and subsequent risk of SLD among PLWHIV, but this was not independent of HIV mode of transmission, HCV-infection and smoking. More efforts should be made to improve quality and validity of data on alcohol consumption in cohorts of HIV/HCV-infected individuals.
Highlights
Alcohol consumption is a known risk factor for liver disease in Human immunodeficiency virus (HIV)-infected populations
In the era of combination antiretroviral treatment, people living with HIV/AIDS (PLWHIV) are living longer and long term effects of alcohol consumption are likely to affect people’s quality of life and survival [2]
Knowledge of alcohol consumption behaviour and risk of disease progression associated with hazardous drinking are important in the overall management of HIV disease [3]
Summary
Alcohol consumption is a known risk factor for liver disease in HIV-infected populations. We aimed at assessing the usefulness of routine data collected on alcohol consumption in predicting risk of severe liver disease (SLD) among people living with HIV (PLWHIV) with or without hepatitis C infection seen for routine clinical care in Italy. Identifying unhealthy levels of alcohol consumption in HIV patients seen for routine clinical care is important because of the possible role alcohol plays in HIV disease progression as well as non HIV-related comorbidities such as liver failure [1]. Others studies have used patient interviews, biomarkers or breath tests to assess level of alcohol consumption [27, 28] These different measurement tools has led to methodological challenges in quantifying estimates of alcohol consumption amongst PLWHIV [29]
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