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Impact of Lifetime Alcohol Use on Liver Fibrosis in a Population of HIV ‐Infected Patients With and Without Hepatitis C Coinfection
Author(s) -
Fuster Daniel,
Tsui Judith I.,
Cheng Debbie M.,
Quinn Emily K.,
Bridden Carly,
Nunes David,
Libman Howard,
Saitz Richard,
Samet Jeffrey H.
Publication year - 2013
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/acer.12129
Subject(s) - medicine , coinfection , gastroenterology , hepatitis c , liver disease , odds ratio , hepatitis c virus , population , fibrosis , immunology , human immunodeficiency virus (hiv) , virus , environmental health
Background The effect of alcohol on liver disease in HIV infection has not been well characterized. Methods We performed a cross‐sectional multivariable analysis of the association between lifetime alcohol use and liver fibrosis in a longitudinal cohort of HIV ‐infected patients with alcohol problems. Liver fibrosis was estimated with 2 noninvasive indices, “ FIB ‐4,” which includes platelets, liver enzymes, and age; and aspartate aminotransferase/platelet ratio index (“ APRI ”), which includes platelets and liver enzymes. FIB ‐4 <1.45 and APRI <0.5 defined the absence of liver fibrosis. FIB ‐4 >3.25 and APRI >1.5 defined advanced liver fibrosis. The main independent variable was lifetime alcohol consumption (<150 kg, 150 to 600 kg, >600 kg). Results Subjects ( n = 308) were 73% men, mean age 43 years, 49% with hepatitis C virus ( HCV ) infection, 60% on antiretroviral therapy, 49% with an HIV RNA load <1,000 copies/ml, and 18.7% with a CD 4 count <200 cells/mm 3 . Forty‐five percent had lifetime alcohol consumption >600 kg, 32.7% 150 to 600 kg, and 22.3% <150 kg; 33% had current heavy alcohol use, and 69% had >9 years of heavy episodic drinking. Sixty‐one percent had absence of liver fibrosis and 10% had advanced liver fibrosis based on FIB ‐4. In logistic regression analyses, controlling for age, gender, HCV infection, and CD 4 count, no association was detected between lifetime alcohol consumption and the absence of liver fibrosis ( FIB ‐4 <1.45) (adjusted odds ratio [ AOR ] = 1.12 [95% CI : 0.25 to 2.52] for 150 to 600 kg vs. <150 kg; AOR = 1.11 [95% CI : 0.52 to 2.36] for >600 kg vs. <150 kg; global p = 0.95). Additionally, no association was detected between lifetime alcohol use and advanced liver fibrosis ( FIB ‐4 >3.25). Results were similar using APRI , and among those with and without HCV infection. Conclusions In this cohort of HIV ‐infected patients with alcohol problems, we found no significant association between lifetime alcohol consumption and the absence of liver fibrosis or the presence of advanced liver fibrosis, suggesting that alcohol may be less important than other known factors that promote liver fibrosis in this population.