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The Role of Current and Historical Alcohol Use in Hepatic Fibrosis Among HIV-Infected Individuals

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Abstract

We examined risk factors for advanced hepatic fibrosis [fibrosis-4 (FIB)-4 >3.25] including both current alcohol use and a diagnosis of alcohol use disorder among HIV-infected patients. Of the 12,849 patients in our study, 2133 (17%) reported current hazardous drinking by AUDIT-C, 2321 (18%) had a diagnosis of alcohol use disorder, 2376 (18%) were co-infected with chronic hepatitis C virus (HCV); 596 (5%) had high FIB-4 scores >3.25 as did 364 (15%) of HIV/HCV coinfected patients. In multivariable analysis, HCV (adjusted odds ratio (aOR) 6.3, 95% confidence interval (CI) 5.2–7.5), chronic hepatitis B (aOR 2.0, 95% CI 1.5–2.8), diabetes (aOR 2.3, 95% CI 1.8–2.9), current CD4 <200 cells/mm3 (aOR 5.4, 95% CI 4.2–6.9) and HIV RNA >500 copies/mL (aOR 1.3, 95% CI 1.0–1.6) were significantly associated with advanced fibrosis. A diagnosis of an alcohol use disorder (aOR 1.9, 95% CI 1.6–2.3) rather than report of current hazardous alcohol use was associated with high FIB-4. However, among HIV/HCV coinfected patients, both current hazardous drinkers (aOR 1.6, 95% CI 1.1–2.4) and current non-drinkers (aOR 1.6, 95% CI 1.2–2.0) were more likely than non-hazardous drinkers to have high FIB-4, with the latter potentially reflecting the impact of sick abstainers. These findings highlight the importance of using a longitudinal measure of alcohol exposure when evaluating the impact of alcohol on liver disease and associated outcomes.

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Acknowledgements

We are grateful to all patients, physicians, investigators, and staff involved in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS). We thank Robin Nance for her assistance with the analysis.

Funding

This work was supported by the National Institutes of Alcohol Abuse and Alcoholism (NIAAA) at the National Institutes of Health [U24AA020801, U01AA020793 and U01AA020802]. Additional support came from the National Institute of Allergy and Infectious Diseases [P30 AI027757, P30 AI027763, P30 AI027767, P30 AI036214, P30 AI060354, P30 AI094189, P30 AI50410, and R24 AI067039].

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Authors and Affiliations

  1. Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, 325 Ninth Avenue, Box 359930, Seattle, WA, 98104, USA

    H. Nina Kim, Heidi M. Crane, Carla V. Rodriguez, Stephen Van Rompaey, Joseph O. Merrill & Mari M. Kitahata

  2. Fenway Institute, Fenway Health, Boston, MA, USA

    Kenneth H. Mayer

  3. School of Medicine, University of California San Francisco, San Francisco, CA, USA

    Katerina Christopoulos & Elvin Geng

  4. Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Sonia Napravnik & Joseph J. Eron

  5. Department of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Geetanjali Chander & Richard Moore

  6. Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Heidi Hutton & Mary E. McCaul

  7. Department of Medicine, University of California San Diego, San Diego, CA, USA

    Edward R. Cachay

  8. Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AB, USA

    Michael J. Mugavero & Michael S. Saag

Authors
  1. H. Nina Kim
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  2. Heidi M. Crane
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  3. Carla V. Rodriguez
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  6. Katerina Christopoulos
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  7. Sonia Napravnik
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  8. Geetanjali Chander
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  9. Heidi Hutton
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  10. Mary E. McCaul
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  11. Edward R. Cachay
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  12. Michael J. Mugavero
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  13. Richard Moore
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  14. Elvin Geng
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  15. Joseph J. Eron
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  16. Michael S. Saag
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  17. Joseph O. Merrill
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  18. Mari M. Kitahata
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Corresponding authors

Correspondence to H. Nina Kim or Mari M. Kitahata.

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Conflict of interest

JJE has received grant support from ViiV Healthcare, Gilead Sciences, BMS and Janssen; he is a consultant for ViiV Healthcare, Gilead, BMS, Janssen and Merck. MS has received grant support from BMS, ViiV, Merck, Gilead, BMS Abbvie and Janssen; he is a consultant for Merck, Gilead and BMS. The remaining authors declare that they have no conflict of interest.

Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent to participate in CNICS was obtained from all individual participants included in the study.

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Kim, H.N., Crane, H.M., Rodriguez, C.V. et al. The Role of Current and Historical Alcohol Use in Hepatic Fibrosis Among HIV-Infected Individuals. AIDS Behav 21, 1878–1884 (2017). https://doi.org/10.1007/s10461-016-1665-6

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  • DOI: https://doi.org/10.1007/s10461-016-1665-6

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