title: Alcohol use among patients with HIV infection.
abstract: OBJECTIVE
  To evaluate alcohol use in patients with HIV infection, assess ethnic and social associations, and describe outcomes.
  
  
  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.
  
  
  METHODS
  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 alcohol 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 hepatitis 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, including 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 mortality 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.
authors.affiliation: Department of Transplantation, California Pacific Medical Center, San Francisco CA 94115, USA. bonacim@sutterhealth.org
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bonacini
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control; D016009:Chi-Square Distribution; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013695:Temperance; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult