title: Impact of lifetime alcohol use on liver fibrosis in a population of HIV-infected patients with and without hepatitis C coinfection.
abstract: 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 CD4 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 CD4 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.
authors: Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine , Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts.
authors: Daniel
authors: D
authors: Fuster
authors: Judith I
authors: JI
authors: Tsui
authors: Debbie M
authors: DM
authors: Cheng
authors: Emily K
authors: EK
authors: Quinn
authors: Carly
authors: C
authors: Bridden
authors: David
authors: D
authors: Nunes
authors: Howard
authors: H
authors: Libman
authors: Richard
authors: R
authors: Saitz
authors: Jeffrey H
authors: JH
authors: Samet
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000473:pathology; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D060085:Coinfection / Q000175:diagnosis / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies
keywords: Alcohol; HIV; Hepatitis C Virus; Liver Fibrosis
references: Hepatology. 2002 Nov;36(5 Suppl 1):S220-5
references: 12407597
references: J Psychiatr Res. 1975 Nov;12(3):189-98
references: 1202204
references: Am J Gastroenterol. 2010 Jun;105(6):1346-53
references: 20179698
references: Alcohol Clin Exp Res. 2004 Apr;28(4):572-7
references: 15100608
references: Drug Alcohol Depend. 2006 Feb 28;81(3):259-65
references: 16129567
references: Am J Gastroenterol. 2008 Aug;103(8):1973-80
references: 18796094
references: World J Gastroenterol. 2010 Mar 21;16(11):1337-43
references: 20238400
references: Curr HIV Res. 2011 Jun;9(4):256-62
references: 21675942
references: Hepatology. 1999 Oct;30(4):1054-8
references: 10498659
references: AIDS. 2008 Oct 1;22(15):1979-91
references: 18784461
references: Alcohol Clin Exp Res. 2006 Apr;30(4):709-19
references: 16573590
references: Semin Liver Dis. 2009 May;29(2):188-99
references: 19387918
references: Lancet. 1997 Mar 22;349(9055):825-32
references: 9121257
references: Hepatology. 1997 Aug;26(2):485-90
references: 9252163
references: AIDS. 2012 Mar 13;26(5):599-607
references: 22156972
references: Hepatology. 2007 Jul;46(1):32-6
references: 17567829
references: Gastroenterology. 2006 May;130(6):1607-16
references: 16697724
references: AIDS Res Hum Retroviruses. 2004 Feb;20(2):151-5
references: 15018702
references: J Stud Alcohol. 1982 Nov;43(11):1157-70
references: 7182675
references: J Infect Dis. 2012 Mar 15;205(6):1005-13
references: 22291196
references: J Stud Alcohol Drugs. 2009 Mar;70(2):296-303
references: 19261242
references: Lancet. 2011 Apr 2;377(9772):1198-209
references: 21459211
references: Clin Infect Dis. 2011 May;52(9):1164-73
references: 21467023
references: Hepatology. 2009 Apr;49(4):1335-74
references: 19330875
references: J Infect Dis. 2008 Dec 15;198(12):1766-75
references: 18956976
references: PLoS One. 2011;6(7):e22698
references: 21799935
references: JAMA. 2000 Jul 26;284(4):450-6
references: 10904508
references: J Acquir Immune Defic Syndr. 2007 Oct 1;46(2):194-9
references: 17667330
references: Alcohol Alcohol. 2008 Mar-Apr;43(2):137-42
references: 18216180
references: Drug Alcohol Rev. 2010 Jul;29(4):437-45
references: 20636661
references: Clin Infect Dis. 2011 Mar 1;52(5):674-80
references: 21248367
references: HIV Med. 2009 Mar;10(3):133-42
references: 19207596
references: Hepatology. 2009 Jan;49(1):97-105
references: 19053048
references: J Viral Hepat. 2003 Mar;10(2):118-25
references: 12614468
references: J Acquir Immune Defic Syndr. 2006 Dec 1;43(4):411-7
references: 17099312
references: Hepatology. 2004 Mar;39(3):826-34
references: 14999703
references: Clin Gastroenterol Hepatol. 2005 Nov;3(11):1150-9
references: 16271348
references: Proc Natl Acad Sci U S A. 2002 Nov 26;99(24):15661-8
references: 12441397
references: Alcohol Alcohol. 2006 Sep-Oct;41(5):546-52
references: 16855001
references: Hepatology. 2009 Jun;49(6):1821-7
references: 19291784
references: AIDS. 2008 Jan 30;22(3):415-20
references: 18195568
references: Gut. 1997 Dec;41(6):845-50
references: 9462221
references: J Acquir Immune Defic Syndr. 2005 Dec 15;40(5):538-44
references: 16284529
references: Clin Infect Dis. 2001 Feb 1;32(3):492-7
references: 11170959
references: J Subst Abuse Treat. 2000 Jun;18(4):359-63
references: 10812309
references: World J Gastroenterol. 2007 May 7;13(17):2436-41
references: 17552026
references: Am J Gastroenterol. 2006 Jul;101(7):1500-8
references: 16863553
references: Hepatology. 2002 Nov;36(5 Suppl 1):S161-72
references: 12407590
references: Hepatology. 2003 Aug;38(2):518-26
references: 12883497
references: Hepatology. 2006 Jun;43(6):1317-25
references: 16729309