title: Relationship between alcohol use categories and noninvasive markers of advanced hepatic fibrosis in HIV-infected, chronic hepatitis C virus-infected, and uninfected patients.
abstract: BACKGROUND
  It is unclear if the risk of liver disease associated with different levels of alcohol consumption is higher for patients infected with human immunodeficiency virus (HIV) or chronic hepatitis C virus (HCV). We evaluated associations between alcohol use categories and advanced hepatic fibrosis, by HIV and chronic HCV status.
  
  
  METHODS
  We performed a cross-sectional study among participants in the Veterans Aging Cohort Study who reported alcohol consumption at enrollment (701 HIV/HCV-coinfected; 1410 HIV-monoinfected; 296 HCV-monoinfected; 1158 HIV/HCV-uninfected). Alcohol use category was determined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire and alcohol-related diagnoses and was classified as nonhazardous drinking, hazardous/binge drinking, or alcohol-related diagnosis. Advanced hepatic fibrosis was defined by FIB-4 index >3.25.
  
  
  RESULTS
  Within each HIV/HCV group, the prevalence of advanced hepatic fibrosis increased as alcohol use category increased. For each alcohol use category, advanced hepatic fibrosis was more common among HIV-infected than uninfected (nonhazardous: 6.7% vs 1.4%; hazardous/binge: 9.5% vs 3.0%; alcohol-related diagnosis: 19.0% vs 8.6%; P < .01) and chronic HCV-infected than uninfected (nonhazardous: 13.6% vs 2.5%; hazardous/binge: 18.2% vs 3.1%; alcohol-related diagnosis: 22.1% vs 6.5%; P < .01) participants. Strong associations with advanced hepatic fibrosis (adjusted odds ratio [95% confidence interval]) were observed among HIV/HCV-coinfected patients with nonhazardous drinking (14.2 [5.91-34.0]), hazardous/binge drinking (18.9 [7.98-44.8]), and alcohol-related diagnoses (25.2 [10.6-59.7]) compared with uninfected nonhazardous drinkers.
  
  
  CONCLUSIONS
  Advanced hepatic fibrosis was present at low levels of alcohol consumption, increased with higher alcohol use categories, and was more prevalent among HIV-infected and chronic HCV-infected patients than uninfected individuals. All alcohol use categories were strongly associated with advanced hepatic fibrosis in HIV/HCV-coinfected patients.
authors.affiliation: Veterans Affairs (VA) Connecticut Healthcare System, West Haven.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Lim
authors.forename: Janet P
authors.initials: JP
authors.lastname: Tate
authors.forename: Shawn L
authors.initials: SL
authors.lastname: Fultz
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Goulet
authors.forename: Joseph
authors.initials: J
authors.lastname: Conigliaro
authors.forename: Kendall J
authors.initials: KJ
authors.lastname: Bryant
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gibert
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.forename: Marina B
authors.initials: MB
authors.lastname: Klein
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.forename: Vincent
authors.initials: V
authors.lastname: Lo Re
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects*; D000437:Alcoholism / Q000145:classification; D015415:Biomarkers; D015331:Cohort Studies; D060085:Coinfection; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015995:Prevalence
chemical_list: D015415:Biomarkers
keywords: FIB-4; HIV; alcohol; hepatitis C; liver fibrosis