The association between alcohol use and cardiovascular disease among people living with HIV: a systematic review.
BACKGROUND
People living with HIV-infection (PLWH) have higher prevalence and earlier onset of cardiovascular disease (CVD), compared to uninfected populations. It is unclear how alcohol consumption is related to CVD among PLWH.


OBJECTIVE
To summarize the current literature and strength of evidence regarding alcohol consumption as a risk factor for CVD among PLWH, to generate summary estimates for the effect of alcohol consumption on CVD outcomes, and to make recommendations for clinical practice and future research based on the findings and limitations of existing studies.


METHODS
A systematic review was conducted using Pubmed/Medline to identify relevant peer-reviewed articles published between 1 January 1999 and 1 January 2014. After critical review of the literature, 13 studies were identified. Risk ratios were extracted or calculated and sample size weighted summary estimates were calculated.


RESULTS
The prevalence of a CVD diagnosis or event ranged from 5.7-24.0%. The weighted pooled crude effect sizes were 1.75 (95% CI 1.06, 3.17) for general and 1.78 (95% CI 1.09, 2.93) for heavy alcohol use on CVD. The pooled adjusted effect size was 1.37 (95% CI 1.02, 1.84) for heavy alcohol use on CVD. Pooled estimates differed by CVD outcome and alcohol measure; alcohol consumption was most significant for cerebral/ischemic events.


CONCLUSIONS
HIV clinicians should consider risk factors that are not included in the traditional risk factor framework, particularly heavy alcohol consumption. Neglect of this risk factor may lead to underestimation of risk, and thus under-treatment among PLWH.
a Department of Epidemiology , College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville , FL , USA.
Natalie E
NE
Kelso
a Department of Epidemiology , College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville , FL , USA.
David S
DS
Sheps
a Department of Epidemiology , College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville , FL , USA.
Robert L
RL
Cook
D000428:Alcohol Drinking / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000453:epidemiology / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015995:Prevalence; D012307:Risk Factors
Alcohol; HIV-infection; cardiovascular disease; review; risk factors