title: The J-Curve in HIV: Low and Moderate Alcohol Intake Predicts Mortality but Not the Occurrence of Major Cardiovascular Events.
abstract: OBJECTIVE
  In HIV-negative populations, light-to-moderate alcohol consumption is associated with a lower cardiovascular morbidity and mortality than alcohol abstention. Whether the same holds true for HIV-infected individuals has not been evaluated in detail.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Adults on antiretroviral therapy in the Swiss HIV Cohort Study with follow-up after August 2005 were included. We categorized alcohol consumption into: abstention or very low (<1 g/d), low (1-9 g/d), moderate (10-29 g/d in women and 10-39 g/d in men), and high alcohol intake. Cox proportional hazards models were used to describe the association between alcohol consumption and cardiovascular disease-free survival (combined endpoint), cardiovascular disease events (CADE) and overall survival. Baseline and time-updated risk factors for CADE were included in the models.
  
  
  RESULTS
  Among 9741 individuals included, there were 788 events of major CADE or death during 46,719 patient-years of follow-up, corresponding to an incidence of 1.69 events/100 person-years. Follow-up according to alcohol consumption level was 51% no or very low, 20% low, 23% moderate, and 6% high intake. As compared with no or very low alcohol intake, low (hazard ratio 0.79, 95% confidence interval 0.63 to 0.98) and moderate alcohol intakes (0.78, 0.64 to 0.95) were associated with a lower incidence of the combined endpoint. There was no significant association between alcohol consumption and CADE.
  
  
  CONCLUSIONS
  Compared with no or very low alcohol consumption, low and moderate intake associated with a better CADE-free survival. However, this result was mainly driven by mortality and the specific impact of drinking patterns and type of alcoholic beverage on this outcome remains to be determined.
authors.affiliation: *Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland; †Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; ‡Division of Infectious Diseases and Hospital Epidemiology, University Hospital, University of Zurich, University Hospital Zurich, Zurich, Switzerland; §Cantonal Hospital Aarau, Aarau, Switzerland; ‖University Hospital Geneva, Geneva, Switzerland; ¶University Hospital Lausanne, Lausanne, Switzerland; #University Hospital Basel, Basel, Switzerland; **Cantonal Hospital, St. Gallen, Switzerland; and ††Regional Hospital, Lugano, Switzerland.
authors.forename: Gilles
authors.initials: G
authors.lastname: Wandeler
authors.forename: David
authors.initials: D
authors.lastname: Kraus
authors.forename: Jan
authors.initials: J
authors.lastname: Fehr
authors.forename: Anna
authors.initials: A
authors.lastname: Conen
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
authors.forename: Christina
authors.initials: C
authors.lastname: Orasch
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.forename: Patrick
authors.initials: P
authors.lastname: Schmid
authors.forename: Enos
authors.initials: E
authors.lastname: Bernasconi
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D000434:Alcoholic Beverages; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013557:Switzerland / Q000453:epidemiology