Unhealthy Alcohol Use is Associated with Monocyte Activation Prior to Starting Antiretroviral Therapy.
BACKGROUND
Alcohol use may accelerate HIV disease progression, but the plausible biological mechanisms have not been clearly elucidated.


METHODS
HIV-positive persons who were not on antiretroviral therapy (ART) completed the baseline assessment for a longitudinal study examining the association of alcohol use with HIV disease markers. Oversampling drinkers, baseline samples were tested for markers of monocyte activation (soluble CD14 [sCD14]), inflammation (interleukin-6 [IL-6]-6), and coagulation (d-dimer). We defined "unhealthy alcohol use" as testing positive using the Alcohol Use Disorders Identification Test-Consumption (≥3 for women and ≥4 for men) in the past 3 months or testing positive using a biomarker of heavy drinking, phosphatidylethanol (≥50 ng/ml). Multiple linear regression was used to examine the associations of unhealthy alcohol use with sCD14, log10 IL-6, and d-dimer.


RESULTS
Compared to those who were abstinent from alcohol, unhealthy drinkers had significantly higher sCD14 levels (mean = 1,676 vs. 1,387 ng/ml; mean difference [95% confidence interval (CI)] = 289 [83, 495], p < 0.01). In analyses adjusted for demographic factors, current cigarette smoking, and HIV disease markers, unhealthy drinkers continued to display significantly higher sCD14 levels compared to those who were abstinent from alcohol (adjusted mean = 1,670 vs. 1,406 ng/ml; adjusted mean difference [95% CI] = 264 [47, 480], p = 0.02). Unhealthy alcohol use was not significantly associated with IL-6 or d-dimer levels.


CONCLUSIONS
Unhealthy alcohol use was independently associated with a marker of monocyte activation (i.e., higher sCD14) that predicts mortality in treated HIV infection. Longitudinal research should examine whether unhealthy alcohol use predicts changes in sCD14 prior to and following ART initiation.
Department of Community Health Systems, San Francisco School of Nursing, University of California, San Francisco, San Francisco, California.
Adam W
AW
Carrico
Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco, San Francisco, California.
Peter W
PW
Hunt
Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco, San Francisco, California.
Nneka I
NI
Emenyonu
Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Winnie
W
Muyindike
Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Christine
C
Ngabirano
Boston University School of Public Health, Boston, Massachusetts.
Debbie M
DM
Cheng
Boston University School of Public Health, Boston, Massachusetts.
Michael R
MR
Winter
Boston University School of Public Health, Boston, Massachusetts.|School of Medicine, Boston University, Boston, Massachusetts.
Jeffrey H
JH
Samet
Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco, San Francisco, California.
Judith A
JA
Hahn
D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects / Q000097:blood* / Q000453:epidemiology*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009000:Monocytes / Q000378:metabolism*; D014454:Uganda / Q000453:epidemiology
Alcohol; HIV/AIDS; Immune Activation; Microbial Translocation