title: The Role of Current and Historical Alcohol Use in Hepatic Fibrosis Among HIV-Infected Individuals.
abstract: We examined risk factors for advanced hepatic fibrosis [fibrosis-4 (FIB)-4 >3.25] including both current alcohol use and a diagnosis of alcohol use disorder among HIV-infected patients. Of the 12,849 patients in our study, 2133 (17%) reported current hazardous drinking by AUDIT-C, 2321 (18%) had a diagnosis of alcohol use disorder, 2376 (18%) were co-infected with chronic hepatitis C virus (HCV); 596 (5%) had high FIB-4 scores >3.25 as did 364 (15%) of HIV/HCV coinfected patients. In multivariable analysis, HCV (adjusted odds ratio (aOR) 6.3, 95% confidence interval (CI) 5.2-7.5), chronic hepatitis B (aOR 2.0, 95% CI 1.5-2.8), diabetes (aOR 2.3, 95% CI 1.8-2.9), current CD4 <200 cells/mm3(aOR 5.4, 95% CI 4.2-6.9) and HIV RNA >500 copies/mL (aOR 1.3, 95% CI 1.0-1.6) were significantly associated with advanced fibrosis. A diagnosis of an alcohol use disorder (aOR 1.9, 95% CI 1.6-2.3) rather than report of current hazardous alcohol use was associated with high FIB-4. However, among HIV/HCV coinfected patients, both current hazardous drinkers (aOR 1.6, 95% CI 1.1-2.4) and current non-drinkers (aOR 1.6, 95% CI 1.2-2.0) were more likely than non-hazardous drinkers to have high FIB-4, with the latter potentially reflecting the impact of sick abstainers. These findings highlight the importance of using a longitudinal measure of alcohol exposure when evaluating the impact of alcohol on liver disease and associated outcomes.
authors.affiliation: Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, 325 Ninth Avenue, Box 359930, Seattle, WA, 98104, USA. hyangkim@uw.edu.
authors.forename: H Nina
authors.initials: HN
authors.lastname: Kim
authors.affiliation: Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, 325 Ninth Avenue, Box 359930, Seattle, WA, 98104, USA.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
authors.affiliation: Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, 325 Ninth Avenue, Box 359930, Seattle, WA, 98104, USA.
authors.forename: Carla V
authors.initials: CV
authors.lastname: Rodriguez
authors.affiliation: Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, 325 Ninth Avenue, Box 359930, Seattle, WA, 98104, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Van Rompaey
authors.affiliation: Fenway Institute, Fenway Health, Boston, MA, USA.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.affiliation: School of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Katerina
authors.initials: K
authors.lastname: Christopoulos
authors.affiliation: Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Chander
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Hutton
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: McCaul
authors.affiliation: Department of Medicine, University of California San Diego, San Diego, CA, USA.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Cachay
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AB, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Moore
authors.affiliation: School of Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Elvin
authors.initials: E
authors.lastname: Geng
authors.affiliation: Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AB, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.affiliation: Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, 325 Ninth Avenue, Box 359930, Seattle, WA, 98104, USA.
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Merrill
authors.affiliation: Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, 325 Ninth Avenue, Box 359930, Seattle, WA, 98104, USA. kitahata@uw.edu.
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D000437:Alcoholism / Q000453:epidemiology*; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D019694:Hepatitis B, Chronic / Q000453:epidemiology*; D019698:Hepatitis C, Chronic / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D019562:Viral Load
keywords: Alcohol; CNICS; HIV; Liver fibrosis