Alcohol Consumption Affects Mortality in HIV Infected Patients

Clinicians need to track not only current alcohol consumption among their HIV-infected patients-but also past use. Any heavy alcohol consumption is associated with all-cause mortality, but only recent heavy consumption is associated with liver-related mortality, according to a new study.

Individuals living with HIV have a high prevalence of alcohol use, which leads to decreased medication adherence and lower viral suppression, as well as accelerated liver fibrosis.

Heavy alcohol use can lead to increased overall and liver-related mortality among HIV-infected patients, state researchers led by Chelsea Canan, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. Few studies have noted how past alcohol consumption or current moderate consumption affects overall and liver-related mortality among those living with HIV, they noted.

Even a moderate level of alcohol consumption can have a detrimental impact on antiretroviral therapy adherence, liver fibrosis and other factors, making it “important to discuss potential alcohol-associated harms among those with moderate alcohol use,” they stated.

The researchers published their results in May 2017 HIV Medicine.

They conducted a prospective cohort study of 1855 people living with HIV in Baltimore, MD, from 2000 to 2013. They ascertained alcohol use by self-reports through a computer-assisted self- interview and medical records of alcohol use documented by providers. The participants characterized their alcohol consumption as heavy (men: > 4 drinks/day or > 14 drinks/week; women: > 3 drinks/day or > 7 drinks/week), moderate (any alcohol consumption less than heavy), or none.

The authors calculated the cumulative incidence of liver-related mortality, and accounted for competing risks. All-cause and liver-related mortality rates were 43.0 and 7.2 per 1000 person-years, respectively. All-cause mortality was highest (85.4 deaths/1000 person-years) among self-reported nondrinkers with provider-documented recent (< 6 months) heavy drinking, and lowest among self-reported moderate drinkers with no provider-documented history of heavy drinking (23.0 deaths/1000 person-years).[[{"type":"media","view_mode":"media_crop","fid":"60401","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_4067417278397","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7641","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 188px; width: 251px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Human liver cirrhosis showing hepatocytes at the top of the image crowded out by fibrosis in the bottom half of the photo. Magnification: 400x. Cirrhosis-Jubal-Harshaw/©Shutterstock.com","typeof":"foaf:Image"}}]]

Self-reported nondrinkers and moderate drinkers with provider-documented recent of heavy drinking had higher liver-related mortality compared with self-reported moderate drinkers with no provider-documented history of heavy drinking. However, self-reported nondrinkers and moderate drinkers with a provider-documented drinking history of more than 6 months ago showed similar rates of liver-related mortality.

“These findings suggest that the risk of liver-related mortality may decrease among those who discontinue heavy alcohol use. This has clinical implications for treating individuals who exhibit hazardous drinking behavior, as the risk of liver-related mortality could approach that of never-hazardous drinkers upon refraining from excess alcohol use,” the researchers stated.

The finding that heavy alcohol use is associated with an increased risk of all-cause mortality is consistent with a previous study in which the population was 90% male and nearly 60% white. “Our study extends their findings regarding all-cause mortality to a different study population (approximately 80% black and 60% male) who were exposed to all levels of alcohol use, including moderate use and no alcohol use,” they stated.

They encourage clinicians to focus on nonjudgmental, empathetic interactions with HIV patients to reduce the stigma associated with self-reporting hazardous alcohol use.