Alcohol Use Linked to Worse Liver Disease Progression in HIV-HCV Coinfected Patients

At the Digestive Disease Week 2007 meeting this week in Washington, DC, researchers presented data from a study of the prevalence and impact of alcohol use on liver disease progression and eligibility for hepatitis C treatment in HIV-HCV coinfected patients.

As background, the investigators noted that, “Alcohol use among patients with HIV is not only associated with decreased antiretroviral therapy (ART) adherence and decreased HIV suppression, but also increased risk of ART-induced hepatotoxicity and high-risk sexual behavior.”

They prospectively collected data on alcohol use from 280 HIV-HCV coinfected and 2958 HCV monoinfected patients seen at 24 medical centers throughout the U.S. There were no significant differences in age or sex between the 2 groups, but coinfected patients were about twice as likely as monoinfected patients to be non-white.

Alcohol use was categorized as follows:

·         Non-drinkers vs ever drinkers;

·         Recent alcohol use (past 12 months).

·         Maximum number of drinks consumed on a regular basis (< 6 vs ≥ 6 drinks/day);

·         “CAGE” alcohol abuse assessment score < 2 vs ≥ 2.

Advanced liver disease was defined as a history of ascites, encephalopathy, or variceal bleeding. Eligibility for hepatitis C treatment was assessed using both standardized published criteria and the opinion of the treating clinician.

Results

·         The proportion of subjects who were ever drinkers (78.9% vs 83.0%; P = 0.10) and recent alcohol users (35.4% vs 36.7%; P = 0.66) were similar in the HIV-HCV coinfected and HCV monoinfected groups.

·         However, coinfected patients were less likely to consume ≥ 6 drinks/day on a regular basis compared with monoinfected individuals (52.3% vs 62.6%; P = 0.002).

·         Coinfected individuals also were less likely to have a CAGE score ≥ 2 (49.6% vs 62.3%; P <0.001).

·         Among the coinfected patients, recent alcohol use was associated with higher total bilirubin levels (≥ 2.0 mg/dL) (9.2% vs 2.8%; P = 0.02) and evidence of advanced liver disease (7.3% vs 1.1%; P = 0.006), but not with elevated ALT levels (72.9% vs 76.8%; P = 0.47).

·         Coinfected patients who reported recent alcohol use were less likely than non-drinkers to be considered candidates for hepatitis C treatment based on published criteria (16.2% vs 29.8%; P = 0.01) or clinician opinion (23.7% vs 40.1%; P = 0.006).

Conclusion

“Recent alcohol use is common among coinfected patients, and is associated with advanced liver disease and a lower likelihood of being a HCV treatment candidate,” the investigators concluded. “HIV-HCV coinfected patients should receive counseling about the hazards of ongoing alcohol consumption.”

VA New York Harbor Healthcare System, New York, NY; NYU School of Medicine, New York, NY; VA Medical Center, San Francisco, CA; VA Medical Center, Houston, TX; VA Medical Center, Bronx, NY; VA Medical Center, Iowa City, IA; VA Medical Center, Palo Alto, CA; VA Medical Center, Long Beach, CA; VA Medical Center, Philadelphia, PA; VA Medical Center, Boston, MA; VA Medical Center, Brooklyn, NY.

05/22/07

Reference
EJ Bini, S Currie, BS Anand, and others. Prevalence and Impact of Alcohol Use Among Patients with HIV-HCV Coinfection: A Prospective National Multicenter Study. Digestive Disease Week 2007 (DDW 2007). Washington, DC. May 19-24, 2007. Abstract M1789.

Return to to DDW 2007 Main Page