Long-term Alcohol Abuse Is Linked to Worse Liver Fibrosis in HIV Positive Veterans with or without HCV Coinfection

By Liz Highleyman

Liver problems are common among HIV positive individuals. Antiretroviral drug toxicity may play a role in liver injury, and it is often caused by coinfection with chronic hepatitis B or C virus (HBV and HCV, respectively). While alcohol consumption is known to contribute to liver damage, the impact of varying levels of alcohol consumption in people with HIV is poorly defined.

As reported at the Digestive Disease Week 2008 conference last month in San Diego, Joseph Lim and colleagues studied alcohol consumption and its relation to liver disease in the Veterans Aging Cohort Study (VACS), a longitudinal study of 6090 age- and sex-matched HIV positive and HIV negative veterans at 8 U.S. sites. Complete data were available for 4678 participants.

Detailed baseline and longitudinal data on HIV, HBV, and HCV status, HAART use, and alcohol consumption were collected. Non-hazardous, hazardous, and binge drinking were defined by National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria.

Liver injury was assessed on the basis of inflammatory and fibrosis markers. The researchers measured alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, and determined FIB-4 scores (an index combining ALT, AST, platelet count, and patient age).

Logistic regression was used to determine the proportion of liver injury due to alcohol after controlling for age, sex, body mass, HIV status, and HBV and/or HCV status.

Results

• Among the 4678 participants with complete data, 425 (9.1%) had advanced fibrosis or cirrhosis (FIB-4 score > 3.25).

• These represented 12.5% of the HIV positive and 4.4% of the HIV negative study subjects.

• There was a trend towards increased liver injury among individuals who engaged in hazardous or binge drinking.

• However, there was a statistically significant increase in advanced fibrosis or cirrhosis only among subjects with an ICD-9 diagnosis of alcohol abuse and dependence (AAD).

• This group included subjects with HIV alone (9.5%), HCV alone (15.6%), and HCV/HIV coinfection (33.1%).

• In a multivariate analysis, after controlling for HIV and HCV status, alcohol use was the strongest predictor of advanced fibrosis or cirrhosis (OR 2.19; P < 0.05).

• Age greater than 50 years, black race, and HBV status were also significantly associated with liver damage.

• Among subjects with advanced fibrosis or cirrhosis, 38.7% had a diagnosis of alcohol abuse and dependence.

Conclusion

"Alcohol abuse and dependence is common among individuals with advanced fibrosis/cirrhosis," the study investigators concluded.

"In a large prospective cohort of U.S. veterans, AAD significantly increased the risk of advanced fibrosis/cirrhosis among those with HIV, HCV, and HCV/HIV coinfection," they added. However, they noted that "this effect was not seen [with] lesser degrees of alcohol consumption."

6/03/08

Reference
JK Lim, SL Fultz, JL Goulet, and others. Impact of alcohol abuse and dependence on liver fibrosis in a prospective cohort of 6090 HIV+/HIV- U.S. veterans. Digestive Disease Week (DDW) 2008. San Diego, CA. May 17-22, 2008. Abstract W1050.