Even Moderate Alcohol Use Raises Liver Fibrosis Risk in HIV/HCV Coinfected People


People with HIV alone or hepatitis C virus alone were more likely to have advanced liver fibrosis if they drank more alcohol, but people coinfected with both HIV and HCV had a greater risk of advanced fibrosis even with moderate or "non-hazardous" drinking, according to a report in the May 15 edition of Clinical Infectious Diseases.

Joseph Lim from the Veterans Affairs Connecticut Healthcare System, Vincent Lo Re from the Philadelphia VA Medical Center, and colleagues evaluated associations between advanced liver fibrosis and alcohol use categories -- non-hazardous drinking, hazardous or binge drinking, and alcohol-related diagnosis such as alcohol abuse or alcoholism -- according to HIV and HCV status.

This cross-sectional study looked at participants in the Veterans Aging Cohort Study who reported alcohol consumption at enrollment; 1410 had HIV alone, 296 had HCV alone, 701 were HIV/HCV coinfected, and 1158 had neither virus.

Within each group, the prevalence of advanced liver fibrosis increased as alcohol use category increased. For all categories, advanced fibrosis was significantly more common among HIV positive versus HIV negative people, and among people with HCV versus those without. The strongest associations, however, were seen in the coinfected group, where even non-hazardous drinking was associated with a 14-fold greater risk of advanced liver disease.

"Advanced hepatic fibrosis was present at low levels of alcohol consumption, increased with higher alcohol use categories, and was more prevalent among HIV-infected and chronic HCV-infected patients than uninfected individuals," the study authors concluded. "All alcohol use categories were strongly associated with advanced hepatic fibrosis in HIV/HCV-coinfected patients."

Below is an edited excerpt from a University of Pennsylvania press release describing the study and its findings in more detail.

Drinking, Even Casual Amounts, Poses Much Greater Risk for Advanced Liver Disease in HIV/Hepatitis C Patients

Penn Medicine Researchers Find Much Stronger Association Between Alcohol Use and Advanced Liver Fibrosis in Patients Compared to Uninfected

Philadelphia -- May 2, 2014 -- Consumption of alcohol has long been associated with an increased risk of advanced liver fibrosis, but a study published online in Clinical Infectious Diseasesfrom researchers at Penn Medicine and other institutions shows that association is drastically heightened in people coinfected with both HIV and chronic hepatitis C virus (HCV) infection.  Even light (“nonhazardous”) drinking -- which typically poses a relatively low risk for uninfected persons -- was linked to an increased risk of liver fibrosis in the co-infected group.

Reasons for this are not fully understood, but preclinical studies have shown that the two viruses can induce liver cell death and that adding alcohol may accelerate that process and more quickly lead to severe liver fibrosis. Toxicity to the liver from antiretroviral drugs may also be exacerbated by alcohol.

 "We’ve shown a much greater risk for coinfected compared to uninfected persons at all levels of alcohol consumption -- from nonhazardous drinking up to hazardous/binge drinking and abuse/dependence," said senior author Vincent Lo Re III, MD, MSCE, assistant professor of Medicine and Epidemiology in the division of Infectious Diseases and department of Biostatistics and Epidemiology at Penn and an infectious disease physician at the Veteran Affairs Medical Center in Philadelphia. "This highlights how important it is for clinicians to be counseling coinfected patients on reducing alcohol consumption. More communication and education about the risks of alcohol may prompt patients to reduce drinking or quit altogether, which will help reduce the incidence of complications."

Few studies have investigated the association between alcohol and liver disease in HIV/HCV-coinfected patients, and none have compared risks to uninfected persons.

For the study, researchers, which included first author Joseph K. Lim, MD, of the Yale University School of Medicine and the Veterans Affairs Connecticut Healthcare System, conducted a cross-sectional study among 7,270 participants from the Veterans Aging Cohort Study: 701 HIV/HCV coinfected; 1,410 HIV-monoinfected; 296 HCV-monoinfected; and 1,158 uninfected. Alcohol use was determined by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire and diagnoses of alcohol abuse/dependence and classified as nonhazardous drinking, hazardous/binge drinking, and alcohol-related diagnosis.

The team found that regardless of HIV or HCV status, the prevalence of advanced hepatic fibrosis increased as alcohol use category increased. However, the strongest associations were observed in coinfected patients across all alcohol categories compared with uninfected non-hazardous drinkers.   

Coinfected individuals with nonhazardous drinking were 13 times more likely to have advanced liver fibrosis than uninfected persons who reported non-hazardous drinking. Coinfected patients with a history of hazardous/binge drinking were 17 times more likely, whereas those who had alcohol-related diagnosis were 21 times more likely, to have advanced liver fibrosis compared to their uninfected non-hazardous drinking counterparts.

"The difference between coinfected and uninfected groups was stark. Given the prevalence of drinking in coinfected individuals, it is important to determine the patterns of alcohol use, such as nonhazardous drinking and even binge drinking, which are not traditionally thought to contribute to liver fibrosis," said Lo Re.

Other researchers from the study include researchers from the US Food and Drug Administration; North Shore-LIJ School of Medicine; National Institute on Alcohol Abuse and Alcoholism; University of Pittsburgh and Pittsburgh VA Medical Center; VA Medical Center and George Washington University Medical Center; Atlanta VA Medical Center and Emory University School of Medicine; VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA; and McGill University Health Centre.



JK Lim, JP Tate, SL Fultz, V Lo Re, et al. Relationship Between Alcohol Use Categories and Noninvasive Markers of Advanced Hepatic Fibrosis in HIV-Infected, Chronic Hepatitis C Virus-Infected, and Uninfected Patients. Clinical Infectious Diseases 58(10):1449-1458. May 15, 2014.

Other Source

University of Pennsylvania. Drinking, Even Casual Amounts, Poses Much Greater Risk for Advanced Liver Disease in HIV/Hepatitis C Patients. Press release. May 2, 2014.