Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men
Research article
Summary and context
The study is the first to demonstrate the increased harm among patients who have suppressed HIV with modern antiretroviral treatment (ART).
Research has shown that it takes fewer alcoholic drinks for a person with HIV to feel the effects. However, most prior studies were done on HIV-positive individuals who had detectable virus. The Yale-led team set out to determine whether the risks associated with alcohol were higher among current patients who are more likely to have the infection under control with ART.
The researchers analyzed data on HIV-positive and uninfected patients from the Veterans Aging Cohort Study (VACS), a large population of individuals receiving care from the Veterans Health Administration, between 2008 and 2012. They examined the association between alcohol consumption and mortality and other signs of physiologic injury.
They found that HIV-positive individuals were more likely to die and experience physiological harm from alcohol consumption than uninfected individuals. Even consumption of one to two alcoholic drinks per day was associated with increased risk for people with HIV. The finding was particularly notable because it held true for individuals with suppressed virus, as per Yale Research News.
It demonstrates that even among people on ART with suppressed viral load, who are much less sick in general, there is still an added effect of alcohol among those individuals than people without HIV,” said Amy Justice, professor of general medicine and of public health.
It suggests the threshold for safe alcohol consumption is likely different for people with HIV.”
Amy Justice, professor of general medicine and of public health
Highlights
- Individuals with HIV on antiretroviral treatment (ART) experience mortality at lower levels of alcohol use.
- Individuals with HIV experience physiologic frailty at lower levels of alcohol use.
- Alcohol consumption limits should be lower among HIV+ individuals.
Abstract
Background
HIV infected (HIV+) individuals may be more susceptible to alcohol-related harm than uninfected individuals.
Methods
The researchers analyzed data on HIV+ and uninfected individuals in the Veterans Aging Cohort Study (VACS) with an Alcohol Use Disorders Identification Test-Consumption AUDIT-C score from 2008 to 2012. They used Cox proportional hazards models to examine the association between alcohol exposure and mortality through July, 2014; and linear regression models to assess the association between alcohol exposure and physiologic injury based on VACS Index Scores. Models were adjusted for age, race/ethnicity, smoking, and hepatitis C infection.
Results
The sample included 18,145 HIV+ and 42,228 uninfected individuals. Among HIV+ individuals, 76% had undetectable HIV-1 RNA.
The threshold for an association of alcohol use with mortality and physiologic injury differed by HIV status. Among HIV+ individuals, AUDIT-C score ≥4 and ≥30 alcoholic drinks per month were associated with increased risk of mortality.
Among uninfected individuals, AUDIT-C score ≥5 and ≥70 alcoholic drinks per month were associated with increased risk.
Similarly, AUDIT-C threshold scores of 5–7 were associated with physiologic injury among HIV+ individuals and a score of 8 or more was associated with injury in uninfected individuals.
Conclusions
Despite antiretroviral therapy, HIV+ individuals experienced increased mortality and physiologic injury at lower levels of alcohol use compared with uninfected individuals.
Alcohol consumption limits should be lower among HIV+ individuals.