People with HIV with a history of heavy drinking have a higher risk of death from any cause, and those with a recent history of such alcohol consumption are more likely to die of liver cancer. Researchers from Johns Hopkins Bloomberg School of Public Health, Baltimore, conducted a prospective cohort study between 2000 and 2013 of 1,855 people living with HIV in Baltimore. They determined alcohol use levels through two means: self-reporting by participants via a computer-assisted self-interview and medical-provider-documented alcohol as registered in medical charts.
The researchers defined heavy drinking as more than four drinks per day or 14 drinks per week for men and more than three drinks per day or seven drinks per week for women. Moderate drinking was any consumption less than those thresholds. Non-drinkers consumed no alcohol.
Overall, the death rate per 1,000 cumulative years of life among the participants was 43 deaths of any cause (known as all-cause mortality) and 7.2 liver-related deaths.
The highest rate of all-cause mortality was seen among those who self-reported as non-drinkers but whose physicians documented them as heavy drinkers during the previous six months; they had a death rate of 85.4 per 1,000 cumulative years. The lowest all-cause mortality rate, at 23 deaths per 1,000 cumulative years, was seen among those who self-reported as moderate drinkers who had no physician-documented heavy drinking in their history.
Compared with self-reported moderate drinkers with no physician-documented history of heavy drinking, those with a physician-documented history of heavy drinking who self-reported as either nondrinkers or moderate drinkers were a respective 7.28- and 3.52-fold more likely to die from liver-related causes.
The researchers concluded that any heavy alcohol consumption was associated with a raised risk of death from any cause among people living with HIV. Only recent heavy consumption was linked with liver-related death. They stressed that assessing an individual’s current level of alcohol consumption is insufficient to properly assess his or her overall risk of death.
Abstract
Objectives: The aim of the study was to examine the association between levels of past and current alcohol consumption and all-cause and liver-related mortality among people living with HIV (PLWH).
Methods: A prospective cohort study of 1855 PLWH in Baltimore, MD was carried out from 2000 to 2013. We ascertained alcohol use by (1) self-report (SR) through a computer-assisted self interview, and (2) medical record abstraction of provider-documented (PD) alcohol use. SR alcohol consumption was categorized 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), and none. We calculated the cumulative incidence of liver-related mortality and fitted adjusted cause-specific regression models to account for competing risks.
Results: All-cause and liver-related mortality rates (MRs) were 43.0 and 7.2 per 1000 person-years (PY), respectively. All-cause mortality was highest among SR nondrinkers with PD recent (< 6 months) heavy drinking (MR = 85.4 deaths/1000 PY) and lowest among SR moderate drinkers with no PD history of heavy drinking (MR = 23.0 deaths/1000 PY). Compared with SR moderate drinkers with no PD history of heavy drinking, SR nondrinkers and moderate drinkers with PD recent heavy drinking had higher liver-related mortality [hazard ratio (HR) = 7.28 and 3.52, respectively]. However, SR nondrinkers and moderate drinkers with a PD drinking history of > 6 months ago showed similar rates of liver-related mortality (HR = 1.06 and 2.00, respectively).
Conclusions: Any heavy alcohol consumption was associated with all-cause mortality among HIV-infected individuals, while only recent heavy consumption was associated with liver-related mortality. Because mortality risk among nondrinkers varies substantially by drinking history, current consumption alone is insufficient to assess risk.
Authors
Canan CE, Lau B, McCaul ME, Keruly J, Moore RD, Chander G
[link url="https://www.poz.com/article/heavy-drinking-linked-increased-risk-death-among-people-hiv"]Poz report[/link]
[link url="http://onlinelibrary.wiley.com/doi/10.1111/hiv.12433/full"]HIV Medicine abstract[/link]