Even moderate drinking increases risk of advanced liver fibrosis for people with HIV and HCV co-infection

Even moderate alcohol consumption is associated with an increased risk of advanced liver fibrosis for people living with HIV and hepatitis C virus (HCV) co-infection, investigators from the United States report in Clinical Infectious Diseases. For all categories of drinking – moderate, severe/binge and alcohol-related disorders – prevalence of advanced liver fibrosis was also higher among people living with HIV or HCV mono-infection compared to people who had neither infection.

“For each alcohol use category, advanced fibrosis was more common among HIV-infected than -uninfected and chronic HCV-infected than -uninfected patients,” comment the authors. “When we evaluated associations between alcohol use categories and advanced fibrosis across groups stratified by HIV/HCV status, the strongest associations were observed among those with HIV/HCV coinfection.”

The investigators believe their findings have important implications for patient care, and that individuals with advanced fibrosis should be advised to abstain from alcohol use or reduce their drinking.

Alcohol consumption is highly prevalent among people living with HIV and/or HCV infection, and heavy drinking has been associated with advanced liver disease in this group. However, the impact of different levels of alcohol consumption on the severity of liver fibrosis in people living with HIV and/or HCV infection is unclear. Investigators from the US Department of Veterans Affairs therefore designed a cross-sectional study to evaluate the associations between different levels of alcohol consumption and advanced liver fibrosis in patients according to their HIV and/or HCV infection status.

Participants were recruited to the study between 2002 and 2010. The study population included 701 people with HIV and HCV-co-infection; 1410 people with HIV mono-infection; 296 people with HCV mono-infection and 1158 people with neither infection (controls). All reported some level of alcohol consumption. Liver fibrosis was assessed non-invasively using the FIB-4 index, a score above 3.5 indicating advanced fibrosis. Participants completed a short questionnaire about their alcohol consumption and were placed into one of three categories: non-hazardous drinking; hazardous/binge drinking; alcohol-related disorders.

Overall, 8% of participants had advanced liver fibrosis. Prevalence was higher among people with HIV (10%) than people who did not have HIV (4%) and also among people with chronic HCV infection (19%) compared to people who did not have HCV (4%).

For all patient groups, the prevalence of severe fibrosis increased with alcohol use category.

Moreover, for each alcohol use category, advanced fibrosis was more common in HIV-positive than HIV-negative patients (non-hazardous: 7 vs 1%; hazardous/binge: 10 vs 3%; alcohol-related disorders: 19 vs 9%; p < 0.01). Findings were similar when the investigators compared HCV-infected and -uninfected patients (non-hazardous 14 vs 3%; hazardous/binge: 18 vs 3%; alcohol-related disorders: 22 vs 7%; p < 0.01).

For each category of alcohol use, the prevalence of advanced liver fibrosis was highest among people living with HIV and HCV co-infection.

In analysis that controlled for potential confounders, the association between alcohol use category and the risk of advanced liver fibrosis was strongest for people with HIV and HCV co-infection: non-hazardous drinking, OR, 14.2; 95% CI, 5.91-34.0; hazardous/binge, OR, 18.9; 95% CI, 7.98-44.8; alcohol-related disorders, OR, 25.2; 95% CI, 10.6-59.7 (all comparisons with HIV/HCV-uninfected non-hazardous drinkers).

“These results provide new data that suggest there is a stepwise increased risk of advanced liver fibrosis with greater severity of alcohol use,” write the investigators. “They also demonstrate that all alcohol use categories are strongly associated with advanced hepatitis fibrosis in HIV/HCV-coinfected patients.”

The authors believe their findings have important implications for patient care. First, all patients should have their alcohol consumption assessed; people living with HIV and HCV co-infection should be counselled to reduce their alcohol consumption; and any patient with advanced fibrosis should be advised “to reduce or avoid alcohol consumption.”