Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
HIV Med. 2009 Mar;10(3):133-42. doi: 10.1111/j.1468-1293.2008.00662.x. Epub 2008 Dec 20.
The aim of the study was to determine the relationship between alcohol consumption and liver fibrosis as assessed by aspartate aminotransferase to platelet ratio index (APRI) in HIV-infected adults and to explore the relative contributions of alcohol and hepatitis C virus (HCV) to APRI among HIV/HCV-coinfected adults.
We performed a cross-sectional analysis of data from an observational clinical cohort. Alcohol consumption was categorized according to National Institute on Alcohol Abuse and Alcoholism guidelines. We defined significant liver disease as APRI>1.5, and used multinomial logistic regression to identify correlates of increased APRI.
Among 1358 participants, 10.4% reported hazardous drinking. It was found that 11.6% had APRI>1.5, indicating liver fibrosis. Hazardous drinking was associated with increased APRI [adjusted relative risk ratio (RRR) 2.30; 95% confidence interval (CI) 1.26-4.17]. Other factors associated with increased APRI were male gender, viral hepatitis, and HIV transmission category of injecting drug use. Among coinfected individuals, 18.3% had APRI>1.5, and hazardous drinking was not associated with APRI. Among non-HCV-infected individuals, 5.3% had APRI>1.5 and hazardous drinking was associated with increased APRI (adjusted RRR 3.72; 95% CI 1.40-9.87).
Hazardous drinking is an important modifiable risk factor for liver fibrosis, particularly among non-HCV-infected patients. Clinicians and researchers must address alcohol use as the burden of liver disease increases among HIV-positive individuals.
本研究旨在确定 HIV 感染成年人的天门冬氨酸氨基转移酶与血小板比值指数（APRI）评估的酒精摄入量与肝纤维化之间的关系，并探讨 HIV/HCV 合并感染成年人中酒精和丙型肝炎病毒（HCV）对 APRI 的相对贡献。
我们对观察性临床队列的数据分析进行了横断面分析。根据美国国家酒精滥用和酗酒研究所的指南对酒精摄入量进行了分类。我们将显著的肝脏疾病定义为 APRI>1.5，并使用多项逻辑回归来确定 APRI 增加的相关因素。
在 1358 名参与者中，10.4%报告有危险饮酒行为。发现 11.6%的人 APRI>1.5，表明存在肝纤维化。危险饮酒与 APRI 增加相关[调整后的相对风险比（RRR）为 2.30；95%置信区间（CI）为 1.26-4.17]。其他与 APRI 增加相关的因素包括男性、病毒性肝炎和 HIV 传播的注射吸毒类别。在合并感染的个体中，18.3%的人 APRI>1.5，而危险饮酒与 APRI 无关。在未感染 HCV 的个体中，5.3%的人 APRI>1.5，危险饮酒与 APRI 增加相关（调整后的 RRR 为 3.72；95%CI 为 1.40-9.87）。
危险饮酒是肝纤维化的一个重要可改变的危险因素，特别是在未感染 HCV 的患者中。随着 HIV 阳性人群中肝病负担的增加，临床医生和研究人员必须解决饮酒问题。
