Department of Transplantation, California Pacific Medical Center, San Francisco CA 94115, USA.
Ann Hepatol. 2011 Oct-Dec;10(4):502-7.
To evaluate alcohol use in patients with HIV infection, assess ethnic and social associations, and describe outcomes.
design: cohort study. setting: Academic HIV-Liver Clinic. patients: 431 HIV-infected patients (371 men, 60 women); 249 patients with HIV/HCV coinfection, 115 HIV alone, and 67 with HIV/HBV.
alcohol use was estimated at first interview and reported as the estimated average lifetime consumption in grams/day. outcome measures: laboratory values, liver fibrosis, decompensation and mortality.
Twenty-two percent of patients in the entire cohort had high risk lifetime average alcohol consumption, defined as ≥ 50 mg/day. Fifty-six percent of patients had quit all alcohol when first evaluated, but follow-up showed that 26% continued high risk consumption. By univariate analysis high alcohol consumption was associated with Latino ethnicity, injection drug use (IDU) and hepatitis C (HCV) coinfection. Multivariable analysis showed only IDU to be independently associated with high alcohol consumption (RR = 4.1, p = 0.0005). There were no significant differences in laboratory values, including CD4 cell counts, except for a trend towards higher transaminases and liver fibrosis scores, between high and low alcohol users. All-cause mortality was statistically higher in the high (37%) vs. low (25%, p = 0.03) alcohol use group, and was associated with both IDU (RR = 2.2, p = 0.04) and the amount of alcohol consumed (RR = 1.1, p = 0.04). Liver decompensation and mortality were both higher in the high use group but of borderline significance. Using an ordinal grouping, we found a strong correlation (R =0.88) between alcohol consumption and the percentage of liver death over total deaths, with lowest mortality rates found in those use of 10 g/day or less.
Unsafe use of alcohol is prevalent in HIV-infected patients and stoppage is not universal. There is a significant impact on all-cause mortality and a trend towards higher liver morbidity and mortality. IDU is significantly and independently associated with high ethanol intake. Practitioners should strongly recommend that HIV patients minimize alcohol use.
评估 HIV 感染者的饮酒情况，评估种族和社会关联，并描述结局。
设计：队列研究。地点：学术性 HIV-肝脏诊所。患者：431 例 HIV 感染患者（371 例男性，60 例女性）；249 例 HIV/HCV 合并感染，115 例 HIV 单独感染，67 例 HIV/HBV 合并感染。
在首次访谈时评估饮酒情况，并报告估计的终生平均饮酒量（以克/天计）。结局指标：实验室值、肝纤维化、失代偿和死亡率。
整个队列中 22%的患者有高风险的终生平均酒精摄入量，定义为≥50mg/天。56%的患者在首次评估时已完全戒酒，但随访发现 26%的患者仍持续高风险饮酒。单因素分析显示，高酒精摄入量与拉丁裔种族、注射吸毒（IDU）和丙型肝炎（HCV）合并感染相关。多因素分析显示，仅 IDU 与高酒精摄入量独立相关（RR=4.1，p=0.0005）。高和低酒精使用者之间的实验室值（包括 CD4 细胞计数）无显著差异，除了转氨酶和肝纤维化评分呈升高趋势。高（37%）和低（25%，p=0.03）酒精使用组的全因死亡率有统计学差异，且与 IDU（RR=2.2，p=0.04）和饮酒量（RR=1.1，p=0.04）相关。高饮酒组的肝失代偿和死亡率均较高，但无统计学意义。采用有序分组，我们发现酒精摄入量与肝脏死亡占总死亡的百分比之间存在很强的相关性（R=0.88），酒精摄入量为 10g/天或以下的患者死亡率最低。
HIV 感染者中普遍存在不安全的饮酒行为，且戒酒并不普遍。这对全因死亡率有显著影响，且有更高的肝发病率和死亡率趋势。IDU 与高乙醇摄入量显著且独立相关。临床医生应强烈建议 HIV 患者尽量减少饮酒。
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