Kim H Nina, Crane Heidi M, Rodriguez Carla V, Van Rompaey Stephen, Mayer Kenneth H, Christopoulos Katerina, Napravnik Sonia, Chander Geetanjali, Hutton Heidi, McCaul Mary E, Cachay Edward R, Mugavero Michael J, Moore Richard, Geng Elvin, Eron Joseph J, Saag Michael S, Merrill Joseph O, Kitahata Mari M
Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine, University of Washington, 325 Ninth Avenue, Box 359930, Seattle, WA, 98104, USA.
Fenway Institute, Fenway Health, Boston, MA, USA.
AIDS Behav. 2017 Jul;21(7):1878-1884. doi: 10.1007/s10461-016-1665-6.
We examined risk factors for advanced hepatic fibrosis [fibrosis-4 (FIB)-4 >3.25] including both current alcohol use and a diagnosis of alcohol use disorder among HIV-infected patients. Of the 12,849 patients in our study, 2133 (17%) reported current hazardous drinking by AUDIT-C, 2321 (18%) had a diagnosis of alcohol use disorder, 2376 (18%) were co-infected with chronic hepatitis C virus (HCV); 596 (5%) had high FIB-4 scores >3.25 as did 364 (15%) of HIV/HCV coinfected patients. In multivariable analysis, HCV (adjusted odds ratio (aOR) 6.3, 95% confidence interval (CI) 5.2-7.5), chronic hepatitis B (aOR 2.0, 95% CI 1.5-2.8), diabetes (aOR 2.3, 95% CI 1.8-2.9), current CD4 <200 cells/mm (aOR 5.4, 95% CI 4.2-6.9) and HIV RNA >500 copies/mL (aOR 1.3, 95% CI 1.0-1.6) were significantly associated with advanced fibrosis. A diagnosis of an alcohol use disorder (aOR 1.9, 95% CI 1.6-2.3) rather than report of current hazardous alcohol use was associated with high FIB-4. However, among HIV/HCV coinfected patients, both current hazardous drinkers (aOR 1.6, 95% CI 1.1-2.4) and current non-drinkers (aOR 1.6, 95% CI 1.2-2.0) were more likely than non-hazardous drinkers to have high FIB-4, with the latter potentially reflecting the impact of sick abstainers. These findings highlight the importance of using a longitudinal measure of alcohol exposure when evaluating the impact of alcohol on liver disease and associated outcomes.
我们研究了晚期肝纤维化（纤维化-4（FIB）-4>3.25）的风险因素，包括HIV感染患者当前的饮酒情况和酒精使用障碍的诊断。在我们研究的12849名患者中，2133名（17%）通过酒精使用障碍鉴定测试（AUDIT-C）报告当前存在危险饮酒，2321名（18%）被诊断为酒精使用障碍，2376名（18%）合并感染慢性丙型肝炎病毒（HCV）；596名（5%）FIB-4评分>3.25，在HIV/HCV合并感染患者中这一比例为364名（15%）。在多变量分析中，HCV（调整优势比（aOR）6.3，95%置信区间（CI）5.2-7.5）、慢性乙型肝炎（aOR 2.0，95%CI 1.5-2.8）、糖尿病（aOR 2.3，95%CI 1.8-2.9）、当前CD4<200细胞/mm（aOR 5.4，95%CI 4.2-6.9）和HIV RNA>500拷贝/mL（aOR 1.3，95%CI 1.0-1.6）与晚期纤维化显著相关。酒精使用障碍的诊断（aOR 1.9，95%CI 1.6-2.3）而非当前危险饮酒的报告与高FIB-4相关。然而，在HIV/HCV合并感染患者中，当前的危险饮酒者（aOR 1.6，95%CI 1.1-2.4）和当前的非饮酒者（aOR 1.6，95%CI 1.2-2.0）比非危险饮酒者更有可能具有高FIB-4，后者可能反映了因病戒酒者的影响。这些发现突出了在评估酒精对肝脏疾病及相关结果的影响时使用酒精暴露纵向测量方法的重要性。
