Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, District of Columbia.
Alcohol Clin Exp Res. 2019 Apr;43(4):695-703. doi: 10.1111/acer.13974. Epub 2019 Feb 28.
The relationship between alcohol consumption and atherosclerosis has not been sufficiently examined among people living with HIV (PLWH).
We analyzed data from PLWH in the Women's Interagency HIV Study (WIHS; n = 1,164) and the Multicenter AIDS Cohort Study (MACS; n = 387) with no history of cardiovascular disease (CVD). Repeated measures of intima-media thickness of the right common carotid artery (CCA-IMT) were assessed using B-mode ultrasound from 2004 to 2013. Current alcohol consumption was collected at time of CCA-IMT measurement and was categorized according to gender-specific weekly limits. Group-based trajectory models categorized participants into past 10-year consumption patterns (1994 to 2004). Multivariate generalized estimating equations were conducted to assess the association of past and current alcohol use patterns on change in CCA-IMT by cohort, controlling for age, race, cigarette and illicit drug use, probable depression, HIV RNA viral load, antiretroviral therapy exposure, and hepatitis C coinfection.
Among the WIHS, past heavy alcohol consumption was associated with increased CCA-IMT level over time (β = 8.08, CI 0.35, 15.8, p = 0.04), compared to abstinence. Among the MACS, compared to abstinence, all past consumption patterns were associated with increased CCA-IMT over time (past low: β = 15.3, 95% CI 6.46, 24.2, p < 0.001; past moderate: β = 14.3, CI 1.36, 27.2, p = 0.03; past heavy: β = 21.8, CI 4.63, 38.9, p = 0.01). Current heavy consumption was associated with decreased CCA-IMT among the WIHS (β = -11.4, 95% CI -20.2, -2.63, p = 0.01) and MACS (β = -15.4, 95% CI -30.7, -0.13, p = 0.04). No statistically significant time by consumption pattern effects were found.
In both cohorts, 10-year heavy consumption was associated with statistically significant increases in carotid artery thickness, compared to abstinence. Long-term patterns of drinking at any level above abstinence were particularly significant for increases in IMT among men, with heavy consumption presenting with the greatest increase. Our results suggest a potentially different window of risk among past and current heavy drinkers. Further studies are needed to determine whether alcohol consumption level is associated with intermediate measures of atherosclerosis. Alcohol screening and interventions to reduce heavy consumption may benefit PLWH who are at risk of CVD.
在艾滋病毒感染者（PLWH）中，酒精摄入与动脉粥样硬化之间的关系尚未得到充分研究。
我们分析了来自妇女艾滋病研究机构（WIHS；n=1164）和多中心艾滋病队列研究（MACS；n=387）中没有心血管疾病（CVD）病史的 PLWH 数据。使用 B 型超声从 2004 年至 2013 年对右颈总动脉内膜中层厚度（CCA-IMT）进行重复测量。当前的酒精摄入量在 CCA-IMT 测量时收集，并根据性别特异性每周限量进行分类。基于群组的轨迹模型将参与者分为过去 10 年的消费模式（1994 年至 2004 年）。采用多变量广义估计方程，根据队列，控制年龄、种族、吸烟和非法药物使用、可能的抑郁、HIV RNA 病毒载量、抗逆转录病毒治疗暴露和丙型肝炎合并感染，评估过去和当前饮酒模式与 CCA-IMT 变化的相关性。
在 WIHS 中，与戒酒相比，过去大量饮酒与 CCA-IMT 水平随时间的增加有关（β=8.08，CI 0.35，15.8，p=0.04）。在 MACS 中，与戒酒相比，所有过去的饮酒模式都与 CCA-IMT 随时间的增加有关（过去低：β=15.3，95%CI 6.46，24.2，p<0.001；过去中等：β=14.3，CI 1.36，27.2，p=0.03；过去高：β=21.8，CI 4.63，38.9，p=0.01）。在 WIHS 中，当前大量饮酒与 CCA-IMT 降低有关（β=-11.4，95%CI-20.2，-2.63，p=0.01），MACS 也存在类似的情况（β=-15.4，95%CI-30.7，-0.13，p=0.04）。未发现饮酒模式与时间之间存在统计学显著的相互作用。
在两个队列中，与戒酒相比，10 年大量饮酒与颈动脉厚度的统计学显著增加有关。与戒酒相比，任何水平的长期饮酒模式，特别是男性的 IMT 增加更为显著，其中大量饮酒者的增加最为显著。我们的研究结果表明，过去和现在的重度饮酒者可能存在不同的风险窗口。需要进一步的研究来确定饮酒量是否与动脉粥样硬化的中间指标有关。对有 CVD 风险的 PLWH 进行酒精筛查和干预以减少大量饮酒可能会受益。
