Risky Alcohol Use Associated with Elevated Serum Aminotransferase Levels in HIV/HCV Coinfected Patients

In the United States, roughly half of HIV-infected patients drink alcohol and both HIV and hepatitis C virus (HCV)-infected patients drink more than the general population. Using data from the prospective observational cohort HIV-Longitudinal Interrelationships of Viruses and Ethanol (HIV-LIVE) study, the authors assessed the association between National Institute on Alcohol Abuse and Alcoholism (NIAAA)-defined risky alcohol consumption—drinking greater than 14 standard drinks per week or greater than 4 drinks in a day for men, or drinking greater than 7 drinks per week or greater than 3 drinks in a day for women—and serum aminotransferase levels in HIV-infected patients with and without HCV infection. Regression models that can account for repeated measures were used to assess the association between risky alcohol use and AST and ALT levels over time.

• Of 397 HIV-infected subjects in the HIV-LIVE study with HCV serologic testing, 200 (50.4%) had detectable HCV viral load and were considered HIV/HCV coinfected.
• Among coinfected subjects, risky alcohol use was associated with higher mean AST (adjusted means 62.2 versus 51.4 U/L; adjusted ratio of means 1.2) and ALT (adjusted means 51.3 versus 41.6 U/L.; adjusted ratio of means 1.2), compared with those without risky alcohol use.
• Among HIV monoinfected subjects, the authors found no differences in AST or ALT among patients with or without risky alcohol use.

Comments:

Among HIV/HCV coinfected subjects, mean AST and ALT levels were approximately 20% higher in those with risky alcohol use compared with those without risky alcohol use, while no such association was noted in HIV monoinfected subjects. These data suggest that alcohol use may be particularly concerning in HIV/HCV coinfected patients and that physicians should consider tailoring counseling messages regarding the harmful effects of alcohol to this population.

Jeanette M. Tetrault, MD

Reference:

Tsui JI, Cheng DM, Libman H, et al. Risky alcohol use and serum aminotransferase levels in HIV-infected adults with and without hepatitis C. J Stud Alcohol and Drugs. 2013;74(2):266–270.