Self-reported Unhealthy Alcohol Use Predicts Virological Rebound in HIV/HCV Coinfected Patients
Unhealthy alcohol use is common in HIV-infected patients and is believed to have a negative impact on the course of HIV infection, in part because it is associated with poor adherence to antiretroviral therapy (ART). Unhealthy use is even more harmful in people coinfected with HCV because of the increased risk of progression to end-stage liver disease. Investigators in France performed a prospective study to evaluate the impact of heavy alcohol use,* measured either by physician’s perceptions or patient self-administered interview, on time to detectable viral load. The sample included 512 patients coinfected with HIV/HCV who had achieved viral suppression** through ART. Median follow-up was 21 months.
- At study enrollment, 9% of participants self-reported heavy alcohol use, and 15% were considered to have heavy alcohol use by their physicians.
- Physician report agreed with self-report in 90% of patients not reporting heavy alcohol use and in 77% of those who did, but 61% of those classified by physicians as having heavy alcohol use did not report heavy alcohol use, and 2% of those classified as abstainers or low-risk drinkers reported heavy alcohol use.
- During follow-up, 101 participants (20%) had a detectable viral load. Self-reported heavy alcohol use was independently associated with detectable viral load (adjusted hazard ratio 2), while physician-reported heavy alcohol use was not.
*Defined as consuming ≥4 drinks (11-14 g alcohol) per day for men or ≥3 drinks per day for women “on a regular basis” in the past 6 months.
**HIV RNA below the limit of detection.
Comments:
This study found that heavy alcohol use is associated with detectable HIV viral load, probably through its effect on ART adherence. Furthermore, the results stress the importance of patient self-report (in contrast to physician’s impressions). These results add to mounting evidence that heavy alcohol use should be avoided in HIV/HCV co-infected patients.
Daniel Fuster, MD, PhD,† & Alexander Y. Walley, MD, MSc
†Contributing Editorial Intern and Research Scholar, Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA.
Reference:
Marcellin F, Lions C, Winnock M, et al. Self-reported alcohol abuse in HIV-HCV co-infected patients: a better predictor of HIV virological rebound than physician’s perceptions (HEPAVIH ARNS CO13 cohort). Addiction. 2013;108(7):1250–1258.