The Role of Current and Historical Alcohol Use in Hepatic Fibrosis Among HIV-Infected Individuals |
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Authors: | H Nina Kim Heidi M Crane Carla V Rodriguez Stephen Van Rompaey Kenneth H Mayer Katerina Christopoulos Sonia Napravnik Geetanjali Chander Heidi Hutton Mary E McCaul Edward R Cachay Michael J Mugavero Richard Moore Elvin Geng Joseph J Eron Michael S Saag Joseph O Merrill Mari M Kitahata |
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Institution: | 1.Division of Allergy and Infectious Diseases, Department of Medicine, School of Medicine,University of Washington,Seattle,USA;2.Fenway Institute,Fenway Health,Boston,USA;3.School of Medicine,University of California San Francisco,San Francisco,USA;4.Institute for Global Health and Infectious Diseases,University of North Carolina at Chapel Hill,Chapel Hill,USA;5.Department of Medicine,Johns Hopkins University,Baltimore,USA;6.Department of Psychiatry & Behavioral Sciences,Johns Hopkins University School of Medicine,Baltimore,USA;7.Department of Medicine,University of California San Diego,San Diego,USA;8.Division of Infectious Diseases, Department of Medicine,University of Alabama at Birmingham,Birmingham,USA |
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Abstract: | 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/mm3 (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. |
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