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Contribution of alcohol use in HIV/hepatitis C virus co-infection to all-cause and cause-specific mortality: A collaboration of cohort studies |
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| Authors: | Adam Trickey,Suzanne M. Ingle,Anders Boyd,M. John Gill,Sophie Grabar,Inma Jarrin,Niels Obel,Giota Touloumi,Robert Zangerle,Andri Rauch,Christopher T. Rentsch,Derek D. Satre,Michael J. Silverberg,Fabrice Bonnet,Jodie Guest,Greer Burkholder,Heidi Crane,Ramon Teira,Juan Berenguer,Christoph Wyen,Sophie Abgrall,Mojgan Hessamfar,Peter Reiss,Antonella d’Arminio Monforte,Kathleen A. McGinnis,Jonathan A. C. Sterne,Linda Wittkop,the Antiretroviral Therapy Cohort Collaboration |
| Affiliation: | 1. Population Health Sciences, University of Bristol, Bristol, UK;2. Stichting HIV Monitoring, Amsterdam, The Netherlands Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands Amsterdam UMC, University of Amsterdam, Infectious Diseases, Amsterdam, The Netherlands;3. South Alberta HIV Clinic, Department of Medicine, University of Calgary, Calgary, Canada;4. Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France Department of Public Health, AP-HP, St Antoine Hospital, Paris, France;5. National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III;6. Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;7. Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece;8. Austrian HIV Cohort Study (AHIVCOS), Medizinische Universität Innsbruck, Innsbruch, Austria;9. Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;10. Yale School of Medicine and VA Connecticut Healthcare System, West Haven, Connecticut, USA Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK;11. Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, USA Division of Research, Kaiser Permanente Northern California, Oakland, California, USA;12. Division of Research, Kaiser Permanente Northern California, Oakland, California, USA;13. Institut Bergonié, BPH, U1219, CIC-EC 1401, INSERM, Univ. Bordeaux, Bordeaux, France CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, INSERM, Institut Bergonié Hôpital St-André, CIC-EC 1401, Bordeaux, France;14. Atlanta VA Medical Center, Decatur, Georgia, USA Rollins School of Public Health at Emory University, Atlanta, Georgia, USA;15. University of Alabama, Birmingham, Alabama, USA;16. Department of Medicine, University of Washington, Seattle, Washington, USA;17. Servicio de Medicina Interna, Hospital Universitario de Sierrallana, Torrelavega, Spain;18. Hospital General Universitario Gregorio Marañón, Madrid, Spain;19. Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany;20. APHP, Service de Médecine Interne, Hôpital Béclère, Clamart, France CESP, INSERM U1018, Université Paris-Saclay, UVSQ, Le Kremlin-Bicêtre, Villejuif, France;21. Stichting HIV Monitoring, Amsterdam, The Netherlands Department of Global Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands;22. Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University Hospital, Milan, Italy;23. Yale School of Medicine and VA Connecticut Healthcare System, West Haven, Connecticut, USA;24. Population Health Sciences, University of Bristol, Bristol, UK NIHR Bristol Biomedical Research Centre, Bristol, UK Health Data Research UK South-West, Bristol, UK;25. Institut Bergonié, BPH, U1219, CIC-EC 1401, INSERM, Univ. Bordeaux, Bordeaux, France INRIA SISTM Team, Talence, France CHU de Bordeaux, Service d'information Médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France |
| Abstract: | Among persons with HIV (PWH), higher alcohol use and having hepatitis C virus (HCV) are separately associated with increased morbidity and mortality. We investigated whether the association between alcohol use and mortality among PWH is modified by HCV. Data were combined from European and North American cohorts of adult PWH who started antiretroviral therapy (ART). Self-reported alcohol use data, collected in diverse ways between cohorts, were converted to grams/day. Eligible PWH started ART during 2001–2017 and were followed from ART initiation for mortality. Interactions between the associations of baseline alcohol use (0, 0.1–20.0, >20.0 g/day) and HCV status were assessed using multivariable Cox models. Of 58,769 PWH, 29,711 (51%), 23,974 (41%) and 5084 (9%) self-reported alcohol use of 0 g/day, 0.1–20.0 g/day, and > 20.0 g/day, respectively, and 4799 (8%) had HCV at baseline. There were 844 deaths in 37,729 person-years and 2755 deaths in 443,121 person-years among those with and without HCV, respectively. Among PWH without HCV, adjusted hazard ratios (aHRs) for mortality were 1.18 (95% CI: 1.08–1.29) for 0.0 g/day and 1.84 (1.62–2.09) for >20.0 g/day compared with 0.1–20.0 g/day. This J-shaped pattern was absent among those with HCV: aHRs were 1.00 (0.86–1.17) for 0.0 g/day and 1.64 (1.33–2.02) for >20.0 g/day compared with 0.1–20.0 g/day (interaction p < .001). Among PWH without HCV, mortality was higher in both non-drinkers and heavy drinkers compared with moderate alcohol drinkers. Among those with HCV, mortality was higher in heavy drinkers but not non-drinkers, potentially due to differing reasons for not drinking (e.g. illness) between those with and without HCV. |
| Keywords: | alcohol cause-specific cohort hepatitis C virus HIV mortality |