Alcohol use among patients with HIV infection
Alcohol use among patients with HIV infection
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DOI：
10.1016/s1665-2681(19)31519-4
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发表时间：
2011-10-01
影响因子：
3.8
通讯作者：
Bonacini, Maurizio
中科院分区：
文献类型：
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作者：
Bonacini, Maurizio
Objective.评估HIV感染患者的酒精使用情况，评估种族和社会关联，并描述结果。材料和方法。设计：队列研究。设置：学术艾滋病毒肝脏诊所。患者：431例HIV感染患者（371例男性，60例女性）; 249例HIV/HCV合并感染患者，115例HIV单独感染患者，67例HIV/HBV合并感染患者。干预：在第一次访谈时估计酒精使用情况，并报告为估计的平均终生消费量（克/天）。结果测量：实验室检查值、肝纤维化、失代偿和死亡率。结果整个队列中22%的患者具有高风险的终生平均饮酒量，定义为>= 50 mg/天。五十六%的患者在第一次评估时已经戒了所有的酒，但随访显示26%的患者继续高风险消费。通过单变量分析，高饮酒量与拉丁裔、注射毒品使用（IDU）和丙型肝炎（HCV）合并感染相关。多变量分析显示，只有IDU与高饮酒量独立相关（RR = 4.1，p = 0.0005）。在实验室值，包括CD 4细胞计数，没有显着差异，除了较高的转氨酶和肝纤维化评分的趋势，高和低酒精用户之间。高饮酒组的全因死亡率（37%）高于低饮酒组（25%，p = 0.03），且与IDU（RR = 2.2，p = 0.04）和饮酒量（RR = 1.1，p = 0.04）相关。高剂量组的肝功能失代偿和死亡率均较高，但具有临界意义。使用有序分组，我们发现酒精消费量和肝脏死亡占总死亡人数的百分比之间存在很强的相关性（R = 0.88），使用10 g/天或更少的人死亡率最低。不安全饮酒在艾滋病毒感染者中很普遍，戒酒并不普遍。对全因死亡率有显著影响，并有肝脏发病率和死亡率升高的趋势。IDU与高乙醇摄入量显著且独立相关。从业人员应强烈建议艾滋病患者尽量减少饮酒。
Objective. To evaluate alcohol use in patients with HIV infection, assess ethnic and social associations, and describe outcomes. Material and methods. Design: cohort study. Setting: Academic HIV-Liver Clinic. Patients: 431 HIV-infected patients (371 men, 60 women); 249 patients with HIV/HCV coinfection, 115 HIV alone, and 67 with HIV/HBV. Intervention: alcohol use was estimated at first interview and reported as the estimated average lifetime consumption in grams/day. Outcome measures: laboratory values, liver fibrosis, decompensation and mortality. Results. Twenty-two percent of patients in the entire cohort had high risk lifetime average alcohol consumption, defined as >= 50 mg/day. Fifty-six percent of patients had quit all alcohol when first evaluated, but follow-up showed that 26% continued high risk consumption. By univariate analysis high alcohol consumption was associated with Latino ethnicity, injection drug use (IDU) and hepatitis C (HCV) coinfection. Multivariable analysis showed only IDU to be independently associated with high alcohol consumption (RR = 4.1, p = 0.0005). There were no significant differences in laboratory values, including CD4 cell counts, except for a trend towards higher transaminases and liver fibrosis scores, between high and low alcohol users. All-cause mortality was statistically higher in the high (37%) vs. low (25%, p = 0.03) alcohol use group, and was associated with both IDU (RR = 2.2, p = 0.04) and the amount of alcohol consumed (RR = 1.1, p = 0.04). Liver decompensation and mortality were both higher in the high use group but of borderline significance. Using an ordinal grouping, we found a strong correlation (R = 0.88) between alcohol consumption and the percentage of liver death over total deaths, with lowest mortality rates found in those use of 10 g/day or less. Conclusions. Unsafe use of alcohol is prevalent in HIV-infected patients and stoppage is not universal. There is a significant impact on all-cause mortality and a trend towards higher liver morbidity and mortality. IDU is significantly and independently associated with high ethanol intake. Practitioners should strongly recommend that HIV patients minimize alcohol use.