Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men
Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men
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DOI：
10.1016/j.drugalcdep.2016.01.017
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发表时间：
2016-04-01
影响因子：
4.2
通讯作者：
Fiellin, David A.
中科院分区：
文献类型：
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作者：
Justice, Amy C.;McGinnis, Kathleen A.;Fiellin, David A.
背景：HIV感染(HIV+)个体可能比未感染个体更容易受到与酒精相关的伤害。方法：我们使用酒精使用障碍识别测试-消费审计-C评分分析了2008年至2012年退伍军人老龄化队列研究(VICS)中HIV+和未感染个体的数据。我们使用COX比例风险模型来检查酒精暴露与2014年7月之前死亡率之间的关联；使用线性回归模型来评估酒精暴露与生理损伤之间的关联，基于VAS指数评分。模型根据年龄、种族/民族、吸烟和丙型肝炎感染情况进行了调整。结果：样本包括18,145名HIV+感染者和42,228名未感染者。在HIV携带者中，76%的人携带检测不到的HIV-1RNA(=4(危险比[HR]1.25，95%可信区间1.09-1.44)和>；=30杯/月(HR，1.30，95%可信区间1.14-1.50)与死亡风险增加相关。在未感染的个体中，AUDIT-C评分=5(HR，1.19，95%CI为1.07-1.32)和>；=每月饮酒70次(HR为1.13，95%CI为1.00-1.28)与风险增加相关。同样，在HIV+个体中，AUDIT-C阈值得分为5-7与生理损伤相关(Beta 0.47，95%CI 0.22，0.73)，而在未感染个体中，8分或更高与损伤相关(Beta 0.29，95%CI 0.16，0.42)。结论：尽管接受了抗逆转录病毒治疗，但HIV+个体在较低水平的酒精使用时，与非感染者相比，死亡率和生理损伤增加。艾滋病病毒携带者的酒精消费限制应该更低。爱思唯尔爱尔兰有限公司出版。
Background: HIV infected (HIV+) individuals may be more susceptible to alcohol-related harm than uninfected individuals.Methods: We analyzed data on HIV+ and uninfected individuals in the Veterans Aging Cohort Study (VACS) with an Alcohol Use Disorders Identification Test-Consumption AUDIT-C score from 2008 to 2012. We used Cox proportional hazards models to examine the association between alcohol exposure and mortality through July, 2014; and linear regression models to assess the association between alcohol exposure and physiologic injury based on VACS Index Scores. Models were adjusted for age, race/ethnicity, smoking, and hepatitis C infection.Results: The sample included 18,145 HIV+ and 42,228 uninfected individuals. Among HIV+ individuals, 76% had undetectable HIV-1 RNA (= 4 (hazard ratio [HR] 1.25, 95% CI 1.09-1.44) and >= 30 drinks per month (HR, 1.30, 95% CI 1.14-1.50) were associated with increased risk of mortality. Among uninfected individuals, AUDIT-C score >= 5 (HR, 1.19, 95% CI 1.07-1.32) and >= 70 drinks per month (HR 1.13, 95% CI 1.00-1.28) were associated with increased risk. Similarly, AUDIT-C threshold scores of 5-7 were associated with physiologic injury among HIV+ individuals (beta 0.47, 95% CI 0.22, 0.73) and a score of 8 or more was associated with injury in uninfected (beta 0.29, 95% CI 0.16, 0.42) individuals.Conclusions: Despite antiretroviral therapy, HIV+ individuals experienced increased mortality and physiologic injury at lower levels of alcohol use compared with uninfected individuals. Alcohol consumption limits should be lower among HIV+ individuals. Published by Elsevier Ireland Ltd.