The Role of Current and Historical Alcohol Use in Hepatic Fibrosis Among HIV-infected Individuals

Abstract

We examined risk factors for advanced hepatic fibrosis (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, 2,133 (17%) reported current hazardous drinking by AUDIT-C, 2,321 (18%) had a diagnosis of alcohol use disorder, 2,376 (18%) were co-infected with chronic hepatitis C (HCV); 596 (5%) had high FIB-4 scores >3.25 as did 364 (15%) of HIV/HCV coinfected patients. In multivariable analysis, HCV (aOR 6.3, 95% 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/mm ³ (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.