Light alcohol use does not accelerate fibrosis in women with HCV/HIV coinfection

Light alcohol consumption did not influence liver fibrosis in women who were coinfected with HIV and hepatitis C virus, according to recently published findings in Clinical Infectious Diseases.

“HIV/HCV coinfected patients have accelerated fibrosis progression as compared to HCV mono-infected individuals,” Erin Kelly, MD, assistant professor of the Ottowa Hospital, and colleagues wrote. “Whether regular consumption of small quantities of alcohol further increase the rate of fibrosis progression is unknown.”

The researchers conducted a prospective cohort study of 686 women who were enrolled in the Women’s Interagency HIV Study. All women were coinfected with HCV and HIV. Kelly and colleagues gathered sociodemographic data, saw patients in follow-up visits every 6 months, collecting data on renal function, liver enzymes, CD4 count, complete blood count and HIV viral load. The researchers also interviewed patients about alcohol use, defining light use at one to three drinks per week, moderate use as four to seven drinks per week and heavy use as more than seven drinks per week. Patients described as heavy drinkers were substratified into those who had eight to 14 drinks per week and those who had more than 14 per week.

Nearly half of women reported no alcohol use (46%), Kelly and colleagues wrote. Slightly more than one-fourth (27%) reported light alcohol consumption and 7% reported moderate use. One-fifth (20%) reported heavy drinking (46 women had 14 drinks or fewer per week; 89 had more than 14). All patients had similar median FIB-4 at the beginning of the study.

Light and moderate consumption was not associated with fibrosis progression, the researchers reported (0.004 FIB-4 units per year; 95% CI, –0.11 to 0.12 and 0.006 FIB-4 units per year; 95% CI, –0.18 to 0.19, respectively).

However, consuming more than 14 drinks per week was linked with significant acceleration of fibrosis (0.25 FIB-4 units per year; 95% CI, 0.01-0.49) compared with abstinence, whereas drinking eight to 14 drinks each week demonstrated “minimal acceleration” (0.04 FIB-4 units per year; 95% CI, –0.19 to 0.28).

In an accompanying editorial, Vincent Lo Re III, MD, MSCE, of the Perelman School of Medicine at the University of Pennsylvania, wrote that “many critical questions remain regarding the interactions between alcohol, chronic HCV and HIV.

“Additional research is also needed to evaluate the effects of alcohol use categories on adherence to direct-acting antiviral therapy and HCV treatment response and examine whether these outcomes differ by HIV status and sex,” Lo Re wrote. “These data will help inform whether there is a ‘safe’ level of alcohol intake in HIV/HCV patients.” – by Andy Polhamus

Disclosure: Lo Re reports research grant support from AstraZeneca to the University of Pennsylvania. The researchers report no relevant financial disclosures.