Contribution of alcohol use in HIV/hepatitis C virus co-infection to all-cause and cause-specific mortality: A collaboration of cohort studies. Journal of Viral Hepatitis
Trickey et al. compared the impact of alcohol on mortality between people with HIV (PWH) with and without HCV coinfection within the Antiretroviral Therapy Cohort Collaboration (ART-CC), including participants from cohorts of PWH in Europe and North America.
For the present study, the authors included PWH who started antiretroviral therapy (ART) between 2001 and 2017. Alcohol consumption at ART start was categorized into 0 grams per day (no alcohol use), 0.1-20 grams per day, and >20 grams per day. HCV coinfection at ART start was defined as having detectable HCV-RNA. For individuals without available HCV-RNA measurement, HCV seropositivity was used to indicate co-infection. Multivariable Cox regression was used to estimate adjusted hazard ratios (aHR) between alcohol use and all-cause mortality. The associations were stratified by HCV infection status using interaction terms.
The study included 58’769 PWH (median age 40 years, 79% male, 4% individuals who inject drugs) of which 4799 (8%) had HIV/HCV coinfection. During a median follow-up of 7.8 years, 3599 deaths occurred. The mortality rate was 22.4 per 1000 person-years in people with HIV/HCV coinfection, compared to 6.2 per 1000 person-years in those without HCV. For PWH without HCV coinfection, authors observed a J-shaped association between alcohol use and mortality: Compared with individuals who consumed 0.1-20 grams of alcohol per day (reference group), aHR for mortality was 1.17 (95% CI 1.09-1.27) for individuals who consumed no alcohol, and 1.88 (95% CI 1.68-2.09) for those who consumed >20 grams of alcohol per day. Among individuals with HIV/HCV coinfection, the aHR was 1.00 (0.86-1.17) for individuals with no alcohol consumption, and 1.64 (1.33-2.02) for those who consumed >20 grams of alcohol per day.
In summary, the authors observed differing associations of alcohol use and mortality between PWH with and without HCV coinfection. Among PWH without HCV, there was a J-shaped pattern of higher mortality in those reporting no drinking and heavy drinking, while among PWH with HCV, there was higher mortality only among those reporting heavy drinking. Given that individuals with HIV/HCV coinfection have a higher mortality rate compared to other PWH, the excess mortality risk associated with heavy alcohol use is worrying, and therefore interventions to reduce alcohol consumption are warranted in this population.