Author information
1Population Health Sciences, University of Bristol, Bristol, UK.
2Stichting HIV Monitoring, Amsterdam, The Netherlands.
3Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.
4Amsterdam UMC, University of Amsterdam, Infectious Diseases, Amsterdam, The Netherlands.
5South Alberta HIV Clinic, Department of Medicine, University of Calgary, Calgary, Canada.
6Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France.
7Department of Public Health, AP-HP, St Antoine Hospital, Paris, France.
8National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain.
9CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III.
10Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
11Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
12Austrian HIV Cohort Study (AHIVCOS), Medizinische Universität Innsbruck, Innsbruch, Austria.
13Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
14Yale School of Medicine and VA Connecticut Healthcare System, West Haven, Connecticut, USA.
15Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
16Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, USA.
17Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
18Institut Bergonié, BPH, U1219, CIC-EC 1401, INSERM, Univ. Bordeaux, Bordeaux, France.
19CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, INSERM, Institut Bergonié Hôpital St-André, CIC-EC 1401, Bordeaux, France.
20Atlanta VA Medical Center, Decatur, Georgia, USA.
21Rollins School of Public Health at Emory University, Atlanta, Georgia, USA.
22University of Alabama, Birmingham, Alabama, USA.
23Department of Medicine, University of Washington, Seattle, Washington, USA.
24Servicio de Medicina Interna, Hospital Universitario de Sierrallana, Torrelavega, Spain.
25Hospital General Universitario Gregorio Marañón, Madrid, Spain.
26Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany.
27APHP, Service de Médecine Interne, Hôpital Béclère, Clamart, France.
28CESP, INSERM U1018, Université Paris-Saclay, UVSQ, Le Kremlin-Bicêtre, Villejuif, France.
29Department of Global Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
30Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
31Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University Hospital, Milan, Italy.
32NIHR Bristol Biomedical Research Centre, Bristol, UK.
33Health Data Research UK South-West, Bristol, UK.
34INRIA SISTM Team, Talence, France.
35CHU de Bordeaux, Service d'information Médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France.
Abstract
Among persons with HIV (PWH), higher alcohol use and having hepatitis C virus (HCV) are separately associated with increased morbidity and mortality. We investigated whether the association between alcohol use and mortality among PWH is modified by HCV. Data were combined from European and North American cohorts of adult PWH who started antiretroviral therapy (ART). Self-reported alcohol use data, collected in diverse ways between cohorts, were converted to grams/day. Eligible PWH started ART during 2001-2017 and were followed from ART initiation for mortality. Interactions between the associations of baseline alcohol use (0, 0.1-20.0, >20.0 g/day) and HCV status were assessed using multivariable Cox models. Of 58,769 PWH, 29,711 (51%), 23,974 (41%) and 5084 (9%) self-reported alcohol use of 0 g/day, 0.1-20.0 g/day, and > 20.0 g/day, respectively, and 4799 (8%) had HCV at baseline. There were 844 deaths in 37,729 person-years and 2755 deaths in 443,121 person-years among those with and without HCV, respectively. Among PWH without HCV, adjusted hazard ratios (aHRs) for mortality were 1.18 (95% CI: 1.08-1.29) for 0.0 g/day and 1.84 (1.62-2.09) for >20.0 g/day compared with 0.1-20.0 g/day. This J-shaped pattern was absent among those with HCV: aHRs were 1.00 (0.86-1.17) for 0.0 g/day and 1.64 (1.33-2.02) for >20.0 g/day compared with 0.1-20.0 g/day (interaction p < .001). Among PWH without HCV, mortality was higher in both non-drinkers and heavy drinkers compared with moderate alcohol drinkers. Among those with HCV, mortality was higher in heavy drinkers but not non-drinkers, potentially due to differing reasons for not drinking (e.g. illness) between those with and without HCV.
Trial registration: ClinicalTrials.gov NCT02149004.