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Alcohol Abuse Plus Pro-Inflammatory Molecules Equal Early Death in HIV Patients

January 4, 2014

A study led by researchers at Boston University School of Medicine (BUSM) provides new insight into the impact that pro-inflammatory molecules have on early death in HIV patients who abuse alcohol. The findings of the study, unique in its investigation of inflammatory markers in HIV and alcohol abuse, pinpoint the inflammatory markers most associated with early death and may help explain why some patients die earlier than others even when all of these patients are on antiretroviral therapy. The study is published online in the journal AIDS.

Although breakthroughs have been accomplished in HIV antiretroviral therapy, some patients fare better than others. Factors influencing these differences have been identified, including co-infection with hepatitis viruses (especially hepatitis C), substance abuse (alcohol, as well as other drugs), non-adherence with antiviral drugs, CD4+ cell count and HIV viral load. Additionally, researchers have previously identified pro-inflammatory molecules called cytokines that have been associated with elevated HIV viral loads and more advanced HIV disease. Independently, alcohol abuse and chronic hepatitis C infection have also been associated with higher levels of inflammation in the bodies of HIV-positive people. However, it was previously unknown if the elevated inflammatory state in these patients was due to their HIV or other independent risk factors.

Investigators recruited 400 HIV-positive participants who were known to abuse alcohol chronically. Half of them also had chronic hepatitis C. They were followed for a three- to five-year period during which clinical information and laboratory samples were collected. Levels of seven well-known pro-inflammatory cytokine molecules were measured at baseline. From the beginning of the study in 2001 until data gathering was concluded in 2009, all patients were tracked in a national database to verify their survival status.

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Based on this analysis, the researchers found that at the end of the study period, 85 out of the original 400 patients had died. Although these patients represent a population already at high risk of mortality from many problems (smoking, drug abuse, homelessness, etc.), most deaths in the study period were a result of either HIV or hepatitis C. Adjusting for known risk factors, such as age, smoking, and hepatitis status, the researchers found that an increased burden of inflammation was strongly associated with increased mortality in HIV patients who also abused alcohol. This association was found, regardless of whether or not patients were taking their antiretroviral drugs. One inflammatory molecule in particular, known as interleukin-6 (IL-6) was found to have the strongest association with mortality among patients in the study.

"Current antiretroviral drug regimens may be able to improve mortality in most patients, but are unable to decrease the potentially dangerous burden of a chronic inflammatory state in the body," said Daniel Fuster, MD, PhD, a researcher at the Clinical Addiction Research and Education (CARE) unit at BUSM, and the study's lead author. "Additional research should explore how to better manage chronic inflammation in these patients."




This article was provided by Positively Aware. It is a part of the publication Positively Aware Weekly. Visit Positively Aware's website to find out more about the publication.
 

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