Spotlight Series on Hepatitis C


Even Moderate Alcohol Use Increases Liver Disease Risk for People Coinfected With HIV and HCV

May 19, 2014

Even Moderate Alcohol Use Increases Liver Disease Risk for People Coinfected With HIV and HCV

That excessive alcohol consumption is bad for anyone's liver is well known. However, the specific risks associated with different patterns of alcohol use, especially among those infected with HIV, hepatitis C (HCV) or both, are not so well established. A recent study determined that even relatively moderate alcohol use, classified as non-hazardous drinking, significantly increases the risk of advanced hepatic fibrosis among people who are coinfected with HIV and HCV, and also increases that risk for those with only HIV or HCV infection.

The study enrolled participants in the Veterans Aging Cohort Study (VACS) at eight U.S. Department of Veterans Affairs (VA) facilities who reported alcohol use during the prior 12 months and had hepatic fibrosis data available. Of the 3,565 veterans included, 41.5% (1,479) were classified as non-hazardous drinkers, 34.6% (1,232) as hazardous or binge drinkers and 24% (854) received an alcohol-related diagnosis (alcohol categorization based on the three-item Alcohol Use Disorders Identification Test-Consumption [AUDIT-C] questionnaire and VA medical data).

Hepatic fibrosis was determined by using the FIB-4 index, a non-invasive measure of advanced hepatic fibrosis based on liver aminotransferases, platelet count and age. An FIB-4 index greater than 3.25 indicates advanced hepatic fibrosis.

HIV/HCV status among participants was as follows: 1,410 HIV positive only, 296 HCV positive only, 701 HIV/HCV coinfected and 1,158 not infected with either HIV or HCV. About 83% of HIV-positive study participants received antiretroviral therapy (ART) and 23% had a CD4 count less than 200. Mean CD4 counts dropped the higher the alcohol use category was.


Because the study was conducted at VA facilities, participants were predominantly male and black, which may limit the applicability of results to the wider population.

Advanced hepatic fibrosis was diagnosed in 7.6% (271) of study participants. In each alcohol use category, fibrosis was more prevalent among HIV- or HCV-positive patients compared to those not infected, with the highest incidence among participants coinfected with HIV and HCV. Prevalence also increased as alcohol use category increased.

The study authors suggest the following clinical implications for HIV care practitioners:

  • Use the AUDIT-C questionnaire during routine care and explain the potential effects of the patient's alcohol use category on the liver in order to motivate the patient to reduce his or her alcohol consumption.
  • Explain to HIV/HCV coinfected patients the strong association between all alcohol use categories and advanced hepatic fibrosis.
  • Counsel any patient with an FIB-4 index of more than 3.25 to reduce alcohol consumption or avoid alcohol altogether.

Barbara Jungwirth is a freelance writer and translator based in New York.

Follow Barbara on Twitter: @reliabletran.

Copyright © 2014 Remedy Health Media, LLC. All rights reserved.

This article was provided by TheBodyPRO.

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