Moderate Alcohol Tied to Lower Death Rate in Swiss HIV Cohort

May 5, 2016

Compared with no or very low alcohol intake, low or moderate alcohol consumption predicted longer cardiovascular disease-free survival in the Swiss HIV Cohort Study (SHCS). But alcohol consumption did not predict cardiovascular events alone in this 9764-person analysis.

In the general population, light to moderate alcohol consumption is linked to lower cardiovascular morbidity and mortality. To see whether the same associations hold true in people with HIV infection, SHCS investigators conducted a prospective analysis of this large HIV cohort.

The study group consisted of antiretroviral-treated adults in follow-up with alcohol consumption data after August 2005. Researchers categorized participants by self-reported alcohol consumption as abstention or very low (<1 g/d), low (1 to 9 g/d), moderate (10 to 29 g/d in women and 10 to 39 g/d in men) and high (>39 g/d). They used Cox proportional hazards models adjusted for relevant baseline variables to describe associations between time-updated alcohol intake and the primary endpoint, a cardiovascular disease event or death and three secondary endpoints: (1) a cardiovascular disease event, (2) cardiovascular death and (3) overall mortality.

Among the 9764 SHCS members analyzed, 51% reported abstention or very low alcohol intake, 20% reported low alcohol use, 22% moderate use and 7% high use. The no-or-very-low group included a higher proportion of women than the other groups (39.4% versus 15.8% to 22.7%, P < .001) and a higher proportion of blacks (19.1% versus 5.0% to 9.1%, P < .001). Median age was slightly but significantly lower in the very-low and low groups (41 years) than in the moderate group (43 years) or the high group (44 years) (P < .001). The no-or-very-low group included a significantly lower proportion of men who have sex with men than the other groups (31.7% versus 32.8% to 54.0%, P < .001).

During follow-up, 788 people had a new cardiovascular event or died. This combined outcome developed in 8.8% of people with no or very low alcohol use, 6.1% with low alcohol use, 7.1% with moderate alcohol use and 11.4% with high alcohol use. Proportional hazards models determined that, compared with people who drank little or no alcohol, people with low alcohol use had a 21% lower risk of the combined endpoint (adjusted hazard ratio [aHR] 0.79, 95% confidence interval [CI] 0.63 to 0.98) and people with moderate alcohol use had a 22% lower risk (aHR 0.78, 95% CI 0.64 to 0.95). High alcohol use did not affect the combined endpoint compared with no-or-very-low alcohol use.

Other variables associated with the combined endpoint of a cardiovascular event or death were cumulative abacavir use, cumulative protease inhibitor use, lower education, lower CD4+ count, anemia and several classic cardiovascular risk factors: older age, diabetes, smoking, pulmonary hypertension and higher total-to-HDL cholesterol ratio.

Compared with no or very low alcohol use, low alcohol consumption was associated with a 43% lower risk of all-cause mortality (aHR 0.57, 95% CI 0.42 to 0.78), moderate alcohol consumption was associated with a 40% lower risk (aHR 0.60, 95% CI 0.46 to 0.80) and high alcohol use was not associated with all-cause mortality. Low or moderate alcohol use was not associated with a lower risk of cardiovascular events alone or with a lower risk of cardiovascular death.

The SHCS team concludes that "the J-shaped association between alcohol consumption and mortality shown previously in the general population also seems to hold true in HIV-infected individuals" on antiretroviral therapy (ART). The researchers speculate that the make-up of the no-or-very-low alcohol group or statistical overcorrection could explain the failure to show an association between low or moderate drinking and a lower risk of cardiovascular events alone.

The Swiss investigators believe their study "underlines the protective effect of low and moderate alcohol consumption on cardiovascular event-free survival and overall survival." As a result, "there is no signal that low-to-moderate alcohol consumption should be avoided by HIV-infected persons on ART."

Mark Mascolini writes about HIV infection.

Copyright © 2016 Remedy Health Media, LLC. All rights reserved.

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Reader Comments:

Comment by: ROBERT J MCCULLOUGH (New York City) Sat., May. 21, 2016 at 2:10 pm UTC
After re-reading your web site, I can further clarify my confusion in the above post:

I read your recent article by Mark Mascolini, "Moderate Alcohol Tied to Lower Dear Rate in Swiss HIV Cohort" (May 3, 2016.)

However, I saw on your website, also by Mark Mascolini, dated March 3, 2014 "Low/Moderate Alcohol Drinking Trims Heart Disease-Free Death Risk in HIV+ Swiss"

Both articles dated 2 years apart seem to be talking about the same study, since the newest article made no mention of date this information was announced. Are we to assume that the newest article reflects an on-going study of the first study two years ago, and similar findings were documented. Or is this article the findings of the 2014 study re-printed in 2016?

The reason why this is important is that it comes on the heels of another study you printed two months earlier, "Alcohol Risks Higher in HIV+ People And Linked To Increased Mortality" (March 22, 2016, by Gareth Hardy). That study does not support any benefit of alcohol consumption for HIV+ men).

For my satisfaction as a person living for 25 years with HIV, and in keeping abreast of the most up to date studies and research on alcohol consumption and HIV, it is important for me to have the above clarified. Thank you.
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Comment by: Robert (New York City) Wed., May. 18, 2016 at 12:35 am UTC
A study out recently said even low to moderate alcohol consumption by HIV+ individuals lead to increase in disease/mortality. Now this study says it's protective. Which is it? This is crazy. I've been drinking wine in moderation for over 25 yrs since I was diagnosed HIV+ and haven't had any illnesses beyond a cold.
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