Women coinfected with HIV and hepatitis C virus who drank light and moderate amounts of alcohol did not experience significant progression of liver fibrosis, compared with those who drank heavily, results from a large cohort study found.

“Although heavy alcohol use is clearly detrimental to the health of patients with CHC [chronic hepatitis C], it is unclear whether consumption of smaller quantities of alcohol impact fibrosis progression,” researchers led by Erin M. Kelly, MD , wrote in a study published online Aug. 16 in Clinical Infectious Diseases ( doi: 10.1093/cid/cix716). “Many patients with CHC consume alcohol and are unable or unwilling to completely abstain. Some studies have suggested a linear dose-response relationship for fibrosis progression even at lower quantities, while others have not clearly demonstrated a risk for fibrosis progression below 20-50 g of alcohol per day. HIV/HCV [hepatitis C virus]-coinfected patients have accelerated fibrosis progression, compared with HCV monoinfected individuals. Whether regular consumption of small quantities of alcohol further increase the rate of fibrosis progression is unknown.”

To examine the impact of moderate alcohol use on liver fibrosis progression in a well-characterized cohort of women coinfected with HIV and HCV, Dr. Kelly of the department of medicine at the University of Ottawa and her associates evaluated data from the Women’s Interagency HIV Study ( WIHS ), an ongoing, National Institutes of Health–funded, multicenter study of adult women with HIV or at high risk of acquiring HIV. WIHS collects demographic, behavioral, and medical information on participants every 6 months from structured interviews, physical examinations, and biologic specimens. Among 686 women coinfected with HIV and HCV, the researchers ascertained alcohol intake every 6 months and use categorized as abstinent, light (defined as 1-3 drinks per week), moderate (4-7 drinks per week), heavy (more than 7 drinks per week), and very heavy (more than 14 drinks per week). They defined fibrosis progression as the change in the Fibrosis-4 (FIB-4) score using as assessed by random intercept random slope mixed modeling.

At baseline, the mean age of study participants was 40 years, their mean body mass index was 26 kg/m2, 17% had diabetes, and 11% had significant fibrosis, defined as a FIB-4 index of greater than 3.25. Nearly half (46%) reported no alcohol use; 26.8% reported light use; 7.1%, moderate use; and 19.7%, heavy use. The median FIB-4 scores at entry were similar between groups. On multivariable analysis, no significant difference in fibrosis progression was observed in abstainers, compared with those who reported light and moderate alcohol use (0.004 and 0.006 FIB-4 units/year, respectively). On the other hand, those who reported very heavy drinking showed significant fibrosis acceleration, compared with abstainers (0.25 FIB-4 units/year), while those who reported drinking 8-14 drinks per week showed minimal acceleration of fibrosis progression (0.04 FIB-4 units/year).

“Of interest, despite WIHS research clinicians recommending limiting or avoiding alcohol at semiannual visits, most women who consumed alcohol at WIHS entry continued to have periods of alcohol use in follow-up,” Dr. Kelly and her associates wrote. “This suggests that, despite being enrolled in a long-term observational cohort study, patients did not change their drinking behaviors, limiting any potential bias in changing behaviors due to participation in a research study.”

The investigators acknowledged certain limitations of the study, including the fact that while current alcohol use was captured at study entry and at follow-up, lifetime alcohol exposure was not collected. “Women categorized as abstinent may have had a prior history of alcohol use,” they noted. “Some of these women may represent ‘sick abstainers’ that have ceased alcohol consumption due to the severity of their liver disease. This may explain the finding that entry fibrosis scores were similar between groups, when one would expect heavy users to have higher fibrosis scores, as compared to abstinent patients.”

The study was supported by the National Institute of Allergy and Infectious Diseases, with additional cofunding from the National Institute of Child Health and Human Development; the National Cancer Institute; the National Institute on Drug Abuse; the National Institute on Mental Health; and the University of California, San Francisco, Liver Center Biostatistics Core. The researchers reported having no financial disclosures.