Associations of alcohol consumption with long-term mortality of ART-naïve persons seeking HIV care.
Abstract
Background: HIV infection is associated with several chronic diseases. Antiretroviral therapy (ART) is associated with an improved survival in patients living with HIV. The survival benefit is not widespread and the impact of unhealthy alcohol use on clinical outcomes and survival is a matter of debate. We aimed to examine the role of excessive alcohol consumption on all-cause mortality among ART-naïve individuals admitted to HIV care.
Methods: Longitudinal study in the Spanish network on HIV/AIDS (CoRIS) among individuals enrolled between 2004 and 2021 in 47 HIV/AIDS units. We analyzed crude and adjusted mortality rates by alcohol consumption at first visit. We also performed Kaplan-Meier survival analysis stratified by excessive alcohol consumption (>40 gr/day) . We used Cox proportional hazard models to assess the association between excessive alcohol consumption (>40 gr/day) and mortality after controlling for confounders [i.e., age at first visit, sex, HCV infection (EIA+), CD4 cell count and HIV-RNA viral load and persons who inject drugs as mode of HIV acquisition (PWID)].
Results: 8,378 participants (15% women) were included; median age at first visit was 37 years (IQR: 29-44 years). Men who had sex with men (MSM) accounted for 61% of the participants, 28% were heterosexuals and 6.3% persons who inject drugs (PWID). Among drinkers (38% of the study population), mean alcohol consumption was 70 grams per week (± 23.6 gr). In addition, 4.3% of participants reported alcohol consumption >40 grams/day. The prevalence of alcohol consumption >40 grams/day was higher among PWID (26%) than among MSM (2.4%) or heterosexuals (5.3%). Prevalence of HCV infection was 8.8%, median log RNA-HIV load was 4.54 (IQR: 3.67-5.13) and median CD4 count was 398 cells/ mm3 (IQR: 219-596).
After a median follow up of 5.6 years (IQR: 2.5-9.8 years) and a total follow-up of 52,799 person-years (p-y), 267 participants (3.1%) had died.
Crude mortality rate of those who drank >40 grams/day was 1.86 x 100 p-y vs. 0.43 x 100 p-y among those who drank <40 grams/day [RR 4.30 (95% CI: 33.15-5.87), p <0.01].
The Kaplan-Meier survival analysis showed an increase risk of death for those with alcohol consumption >40 grams/day (Log-rank <0.01).
In the unadjusted analysis, alcohol consumption >40 grams/day (HR 4.28; 95% CI: 3.13-5.83), age (HR: 2.58; 95% CI: 1.96-3.40), HCV infection (HR: 5.05; 95% CI: 3.94-6.48), CD4 cell count (HR: 2.58; 95% CI: 1.96-3.40) and PWID (HR: 4.72; 95% CI: 3.64-6.17) were associated with higher risk of mortality. In the adjusted model, alcohol consumption >40 grams/day was associated with a higher risk of mortality [HR 2.39 (95% CI: 1.68-3.42), p <0.01)]
Conclusion: In this cohort of ART-naïve individuals entering HIV care, unhealthy alcohol use (>40 grams/day) was associated with reduced survival. These results underscore the importance of addressing alcohol use in patients living with HIV.
