Is physician assessment of alcohol consumption useful in predicting risk of severe liver disease among people with HIV and HIV/HCV co-infection?

摘要

BackgroundIdentifying unhealthy levels of alcohol consumption in HIV patients seen for routine clinical care is important because of the possible role alcohol plays in HIV disease progression as well as non HIV-related comorbidities such as liver failure [1]. In the era of combination antiretroviral treatment (cART), people living with HIV/AIDS (PLWHIV) are now living longer and long term effects of alcohol consumption are likely to affect people’s quality of life and survival [2]. Therefore, knowledge of alcohol consumption behaviour and risk of disease progression associated with hazardous drinking are important in the overall management of HIV disease [3]. Alcohol consumption is common in PLWHIV with estimates of current alcohol use reported to be 50% in studies of HIV-positive people [1, 4,5,6,7,8] and hazardous drinking, has reported prevalence ranging between 8 and 12%. Hazardous drinking can lead to harmful consequences such as liver disease progression or liver related mortality [7, 9,10,11,12,13,14,15,16,17,18].Assessment of alcohol consumption in HIV cohort studies varies because of the measurement tools implemented, mode of assessment and risk groups under investigation [18,19,20,21,22,23,24,25]. Most studies have used methods of alcohol assessment based on brief self-reported questionnaires relating to quantity and/or frequency of drinks consumed [26]. Others studies have used patient interviews, biomarkers or breath tests to assess level of alcohol consumption [27, 28]. These different measurement tools has led to methodological challenges in quantifying estimates of alcohol consumption amongst PLWHIV [29].In this analysis, we use data routinely collected by treating physicians in two cohorts of PLWHIV seen for routine clinical care in Italy, including questions related to both frequency and quantity of alcohol consumed. Our objective is two-fold. Firstly, we aim to categorise drinking behaviour using data routinely collected in our cohorts by mapping the questions on the electronic case report form (CRF) to those used in national drinking guidelines known as the National Institute for Food and Nutrition (NIFN) in Italy. Secondly, to assess the association between alcohol consumption and risk of severe liver disease (SLD) among PLWHIV with or without HCV infection.