Compared with moderate alcohol drinkers, people with self-reported or provider-reported heavy drinking ran a higher risk of dying from any cause in a 10-year study of 1,855 people with HIV. Self-reports and provider reports often differed in their estimation of heavy drinking.
Research links heavy alcohol drinking to inconsistent pill taking, which can lead to higher viral loads in people with HIV. Heavy drinking also leads to liver fibrosis (scar tissue formation) and higher death rates in people with HIV. Much of this previous research considers heavy drinking as either present or absent. Researchers at Johns Hopkins University in Baltimore conducted this new study to consider the impact of heavy drinking defined in different ways: heavy, moderate, and none; by the person versus by the provider; and current versus in the past.
The study involved HIV-positive adults in a group tracked over many years. Researchers regularly recorded personal, medical and treatment-related data for each person. Since July 2000, study participants completed a computer-assisted self-interview about alcohol and drug use, and other habits. The research team used the computer interviews to determine whether each person considered themselves a heavy drinker (more than 14 drinks per week for men or more than seven drinks per week for women), a moderate drinker (drinking less than that), or a nondrinker. The researchers used medical records to determine whether providers rated study participants as current drinkers (in the past six months) or past drinkers (not in the past six months) and whether drinking was heavy or not. The research team then determined the impact of drinking on risk of death regardless of whatever risk factors a person had.
Related: Heavy and Binge Alcohol Drinking Tied to Missing HIV Care Appointments (On TheBodyPRO.com)
Of the study participants, 37% were women and 81% black, and half were 44 years old or younger at their first study visit. While 10% rated themselves heavy drinkers, 34% said they drank moderately, and 56% said they did not drink. In contrast, HIV providers reported that 19% of these people drank heavily within the past 6 months, 16% did so more than six months ago, and 65% never drank heavily. Among people who rated themselves as moderate drinkers, providers reported that 21% drank heavily in the past six months. And among people who reported not drinking, providers reported 14% drank heavily recently.
During the study period, 304 people died, yielding a death rate of 43 per 1,000 person-years (43 of every 1,000 people died each year). The death rate was lowest in people who called themselves moderate drinkers and whose providers reported no heavy drinking in the past six months (23 per 1,000 person-years).
All-cause death (dying from any cause) rates were higher for: self-reported moderate drinkers whose providers reported recent heavy drinking (40.8 per 1000 person-years); all self-reported heavy drinkers (44.5 per 1000 person-years); self-reported moderate drinkers whose providers reported drinking more than six months ago (50.4 per 1000 person-years); and self-reported nondrinkers whose providers reported heavy drinking in the past six months (85.4 per 1000 person-years).
Forty-eight people died of liver-related causes during the study period to yield a liver-related death rate of 3.4 per 1,000 person-years. Liver-related death rates were highest in self-reported moderate drinkers whose providers reported heavy drinking in the past six months (11.5 per 1,000 person-years), and next highest in self-reported nondrinkers whose providers reported heavy drinking in the past 6 months (24.3 per 1,000 person-years).
Statistical analysis determined that self-reported moderate drinkers whose providers reported no heavy drinking had the lowest risk of death from any cause. Compared with this group the risk of death from any cause was 2.6 times higher in self-reported nondrinkers whose providers reported past heavy drinking, and 3.8 times higher in self-reported nondrinkers whose providers reported heavy drinking within the past six months. Self-reported moderate or heavy drinkers whose providers also reported drinking had about double the death risk of the comparison group.
Looking only at liver-related death, the researchers found that moderate drinkers whose providers reported no heavy drinking had the lowest death risk. Compared with them, people whose providers reported heavy drinking within the past six months had a 3.5 to 7.3 times higher risk of liver-related death. But the liver death risk was not significantly higher in people whose providers reported heavy drinking more than six months ago.
This large study confirms prior research finding a higher risk of death from any cause among heavy drinkers with HIV infection -- and a higher risk of liver-related death only among recent heavy drinkers. The second finding suggests that the risk of liver death drops in HIV-positive people who stop heavy drinking.
According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), besides damaging the liver, heavy alcohol drinking can contribute to death by damaging the heart and the pancreas and by adding to the risk of several cancers. The NIAAA provides information on alcohol abuse and on support and treatment for drinkers.