Alcohol consumption and cardiovascular disease (CVD) in HIV-infected patients receiving antiretroviral treatment (ART): results from the ANRS CO8 APROCO-COPILOTE cohort
Background:
Cardiovascular
disease (CVD) is a major concern in HIV-infected patients as antiretroviral
therapy (ART) and patients' lifestyle can increase its risk. The relationship
between alcohol use and CVD was investigated in HIV-infected individuals
receiving ART in the French ANRS CO8 APROCO-COPILOTE cohort.
Methods:
The
APROCO-COPILOTE cohort was set up in 1996 to study clinical and
immuno-virological progression after ART initiation. Two questions in the
self-administered questionnaires helped to estimate the daily number of alcohol
units at baseline and every 8 months thereafter. Metabolic data (including
hyperlipidemia and history of coronary heart disease and hypertension) were
available in a subset of patients. Two Cox models were used to estimate
the association between self-reported daily alcohol consumption and the first
occurrence of a CVD event after adjustment for known correlates and
confounders, first on the whole dataset (N=1154) and second, on the subset including
metabolic data (N=675).
Results:
During
follow-up, 85 CVD events were observed (incidence rate [95% CI]=1.3 [1.0-1.6]
per 100 person-years) including coronary artery disease/myocardial infarction
(n=30), phlebitis/pulmonary embolism (n=22), cardiomyopathy/congestive heart
failure (n=9), stroke (n=7), peripheral vascular disease (n=7), other events
(cardiac dysrhythmia, cerebral haemorrhage, aortic aneurysm, cardiovascular
surgery). In the restricted database with metabolic data (n=675), after adjustment
for age, smoking>20 cigarettes/day, CD4>200, undetectable viral load and
hyperlipidemia, individuals with moderate alcohol consumption (≤3 AU/day) were
at lower risk of CVD (HR [95% CI]=0.37 [0.21-0.64], p< 0.001), while the risk
for those drinking>3 AU/day was not significantly different from abstainers
(0.53 [0.17-1.65]). These results were confirmed on the extended dataset
without adjustment for hyperlipidemia.
Conclusion:
As in
the general population, moderate alcohol consumption seems to play a protective
role in the onset of CVD in HIV-infected patients receiving ART. Further
research is needed, however, to understand to what extent moderate alcohol use
remains beneficial in patients with comorbidities.
M.P. Carrieri1, C. Protopopescu1, G. Chêne2, J.M. Ragnaud3, B. Spire1, B. Marchou4, C. Perronne5, F. Raffi6, C. Leport7, the ANRS CO 8 Aproco-Copilote Study Group
1INSERM, U912 (SE4S) - Observatoire Régional de la Santé Provence Alpes Côte d'Azur (ORS PACA), Marseille, France, 2INSERM, U897, ISPED, Université Bordeaux Segalen, Bordeaux, France, 3Hôpital Pellegrin, Bordeaux, France, 4Hôpital de Purpan, Toulouse, France, 5CHU Raymond Poincaré, Garches, France, 6CHRU Hôtel Dieu, Nantes, France, 7LRPI, Université Paris Diderot-Paris 7, Paris, France