CD4+ cell count ≥200 cells/mm3 and moderate alcohol consumption in HIV-positive patients over 11 years of antiretroviral therapy: evidence of protection against coronary and other arterial disease events

Background: To investigate the relationship between response to antiretroviral treatment (ART), alcohol use and occurrence of a major coronary or other arterial disease event (CADE) in treated HIV-infected individuals followed in the French ANRS CO8 APROCO-COPILOTE cohort.
Methods: The ANRS CO8 cohort was set up in 1997 to study clinical progression and patient-reported outcomes (PRO) after initiating a protease inhibitor-containing ART. Clinical data were retrieved from medical records. Self-administered questionnaires collected - at baseline, one month, 4 months end every 8/12 months thereafter - data on PRO and behaviors, including alcohol use. Among the study patients (n=1154), metabolic data - including hypertriglyceridemia and a family history of CHD - were available only for a subgroup (n=675). Cox models were used to identify correlates of a first occurrence of a major CADE - myocardial infarction, stroke, coronary and peripheral arterial disease or cardiovascular surgery.
Results: Over the 11-year follow-up, 49 CADE were observed, with an incidence rate [95%CI]=0.75[0.57-0.99] per 100 person-years. CD4+ cell count ≥200 cells/mm3 was associated with a reduced risk of CADE (adjusted hazard ratio AHR [95% CI]=0.40 [0.18-0.86]) after adjustment for female gender (0.25 [0.08-0.83]), older age at baseline (1.07[1.04-1.10]) and smoking>20 cigarettes/day (4.19[2.17-8.11]). Moreover, multivariate analyses revealed that individuals with moderate alcohol consumption (≤3 AU/day) had a lower risk of CADE (0.38[0.20-0.71]) than alcohol abstainers, while the risk for individuals drinking>3 AU/day was not significantly different from those in this latter group (p=0.229). The same associations remained valid after adjustment for metabolic disorders. No significant association with exposure to any specific ART was detected.
Conclusions: In the long term, CD4+ cell count ≥200 cells/mm3 and moderate alcohol consumption remain the principal factors associated with a lower risk of CADE. Combined interventions to reduce CADE risk-related behaviors and sustain ART adherence in HIV-infected individuals are now a clinical and public health priority.

C. Protopopescu1, M. Dupon2, L. Hardel3, C. Rabaud4, D. Salmon5, F. Couturier3, S. Habak6, B. Spire1, F. Raffi7, M.P. Carrieri1, ANRS CO8 APROCO-COPILOTE Study Group
1INSERM, U 912 (SESSTIM), Aix Marseille Univ, IRD, UMR-S 912, ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France, 2Fédération des Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Bordeaux, France, 3INSERM, U 897, Université Bordeaux Segalen, ISPED, Bordeaux, France, 4Service des Maladies Infectieuses et Tropicales, CHU de Nancy, Hôpitaux de Brabois, Vandeuvre les Nancy, France, 5Hôpital Cochin-Port-Royal, Paris, France, 6Université Paris Diderot, Sorbonne Paris Cité, INSERM, UMR 738, Paris, France, 7CHU Hôtel-Dieu, Nantes, France