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