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Alcohol consumption and cardiovascular disease (CVD) in HIV-infected patients receiving antiretroviral treatment (ART): results from the ANRS CO8 APROCO-COPILOTE cohort
Abstract Content:
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.
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.