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Association of Alcohol Consumption and HIV Surrogate Markers in Participants of the Swiss HIV Cohort Study

Conen, Anna MD*; Wang, Qing PhD; Glass, Tracy R. PhD; Fux, Christoph A. MD*; Thurnheer, Maria C. MD; Orasch, Christina MD§; Calmy, Alexandra MD, PhD; Bernasconi, Enos MD; Vernazza, Pietro MD#; Weber, Rainer MD**; Bucher, Heiner C. MD, MPH†,††; Battegay, Manuel MD††; Fehr, Jan MD**

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15th, 2013 - Volume 64 - Issue 5 - p 472–478
doi: 10.1097/QAI.0b013e3182a61ea9
Clinical Science

Background: Alcohol consumption may affect the course of HIV infection and/or antiretroviral therapy (ART). The authors investigated the association between self-reported alcohol consumption and HIV surrogate markers in both treated and untreated individuals.

Design: Prospective cohort study.

Methods: Over a 7-year period, the authors analyzed 2 groups of individuals in the Swiss HIV Cohort Study: (1) ART-naïve individuals remaining off ART and (2) individuals initiating first ART. For individuals initiating first ART, time-dependent Cox proportional hazards models were used to assess the association between alcohol consumption, virological failure, and ART interruption. For both groups, trajectories of log-transformed CD4 cell counts were analyzed using linear mixed models with repeated measures.

Results: The authors included 2982 individuals initiating first ART and 2085 ART naives. In individuals initiating first ART, 241 (8%) experienced virological failure. Alcohol consumption was not associated with virological failure. ART interruption was noted in 449 (15%) individuals and was more prevalent in severe compared with none/light health risk drinkers [hazard ratio: 2.24, 95% confidence interval: 1.42 to 3.52]. The association remained significant even after adjusting for nonadherence. The authors did not find an association between alcohol consumption and change in CD4 cell count over time in either group.

Conclusions: No effect of alcohol consumption on either virological failure or CD4 cell count in both groups of ART-initiating and ART-naive individuals was found. However, severe drinkers were more likely to interrupt ART. Efforts on ART continuation should be especially implemented in individuals reporting high alcohol consumption.

*Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Aarau, Aarau, Switzerland;

Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland;

Clinic for Infectious Diseases, University Hospital Berne, University of Berne, Berne, Switzerland;

§Division of Infectious Diseases and Hospital Epidemiology, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland;

Division of Infectious Diseases and Hospital Epidemiology, University Hospital Geneva, University of Geneva, Geneva, Switzerland;

Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland;

#Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland;

**Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland; and

††Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.

Correspondence to: Jan Fehr, MD, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, Rämistrasse 100, CH-8091 Zürich (e-mail: jan.fehr@usz.ch).

Supported by grants from the Swiss National Science Foundation Grant number 33CS30_134277, SHCS project 668. Q.W., T.G., and H.C.B. are supported by grants from Santésuisse and the Gottfried and Julia Bangerter-Rhyner-Foundation.

A.C. received unrestricted travel grants from Merck Sharp & Dome, Gilead, Bristol-Myers Squibb, and VIIV. M.C.T. received unrestricted research grants from Bristol-Myers Squibb and Roche. C.O. received unrestricted travel grants from Merck Sharp & Dome, Gilead, Janssen, Bristol-Myers Squibb, Roche, VIIV, Abbott, and Boehringer Ingelheim. A.C. is a member of advisory board of Merck Sharp & Dome and Janssen-Cilag. She received travel grants from Gilead and Janssen-Cilag. P.V. participated as speaker in symposia and/or advisor for Gilead Sciences, Merck Sharp & Dome, Janssen, Bristol-Myers Squibb, VIIV-Healthcare, and GlaxoSmithKline, and his institution as well as he himself received travel grants from all mentioned pharmaceutical companies plus Roche and Pfizer. R.W. received travel grants from Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Merck Sharp & Dome, Pfizer, Roche, TRB Chemedica, and Tibotec. H.C.B. is the owner of a vineyard and a non-commercial producer of wine and grappa. M.B. received unrestricted research and educational grants from Gilead, Merck, Janssen, Bristol-Myers Squibb, VIIV, Abbott, and Boehringer Ingelheim. J.F. is a member of the advisory board of Merck Sharp & Dome and Janssen and received unrestricted and travel grants from Gilead, Merck Sharp & Dome, Janssen, Bristol-Myers Squibb, Roche, VIIV, Abbott, and Boehringer Ingelheim. The other authors have no conflicts of interest to disclose.

A.C. and J.F. were the main authors involved in conception and performing the study, in data interpretation and manuscript writing. Q.W., T.G., and H.C.B. were involved in the conception of the study and were responsible for the analysis of data. M.B. was involved in planning the study, data interpretation and reviewing the article. All authors were involved in data interpretation and revised the article critically. All centers collected data for the Swiss HIV Cohort Study.

Received May 10, 2013

Accepted July 22, 2013

© 2013 by Lippincott Williams & Wilkins