Human immunodeficiency virus and hepatitis B virus infections in a New York City alcoholic population

Viral hepatitis in alcohol-dependent inpatients: prevalence, risk factors, and treatment uptake

OBJECTIVES

Most epidemiological literature on the prevalence of viral hepatitis in alcohol-dependent patients is based on older data. This study aimed to provide current estimates and an assessment of risk factors. We further investigated whether the initiation of antiviral hepatitis C virus (HCV) treatment is feasible after detoxification.

METHODS

We assessed serological markers for hepatitis B virus (HBV) and HCV infection and liver enzyme levels (alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase) in a sample of 463 inpatients in a tertiary care hospital, fulfilling International Classification of Diseases, Tenth Revision criteria for alcohol dependence. A subsample of 141 patients was interviewed on addiction history and risk factors for HCV acquisition. All patients with an indication for antiviral treatment were followed up.

RESULTS

Compared with that in the general population, we found an elevated anti-HCV prevalence in alcohol-dependent patients (5.2%; 95% confidence interval, 3.2%-7.2%), whereas anti-Hbc immunoglobulin G prevalence (8.3%; 95% confidence interval, 5.7%-10.8%) corresponded to normal rates. Liver enzyme levels significantly differed between patients with chronic, past/remitted, or no HCV infection. On an observational level, a history of injection drug use or nonprofessional tattooing emerged as potential risk factors. In 1 of 10 patients, antiviral therapy was initiated. This 1 patient achieved the end-of-treatment response after extended rapid virological response, despite continuous alcohol consumption.

CONCLUSIONS

The elevated HCV infection rates in our sample and the higher levels of fibrosis biomarkers in those with positive polymerase chain reaction corroborate previous findings and emphasize the importance of HCV screening in this population, particularly if further risk factors like injection drug use are given. Factors influencing treatment reluctance and conditions that may enhance the feasibility of antiviral treatment in alcohol-dependent patients should be subject of further research.

HIV-1 infection in peripheral blood lymphocytes (PBLs) exposed to alcohol

Epidemiological and in vitro studies have implied that heavy alcohol consumption may increase an individual's risk of HIV-1 infection. To examine the role of alcohol in direct infection of T-cells, viral reverse transcripts and HIV-1 receptor expression were examined in infected peripheral blood lymphocytes (PBLs) pretreated with alcohol. PCR results showed that alcohol increased HIV-1 DNA in PBLs by at least 10-fold. Alcohol enhanced the expression of the CXCR4 chemokine co-receptor but not the major HIV-1 CD4 receptor. Pretreatment with alcohol was also associated with increased intracellular cAMP. Thus, alcohol may facilitate enhanced viral infection by increasing the availability of HIV-1 co-receptor. This effect is associated with increases in intracellular cAMP.

Ethanol strongly potentiates apoptosis induced by HIV-1 proteins in primary human brain microvascular endothelial cells

Ethanol may have significant effects on human immunodeficiency virus type I (HIV-1) pathogenesis in vivo. As such, the effects of ethanol treatment were studied on the proapoptotic potential of various HIV-1 proteins in primary isolated human brain microvascular endothelial cells (MVECs), a major cellular component of the blood-brain barrier. Low-passage primary brain MVECs were treated with recombinant HIV-1 proteins Nef, Vpr, Tat and gp120 proteins from X4, R5, and X4R5 viral strains, with and without ethanol at various relevant concentrations. The apoptotic potential of each HIV-1 protein with and without ethanol was compared with cells treated with ethanol alone or GST protein as a control, under similar conditions. Specific HIV-1 proteins induced apoptosis in primary isolated human brain MVECs, which was potentiated on treatment with 0.1 and 0.3% (v/v) ethanol. Cotreatment with ethanol and specific HIV-1 proteins showed enhanced lactate dehydrogenase release, compared with MVECs treated with ethanol alone. The presence of ethanol in in vitro culture medium also enhanced HIV-1 protein-mediated tumor necrosis factor-alpha production, compared with cells treated with ethanol alone or GST protein. Thus, these studies demonstrate ethanol's potential for inducing apoptosis of human MVECs with relevant HIV-1-specific proteins and suggest a potential synergistic effect in augmenting HIV-1 neuroinvasion and neuropathogenesis in vivo.

Prevalence of human immunodeficiency virus infection in alcoholics

To verify the prevalence of infection by human immunodeficiency virus (HIV) in alcoholics we studied 131 alcoholic patients (119 males and 12 females) with a mean age of 44.3 +/- 10.8 years. Serum samples were collected from this group and analysed, by ELISA, for antibodies against HIV as well as for serological markers for hepatitis B virus (HBV) and hepatitis C virus (HCV). As we have previously described, we found a high prevalence of HBV (26.4%) and HCV (4.2%) markers as compared to the prevalence of these markers in samples of normal blood donors from Uberlândia's Hemocentro Regional, which are 4% and 0.4%, respectively. Of the 131 patients, four (3%) had antibodies against HIV, three (75%) of which were injecting drug users (IDU). In the HIV-negative group, only one patient was an IDU. The prevalence of HIV in our population, according to data from the city's Health Secretary, varies from 3.1% to 6.2%. We conclude that, at least for the moment, alcoholism per se, did not constitute an important risk factor for HIV infection. However, acquired immunodeficiency syndrome is a rather recent disease as compared to hepatitis B and C and, as the transmission routes are similar for HIV and hepatitis viruses, an increase in the incidence of HIV infection in alcoholics may be just a question of time.

Patterns of HIV risk and alcohol use among African-American crack abusers

Although the association between heavy alcohol use and HIV risk has been studied in treatment populations, we know little about patterns of alcohol use and HIV risk among out-of-treatment African-American drug users. This study examines the extent to which alcohol use affects HIV risk in a sample of 495 African-American crack users who did not inject drugs. We present differences between levels of alcohol and crack use with regard to sexual practices (including sex while impaired), number of partners, frequency of sexual activity, and condom use. The findings suggest an intimate relationship between alcohol use, crack use, and sexual risks for HIV infection. Respondents who reported frequent use (15-30 days in the last 30 days) of alcohol, crack, or both displayed significantly greater risk than those who reported less than frequent use.

HIV risk behavior among alcoholic inpatients before and after treatment

In order to evaluate the natural history of HIV risk behavior among alcoholics during pretreatment active alcoholism, posttreatment sobriety, and posttreatment postrelapse periods, self-report data were collected from alcoholic inpatients at two times. During treatment, patients reported pretreatment behaviors. At 90 day follow-up, patients reported behavior during posttreatment sobriety, and if appropriate, during posttreatment postrelapse periods. A total of 68 patients participated, with 28 (41.2%) completing follow-up questionnaires. There were no differences on pretreatment HIV risk behaviors between completers and those lost to follow-up, although there were several differences on age of onset of alcoholism. Among the 28 completers, 9 relapsed before follow-up. Data were analyzed comparing pretreatment and posttreatment sobriety behaviors on all 28 patients, and pretreatment, posttreatment sobriety, and posttreatment postrelapse behaviors on the 9 relapsers. Findings indicated that survivors (those who had not relapsed) significantly decreased HIV risk behavior during posttreatment sobriety. There was a relapse by time interaction such that relapsers reported more sex partners per day during posttreatment sobriety than did survivors. There was no significant change upon relapse, although this may have reflected the low power of this pilot study. The author concludes that HIV risk behaviors among alcoholics are associated with the context of active alcoholism. Relapsers appeared to continue in that context, with its concomitant HIV risk behavior, even during posttreatment sobriety.

Universal HIV screening at a major metropolitan TB clinic: HIV prevalence and high-risk behaviors among TB patients

OBJECTIVES

This study assessed the outcome of implementing a policy of universal screening of patients with tuberculosis (TB) for HIV infection at a major metropolitan public health TB clinic.

METHODS

HIV serologic testing was completed on 768 (93%) of 825 eligible patients. Ninety-eight HIV-positive cases (13%) were compared with 670 HIV-negative cases. The presence of adult HIV risk factors was determined by structured interview and review of medical records.

RESULTS

One or more HIV risk factors were present in 93% of HIV-positive cases and 42% of HIV-negative cases.

CONCLUSIONS

The metropolitan TB clinic is well suited for HIV screening, and HIV-antibody testing and counseling should be provided to all TB patients.

Effect of ethanol on monocytic function in human immunodeficiency virus type 1 infection

We have developed a novel system to study monocytic function after human immunodeficiency virus type 1 (HIV-1) infection by infecting a series of human macrophage hybridoma cell lines with HIV-1. Since ethanol has detrimental effects on immune function, we investigated the effect of ethanol and its metabolites acetaldehyde and acetate on monocytic function by utilizing one human macrophage hybridoma cell line, clone 43, as well as primary monocytes. Pretreatment of clone 43 and primary monocytes with ethanol and its metabolites resulted in diminished accessory cell function for mitogen-, anti-CD3-, and antigen-induced T-cell proliferation. The decreased accessory cell function was associated with reduced interleukin 1alpha (IL-1alpha), IL-1beta, and tumor necrosis factor alpha production with loss of intracellular cytokine and mRNA production and the induction of transforming growth factor beta. In ethanol-, acetaldehyde-, and acetate-treated HIV-1-infected clone 43 cells (43HIV), there was a more rapid loss (3 days after infection) of accessory cell function at a lower infecting dose of HIV-1 than that in untreated 43HIV cells. We also observed a more rapid loss of surface class II antigen expression in the ethanol-, acetaldehyde-, and acetate-treated 43HIV cells, but no change in surface expression of CD80 or CD86. Ethanol-induced impairment of monocytic function may compound the immunologic defects of AIDS, making the infected individual more susceptible to the complications of the disease.

The influence of psychosocial factors, alcohol, drug use on African-American women's high-risk sexual behavior

OBJECTIVE

The present study examines psychosocial and behavioral influences, particularly drug and alcohol use, as correlates of inconsistent condom use and having multiple sexual partners during the past months among African-American women.

METHODS

The cross-sectional study, conducted between May and June 1996, recruited a convenience sample of 180 African-American women in Birmingham, Alabama. Women completed a face-to-face interview that assessed alcohol and drug use, sexual behaviors, depression, condom use, and negotiation skills.

RESULTS

The majority of women, 51.6% (n = 93), had used either alcohol or drugs during the previous month. Many women, 31.1%, consumed alcohol, 18.3% used marijuana, and 8.3% had smoked crack within the past month. Nearly 42.7% of women used condoms inconsistently in the past month and 13.3% of women had multiple sexual partners within the past month. A logistic regression model predicting inconsistent condom use indicated that women were less likely to use condoms if they consumed alcohol between 20 and 30 days of the month (OR = 2.8, 90% CI = 1.3-5.9) and if they had not negotiated condom use (OR = 32.4, 90% CI = 7.9-131.6). The logistic regression model predicting multiple sexual partners indicated that women were more likely to have multiple sexual partners if they had smoked crack in the past month (OR = 5.3, 90% CI = 1.6-18.2).

CONCLUSION

HIV sexual risk-reduction interventions for African-American women need to address the overlapping epidemics of drugs, alcohol, and STDs. Additionally, HIV sexual risk reduction efforts should be incorporated into existing drug and alcohol treatment programs and STD clinics.

Alcoholic liver disease

Alcohol has been implicated in the genesis of liver disease for centuries. Significant progress has been made in our understanding of the pathogenesis of ALD. It is now apparent that both the consumption and the metabolism of alcohol promote the production of inflammatory mediators (cytokines) that result in hepatotoxicity and fibrogenesis. With time, this leads to progressively severe liver injury and, eventually, causes cirrhosis. Unfortunately, effective therapies for most individuals with ALD have not been found. High per capita consumption of alcohol, coupled with the dearth of effective treatments and the failure of most affected individuals to abstain from alcohol, explains why ALD is one of the most prevalent forms of disabling, chronic liver disease in the United States.

The trading of sex for money or drugs, sexually transmitted diseases (STDs), and HIV-related risk behaviors among multisubstance using alcoholic inpatients

Data from 802 multisubstance using alcoholic inpatients (481 men and 321 women) were analyzed to determine whether trading sex for money or drugs was associated with self-reported STDs, self-reported HIV infection, and perceptions of current and future probable infection. Logistic and ordinal polychotomous regression models were used to evaluate the statistical significance of sex trade on STDs and HIV-related behaviors while controlling for other potential confounding variables such as cocaine abuse and i.v. drug use. Involvement in sex trade was associated with higher cocaine abuse, with STDs, and with self-reported HIV infection. The multivariate (adjusted) models supported the significance of sex trade with regard to STDs and HIV-related behaviors. The findings indicated that, among these multisubstance using alcoholic inpatients, high levels of trading sex for money or drugs were independently associated with self-reported STDs, a cofactor of HIV infection, as well as self-reported HIV infection and perceptions of risk for infection.

Efficacy of a high and accelerated dose of hepatitis B vaccine in alcoholic patients: a randomized clinical trial

PURPOSE

A randomized, double-blind trial was conducted to compare the efficacy of a high-dose versus standard-dose hepatitis B vaccine in alcoholic patients.

PATIENTS AND METHODS

One hundred ten alcoholic patients were randomized to either receive the standard dose (20 micrograms at 0.1, and 6 months) or a high dose (40 micrograms at 0, 1, 2, and 6 months) of recombinant hepatitis B vaccine (Engerix-B). Patients were monitored for relapse of drinking using self-report, serial serum carbohydrate deficient transferrin, and collateral verification. The final titer of antibody to hepatitis B surface antigen (anti-HBs) was obtained 12 months after the first vaccine dose; a seroconversion was defined as a titer greater than 10 mlU/ml.

RESULTS

One hundred subjects completed the study; 10 of these had clinical or pathological evidence of cirrhosis. Thirty-six out of 48 (75%) of patients administered the high-dose regimen seroconverted compared with 24 of 52 (46%) in the standard dose group (P < 0.005). The mean anti-HBs titer of the high dose group was significantly greater than of the standard dose group (76.4 versus 39.4 mlU/ml, P < 0.01). Logistic regression demonstrated a significant effect on seroconversion for the vaccine dose (P < 0.005) and serum albumin (P = 0.05) but not for the other variables such as race, age, drinking during the study, serum creatinine, arm muscle circumference, and cirrhosis.

CONCLUSIONS

A high- and accelerated-dose regimen of hepatitis B improves the serological response in alcoholic patients. This regimen (currently recommended for hemodialysis patients) should now also be considered for patients with a history of alcoholism.

College students' high-risk sexual behavior following alcohol consumption

This study is a follow-up to a previous study assessing the relationship of alcohol consumption as a disinhibitor to high-risk sexual behavior. Results are based on survey data from 1,902 students attending 12 colleges. Sexual behaviors occurring after people had "let themselves drink more than normal in order to make it easier for them to have sex with someone" were assessed. At least once in the past year, 33.2% of the men and 17.4% of the women had met this criterion. In those instances, 76.3% of the men and 77.1% of the women initiated condom use for vaginal intercourse. Results are discussed in relation to partners' compliance following condom initiation and preventing the spread of HIV disease.