With the advent of effective antiretroviral therapy, people infected with HIV have a longer life expectancy and, consequently, are likely to develop other chronic conditions also found in noninfected people, including cardiovascular disease (CVD). Alcohol consumption, which is common among HIV-infected people, may influence the risk of CVD. In noninfected adults, moderate alcohol consumption can reduce the risk of coronary heart disease (CHD), heart attacks, and the most common type of stroke, whereas heavy drinking increases the risk of these cardiovascular events. These relationships can be partially explained by alcohol's effects on various risk factors for CVD, including cholesterol and other lipid levels, diabetes, or blood pressure. In HIV-infected people, both the infection itself and its treatment using combination antiretroviral therapy may contribute to an increased risk of CVD by altering blood lipid levels, inducing inflammation, and impacting blood-clotting processes, all of which can enhance CVD risk. Coinfection with the hepatitis C virus also may exacerbate CVD risk. Excessive alcohol use can further enhance CVD risk in HIV-infected people through either of the mechanisms described above. In addition, excessive alcohol use (as well as HIV infection) promote microbial translocation-the leaking of bacteria or bacterial products from the intestine into the blood stream, where they can induce inflammatory and immune reactions that damage the cardiovascular system. KEY WORDS: Alcohol consumption; alcohol use disorder; heavy drinking; alcohol and other drug effects and consequences; human immunodeficiency virus; antiretroviral therapy; combination antiretroviral therapy; cardiovascular disease; coronary heart disease; stroke
Currently, more than 60 different medical conditions and 4 percent of the global health burden of disease are caused at least in part by, or are attributable to, alcohol consumption (Room et al. 2005). In the United States, 62.5 percent of adults consume alcohol and 17.6 million have an alcohol use disorder (AUD) (Centers for Disease Control and Prevention 2003; Grant et al. 2004). Because of this widespread and, in many cases, excessive alcohol use, alcohol consumption is associated with the two leading causes of death in the United States-cardiovascular disease (CVD)1 and cancer (Mokdad et al. 2005).
Alcohol consumption and AUDs also are common among adults infected with the human immunodeficiency virus (HIV) (Conigliaro et al. 2003; Cook et al. 2001). With the advent of antiretroviral therapy and, as a result, an increasing life expectancy in this population (Palella et al. 1998), chronic diseases such as coronary heart disease (CHD) have become a prevalent and important health issue facing adults with HIV(FriisMoller et al. 2003b; Holmberg et al. 2002, 2004; Klein et al. 2002). For example, among HIVinfected participants in the Veterans Aging Cohort Study (VACS), hazardous drinking and AUDs were independently associated with an increased prevalence of CVD, even after adjusting for traditional CVD risk factors, such as cholesterol levels or coexisting diabetes (Freiberg et al. 2010). Furthermore, among HIVinfected people with an AUD, those who were coinfected with the hepatitis C virus (HCV) had an even higher prevalence of CVD (Freiberg et al. 2007). However, the mechanism(s) by which alcohol use and HCV infection may influence cardiovascular risk and other chronic diseases among HIVinfected people remain unknown.
This article explores the relationships between alcohol use, HIV infection, and CVD. After reviewing the association between alcohol use and CVD among HIVuninfected adults and the relationship between HIV infection and CVD, the article examines the role of alcohol consumption in CVD among HIVinfected adults. It concludes with a discussion of possible mechanisms underlying alcohol's association with CVD among HIVinfected adults.
ALCOHOL USE AND CVD …