Alcohol use disorder and its impact on chronic hepatitis C virus and human immunodeficiency virus infections

Table 1 Diagnostic criteria for alcohol use disorder and other definitions of unhealthy alcohol use

AUD (DSM-5)

In the past year[2], have you1

Had times when you ended up drinking more, or longer than you intended?

More than once wanted to cut down or stop drinking, or tried to, but couldn’t?

Spent a lot of time drinking? Or being sick or getting over the aftereffects?

Experienced craving - a strong need, or urge, to drink?

Found that drinking or being sick from drinking often interfered with taking care of your home or family? Or caused job troubles? Or school problems?

Continued to drink even though it was causing trouble with your family or friends?

Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?

More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?

Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?

Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?

Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

Risky alcohol use[178]

Drinking more than the recommended amount by the National Institute on Alcohol Abuse and Alcoholism

> 14 drinks per week of > 4 drinks on any day for men

> 7 drinks per week or > 3 drinks on any day for women or men > 65 yr

Problem drinking

Use of alcohol accompanied by alcohol-related consequences but not meeting criteria for AUD

¹Meeting any two of the 11 criteria during the same 12-mo period is consistent with AUD. The severity of an AUD-mild, moderate, or severe-is based on the number of criteria met. AUD: Alcohol use disorder; DSM-5: Diagnostic and statistical manual of mental disorders.

Table 2 Treatment interventions for unhealthy alcohol use and alcohol use disorder

Condition	Intervention
Unhealthy alcohol use	Brief intervention
	Motivational interviewing
AUD	Hospital detoxification
	Individual and group therapy
	Approved pharmacological treatments:
	Disulfiram
	Acamprosate
	Naltrexone
	Nalmefene
	Investigational treatments:
	Baclofene
	Topiramate
	Gabapentin

AUD: Alcohol use disorder.

Table 3 Non-invasive methods for analyzing liver fibrosis in patients with alcohol use disorder, hepatitis C virus infection and hepatitis C virus - human immunodeficiency virus co-infection

Ref.	Setting	Non-invasive method	Method for detecting alcohol consumption	Finding
Lieber et al[69]	VA studies (2) of alcoholic liver disease	APRI1	Average alcohol intake	Low sensitivity and specificity of APRI in comparison to liver biopsy, especially in subjects with HCV
Chaudhry et al[169]	HIV Hopkins clinical cohort	APRI	Past 6-mo hazardous drinking	No effect of alcohol on APRI values in HCV/HIV co-infection
Blackard et al[170]	WIHS cohort	FIB-42	Recent drinking	No association between alcohol intake and FIB-4 values in HCV/HIV co-infection
Muga et al[171]	AUD patients admitted for detoxification	FIB-4	Past 6-mo unhealthy drinking	No association between FIB-4 and alcohol use in HCV/HIV co-infection
Fuster et al[173]	HIV-live cohort	FIB-4 and APRI	LDH	No association between LDH and liver fibrosis measured with FIB-4 or APRI
Lim et al[174]	VACS cohort	FIB-4	AUDIT-C3	Advanced liver fibrosis correlated with alcohol use

¹APRI: AST to platelet ratio index= {[AST/AST upper limit of normal (IU/L)]/platelet count (10⁹/L)} × 100[64];

²FIB-4 = age × AST (IU/L)/platelet count (10⁹/L) × ALT (IU/L)^1/2[63];

³AUDIT-C: Alcohol Use Disorders Identification Test[179]. HIV: Human immunodeficiency virus; AUD: Alcohol use disorder; APRI: Aminotransferase/platelet ratio index; HCV: Hepatitis C virus; LDH: Lifetime drinking history; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; VA: United States Department of Veteran Affairs; WIHS: Women’s Interagency HIV study; VACS: Veterans Aging Cohort study.