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To theEditor—Lim et al [1] report a strong dose–response relationship between 3 categories of alcohol use (nonhazardous, hazardous as defined by the Alcohol Use Disorders Identification Test–Consumption [AUDIT-C] questionnaire [2], and alcohol-related diagnosis) and advanced hepatic fibrosis (AHF), defined as FIB-4 index >3.25 [3], in 701 human immunodeficiency virus (HIV)/hepatitis C virus (HCV)–coinfected patients from the Veterans Aging Cohort Study. They underline the need for confirmatory studies using other noninvasive markers of fibrosis (such as transient elastography), adjustment for lifetime history of alcohol consumption, duration of HIV or HCV infection, potential hepatotoxic medications, and sex-stratified analyses. To act on their suggestions, we used enrollment data from the French ANRS CO13 HEPAVIH cohort of HIV/HCV-coinfected patients [4] to model (using logistic regression) the relationship between alcohol consumption/problems and AHF, defined as having a FibroScan value >9.5 kPa [5], after adjustment (in case of significant association) for age, diabetes, body mass index, time since HIV and HCV diagnosis, chronic HCV infection, CD4 count, HIV RNA level, treatment with hepatotoxic antiretroviral medications (ARVs) (including didanosine, stavudine, nevirapine, ritonavir, and tipranavir), and history of alcohol-related problems (physician's report). A sex-stratified analysis was also conducted. In a first analysis (A), patients were classified into the following 3 mutually exclusive categories: (1) current alcohol-related problems; (2) hazardous or binge drinking without alcohol-related problems, defined as an AUDIT-C score ≥4 (for men) or ≥3 (for women), or reporting ≥6 drinks on any 1 occasion during the previous 6 months, respectively; and (3) nonhazardous drinking [2]. In a second analysis (B), patients were dichotomized into “hazardous or binge drinkers” vs “nonhazardous drinkers” based on AUDIT-C only [6].

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