Background:  In the general population, the association between alcohol consumption and cardiovascular disease (CVD) is J-shaped with moderate drinkers at the lowest risk, infrequent drinkers at intermediate risk, and hazardous drinkers at the highest risk. The reduced risk associated with moderate alcohol consumption is mediated in part by improved lipid profiles and increased insulin sensitivity. ART is associated with dyslipidemia and increased insulin resistance. Whether the association between alcohol consumption and CVD is J-shaped among HIV⁺ people is unknown.

Methods:  We performed cross-sectional analyses using survey and laboratory data from 2028 HIV⁺ and 1927 HIV^– male subjects from the Veterans Aging Cohort Study, a prospective observational cohort of U.S. veterans with and without HIV. We used logistic regression to calculate the odds ratio (OR) for the prevalence of CVD (defined as a self-reported history of angina, coronary heart disease/myocardial infarction, congestive heart failure, or stroke/transient ischemic attack) among those who currently drink alcohol infrequently (<1 drink/week), moderately (1 to 14 drinks/week and <6 drinks/occasion), or hazardously (>14 drinks/week or >6 drinks/occasion).

Results:  The prevalence of infrequent, moderate, and hazardous drinking was 23.9%, 25.1%, and 51.1%, respectively, for HIV⁺ subjects and 23.6%, 22.9%, and 53.4%, respectively, for HIV^– subjects. The prevalence of CVD among infrequent, moderate, and hazardous drinkers was 11.6%, 10.0%, and 13.6%, respectively, for HIV⁺ subjects and 18.3%, 17.0%, and 17.0%, respectively, for HIV^– subjects. After adjusting for age, race, height, weight, lipids, diabetes, hypertension, smoking, CD4 count, ART, liver and kidney disease, hepatitis C, and exercise, the OR for CVD among HIV⁺ subjects was 1.09 (0.69 to 1.72) for moderate and 1.63 (1.10 to 2.41) for hazardous drinkers as compared with infrequent drinkers. Among HIV^– subjects, the adjusted OR (excluding CD4 count and ART) for CVD was 0.74 (0.51 to 1.09) for moderate and 0.92 (0.67 to 1.27) for hazardous drinkers as compared with infrequent drinkers.

Conclusions:  For HIV⁺ veterans the J-shaped relationship between alcohol and CVD was not observed after adjusting for confounders. Among HIV^– veterans, a J- shaped relationship was observed although not statistically significant. Assumptions about alcohol’s impact on CVD risk among HIV⁺ men based on general population findings should be avoided.