Kenna, George A.

Leggio, Lorenzo

Promrat, Kittichai

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Lorenzo eLeggio

Kittichai ePromrat

George eKenna

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Frontiers in Psychiatry

A Call to Action: Alcohol Interventions in HIV-infected patients.

Lorenzo Leggio

Kittichai Promrat

George A. Kenna

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A Call to Action: Alcohol Interventions in HIV-Infected Patients

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www.frontiersin.org April 2012 | Volume 3 | Article 35 | 1
General Commentary
published: 17 April 2012
doi: 10.3389/fpsyt.2012.00035PSYCHIATRY
A commentary on
Case records of the Massachusetts General 
Hospital. Case 6-2012. A 45-year-old man 
with a history of alcohol abuse and rapid 
cognitive decline
by Cho, T. A., Larvie, M., Tian, D., and 
 Mino-Kenudson, M. (2012). N. Engl. J. Med. 
366, 745–755.
In a recent issue of the New England 
Journal of Medicine, Cho et al. (2012) 
provided an interesting and very com-
prehensive description of an alcohol-
dependent patient affected by alcoholic 
liver disease with fibrosis, brain abscess due 
to toxoplasma, and advanced HIV infec-
tion. This case report is a good reminder 
of three important clinical issues, i.e. (a) 
HIV-infected alcoholic patients drink 
more than the general population, alco-
hol is their most commonly abused drug 
and contributes to HIV-related morbidity, 
mortality, and transmission (Fenton et al., 
2010); (b) HIV-infected alcoholic patients 
often have hepatic impairment because of 
alcohol’s effects on liver, HCV coinfection, 
and antiretroviral therapy (ART)-related 
hepatotoxicity risk (Szabo and Zakhari, 
2011); indeed, alcohol alone, like in this 
patient (Cho et al., 2012), can be harm-
ful enough to develop clinically significant 
ALD – notably, in this patient ALD delayed 
ART initiation (Cho et al., 2012), which 
may have contributed to further clinical 
deterioration; (c) Alcohol interventions 
are dramatically needed for HIV-infected 
patients. This patient had declined treat-
ment, e.g., disulfiram (Cho et al., 2012), 
a drug that itself might cause liver failure 
(Edwards et al., 2011). Though prelimi-
nary research is searching for safer and 
more effective pharmacotherapies (e.g., 
Addolorato et al., 2007; Johnson et al., 
2008; Leggio et al., 2011, 2012), this case 
(Cho et al., 2012) highlights the need to 
identify novel pharmacotherapies for alco-
holic patients with ALD in order to provide 
effective interventions that both promote 
abstinence and help prevent progression to 
hepatic failure and death.
REFERENCES
Addolorato, G., Leggio, L., Ferrulli, A., Cardone, S., 
Vonghia, L., Mirijello, A., Abenavoli, L., D’Angelo, 
C., Caputo, F., Zambon, A., Haber, P. S., and 
Gasbarrini, G. (2007). Effectiveness and safety of 
baclofen for maintenance of alcohol abstinence 
in alcohol-dependent patients with liver cirrhosis: 
randomised, double-blind controlled study. Lancet 
370, 1915–1922.
Cho, T. A., Larvie, M., Tian, D., and Mino-Kenudson, M. 
(2012). Case records of the Massachusetts General 
Hospital. Case 6-2012. A 45-year-old man with a his-
tory of alcohol abuse and rapid cognitive decline. N. 
Engl. J. Med. 366, 745–755.
Edwards, S., Kenna, G. A., Swift, R. M., and Leggio, L. 
(2011). Current and promising pharmacotherapies, 
and novel research target areas in the treatment of 
alcohol dependence: a review. Curr. Pharm. Des. 17, 
1323–1332.
Fenton, M., Leggio, L., Kenna, G. A., and Swift, R. M. 
(2010). HIV testing in hazardous drinking: a survey 
analysis. Subst. Use Misuse 45, 204–212.
Johnson, B. A., Rosenthal, N., Capece, J. A., Wiegand, 
F., Mao, L., Beyers, K., McKay, A., Ait-Daoud, 
N., Addolorato, G., Anton, R. F., Ciraulo, D. A., 
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Leggio, L., Ferrulli, A., Zambon, A., Caputo, F., Kenna, G. 
A., Swift, R. M., and Addolorato, G. (2012). Baclofen 
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Leggio, L., Kenna, G. A., Ferrulli, A., Zywiak, W. H., 
Caputo, F., Swift, R. M., and Addolorato, G. (2011). 
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Received: 28 March 2012; accepted: 28 March 2012; pub-
lished online: 17 April 2012.
Citation: Leggio L, Promrat K and Kenna GA (2012) A call 
to action: alcohol interventions in HIV-infected patients. 
Front. Psychiatry 3:35. doi: 10.3389/fpsyt.2012.00035
This article was submitted to Frontiers in Addictive 
Disorders, a specialty of Frontiers in Psychiatry.
Copyright © 2012 Leggio, Promrat and Kenna. This is 
an open-access article distributed under the terms of the 
Creative Commons Attribution Non Commercial License, 
which permits non-commercial use, distribution, and repro-
duction in other forums, provided the original authors and 
source are credited.
A call to action: alcohol interventions in HIV-infected patients
Lorenzo Leggio1*, Kittichai Promrat 2 and George A. Kenna1
1 Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
2 Division of Gastroenterology, Brown University, Providence, RI, USA
*Correspondence: lorenzo_leggio@brown.edu


A call to action: alcohol interventions in HIV-infected patients.

accepted: 28

Baclofen promotes alcohol abstinence in alcohol dependent cirrhotic patients with hepatitis C virus (HCV) infection.

Case records of the Massachusetts General Hospital. Case 6-2012. A 45-year-old man with a history of alcohol abuse and rapid cognitive decline.

Current and promising pharmacotherapies, and novel research target areas in the treatment of alcohol dependence: a review.

Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study.

HIV testing in hazardous drinking: a survey analysis.

Mechanisms of alcoholmediated hepatotoxicity in human-immunodeficiency-virus-infected patients.

Preliminary findings on the use of metadoxine for the treatment of alcohol dependence and alcoholic liver disease.

Psychiatry 3:35. doi: 10.3389/fpsyt.2012.00035 This article was submitted to Frontiers in Addictive Disorders, a specialty of Frontiers

Topiramate for Alcoholism Advisory Board, and Topiramate for Alcoholism Study Group.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3328083

A Call to Action: Alcohol Interventions in HIV-Infected Patients

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