By Seema Gupta, MD, MSPH

Clinical Assistant Professor, Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV

Dr. Gupta reports no financial relationships relevant to this field of study.

SYNOPSIS: In a prospective cohort of patients coinfected with HIV and hepatitis C virus, drinking three or more cups of coffee per day halved the all-cause mortality risk.

SOURCE: Carrieri MP, Protopopescu C, Marcellin F, et al. Protective effect of coffee consumption on all-cause mortality of French HIV-HCV co-infected patients. J Hepatol 2017 Sep 12. pii: S0168-8278(17)32211-0. doi: 10.1016/j.jhep.2017.08.005. [Epub ahead of print].

Next to water, coffee is the leading beverage consumed worldwide. Research has revealed an inverse correlation of coffee consumption with the risks of type 2 diabetes mellitus, several cancers, Parkinsonism, and Alzheimer’s disease.1 The health-promoting properties of coffee often are attributed to its rich phytochemistry, including caffeine and polyphenols such as chlorogenic acid, caffeic acid, and hydroxyhydroquinone. Polyphenols are a rich source of dietary antioxidants that are abundant in coffee as well as red wine, fruits, tea, vegetables, chocolate, and legumes. There also is strong evidence that light-to-moderate coffee consumption is associated with a 14% risk reduction in all-cause mortality.2 Additionally, the polyphenols and caffeine in coffee have several hepatoprotective properties and may be associated with improved hepatic function, resulting in less fibrosis, cirrhosis, and liver cancer.3

This is important in patients with hepatitis C virus (HCV) who also are coinfected with human immunodeficiency virus (HIV) since they are particularly vulnerable to developing liver disease. Not only does the HIV infection modify the natural course of chronic HCV infection, but the immune activation and chronic inflammation with potential exposure to antiretroviral therapy accelerates the progression to fibrosis, cirrhosis, and end-stage liver disease. However, with modern treatment options, it is now possible to achieve near universal HCV clearance and a potential regression of histologic lesions in coinfected patients. While this strategy reduces the progression to end-stage liver disease, similar to HIV, these individuals remain at higher risk of death from other conditions, such as cardiovascular events, cancers, and diabetes-related complications. Previous research demonstrated that in patients coinfected with HIV/HCV, those with elevated coffee consumption exhibited a reduced risk of insulin resistance and lower levels of liver enzymes.4

In the ongoing French prospective cohort study of patients coinfected with HIV/HCV, Carrieri et al gathered data from a five-year follow-up of 1,028 such patients. At enrollment, one in four patients reported drinking at least three cups of coffee daily. Over the course of the study period, 77 deaths occurred, almost half of which were attributable to HCV-related diseases. Upon further analysis, researchers discovered that consuming at least three cups of coffee each day was linked to a 50% reduction in all-cause mortality risk (hazard ratio [HR], 0.5; 95% confidence interval [CI], 0.3-0.9; P = 0.032), even after considering other factors such as HCV clearance, having a steady partner, and not smoking. After multivariable adjustment, an 80% and 60% reduction in mortality risk was observed, respectively, in individuals who cleared HCV post-treatment (HR, 0.2; 95% CI, 0.1-0.7; P = 0.011) and individuals treated but not cured (HR, 0.4; 95% CI, 0.2-0.9; P = 0.036) compared to those not yet treated and those on treatment.

COMMENTARY

Research often highlights the importance of addressing behaviors as an essential part of managing patients. Carrieri et al found that drinking at least three cups of coffee and not smoking daily may halve the risk of mortality in patients infected by both HIV and HCV. While direct-acting antiviral agents can eradicate HCV and provide a cure for nearly all patients, those coinfected with HIV carry a higher risk of death compared to the general population because of an accelerated aging process. Complementing such clinical treatment with behavioral changes, such as exercise and avoidance of alcohol and tobacco, accompanied by consuming three cups of coffee a day may go a long way toward improving the health and survival in these patients. In case some patients cannot tolerate a high intake of caffeine, don’t forget the decaffeinated coffee option.

REFERENCES

  1. Butt MS, Sultan MT. Coffee and its consumption: Benefits and risks. Crit Rev Food Sci Nutr 2011;51:363-373.
  2. Loftfield E, Freedman ND, Graubard BI, et al. Association of coffee consumption with overall and cause-specific mortality in a large US prospective cohort study. Am J Epidemiol 2015;182:1010-1022.
  3. Wadhawan M, Anand AC. Coffee and liver disease. J Clin Exp Hepatol 2016;6:40-46.
  4. Carrieri MP, Sogni P, Cohen J, et al. Elevated coffee consumption and reduced risk of insulin resistance in HIV-HCV coinfected patients (HEPAVIH ANRS CO-13). Hepatology 2012;56:2010.