Latent TB infection associated with very high alcohol use among people with HIV
Compared with medium-level alcohol use, very high use correlated with latent tuberculosis infection among adults with HIV in Uganda, according to a cross-sectional study in Clinical Infectious Diseases.
“Alcohol use is quite common among adults living with HIV in sub-Saharan Africa. Frequently, this results in people living with HIV (PLHIV) who use alcohol being ineligible for isoniazid preventive therapy (IPT) for tuberculosis (TB),” Sarah B. Puryear, MD, MPH, a clinical fellow of medicine at the University of California San Francisco, told Healio. “While we know that alcohol use increases the risk for TB disease, we wanted to understand if alcohol use increases the risk for tuberculosis infection among PLHIV, potentially contributing to a larger population of individuals in need of, but ineligible for, IPT therapy.”
Puryear and colleagues performed a cross-sectional study to assess the relationship between levels of alcohol use and latent tuberculosis (LTBI) among PLHIV who engaged in hazardous alcohol use in Southwestern Uganda between April 2018 and July 2019. Participants included adults who underwent tuberculin skin test (TST) placement during screening for the Drinkers’ Intervention to Prevent Tuberculosis (DIPT) study, an ongoing, randomized controlled trial of economic incentives to decrease drinking and improve IPT completion among persons with HIV/TB coinfection who partake in hazardous levels of alcohol consumption.
Half of the adult PLHIV (866 of 1,733; 50%) screened with AUDIT-C and urine dipstick ethyl glucuronide (EtG) had hazardous alcohol use and were EtG positive, although 119 (14%) of these participants were excluded from the study for elevated transaminases (113; 13%) and pregnancy (6; 1%).
Among the remaining 747 participants eligible for TST placement, most (729; 98%) consented to it. The final analysis included 617 patients (85%) who completed TST screening. Nearly three-quarters of these patients (73%) were men; the median age was 40 years. TB symptom screening was negative in 99.5% (614/617) of participants and TB disease was ruled out in the 3 patients with symptoms.
According to Puryear, the study showed that PLHIV who engage in a very high level of alcohol use defined as an AUDIT-C score of 8 or more are more likely to have TB infection than those who engage in medium-level alcohol use.
The median AUDIT-C score was 6 and drinking levels were medium in 41% of study participants, high in 31% and very high in 28%. Participants most frequently reported drinking two to three times per week (42%), drinking five to six drinks per session (40%) and binge drinking categorized as six drinks or more on one occasion at least monthly (39%).
Overall, the study demonstrated that the incidence of LTBI, as measured by TST positivity, was 35%, with heterogeneity by clinic site. LTBI prevalence was highest among individuals with very high-level alcohol use (45%) relative to high-level and medium-level use (33% and 31%, respectively). A multivariate model that adjusted for age, sex and clinic site also demonstrated that very high-level alcohol use corrected with TST positivity compared with medium-level use (adjusted OR, 1.61; 95% CI, 1.03-2.50).
“PLHIV who engage in higher levels of alcohol use are more likely to have TB disease. This study demonstrates that higher rates of TB infection may contribute to the higher rates of TB disease,” Puryear said. “This highlights an opportunity for TB prevention and the importance of TB preventive therapy, such as IPT, for PLHIV, with higher levels of alcohol use.”