Department of Psychology, University of Washington, Seattle, WA 98195, USA.
J Acquir Immune Defic Syndr. 2009 Oct 1;52(2):180-202. doi: 10.1097/QAI.0b013e3181b18b6e.
Alcohol use is frequently implicated as a factor in nonadherence to highly active antiretroviral therapy (HAART). There have not been efforts to systematically evaluate findings across studies. This meta-analysis provides a quantitative evaluation of the alcohol-adherence association by aggregating findings across studies and examining potential moderators.
Literature searches identified 40 qualifying studies totaling over 25,000 participants. Studies were coded on several methodological variables.
In the combined analysis, alcohol drinkers were approximately 50%-60% as likely to be classified as adherent [odds ratio (OR) = 0.548, 95% confidence interval (CI): 0.490 to 0.612] compared with abstainers (or those who drank relatively less). Effect sizes for problem drinking, defined as meeting the National Institute on Alcohol Abuse and Alcoholism criteria for at-risk drinking or criteria for an alcohol use disorder, were greater (OR = 0.474, 95% CI = 0.408 to 0.550) than those reflecting any or global drinking (OR = 0.604, 95% CI = 0.531 to 0.687). Several variables moderated the alcohol-adherence association.
Results support a significant and reliable association of alcohol use and medication nonadherence. Methodological variables seem to moderate this association and could contribute to inconsistent findings across studies. Future research would benefit from efforts to characterize theoretical mechanisms and mediators and moderators of the alcohol-adherence association.
酒精使用经常被认为是导致不遵守高效抗逆转录病毒治疗（HAART）的一个因素。目前还没有努力系统地评估研究结果。本荟萃分析通过汇总研究结果并检查潜在的调节因素，对酒精与药物依从性之间的关联进行了定量评估。
文献检索确定了 40 项符合条件的研究，共有超过 25000 名参与者。研究被编码了几个方法学变量。
在合并分析中，与不饮酒者（或饮酒较少者）相比，饮酒者被归类为依从性的可能性约低 50%-60%[比值比（OR）=0.548，95%置信区间（CI）：0.490 至 0.612]。定义为符合国家酒精滥用和酒精中毒研究所（National Institute on Alcohol Abuse and Alcoholism）危险饮酒或酒精使用障碍标准的问题饮酒的效应量更大（OR=0.474，95%CI=0.408 至 0.550），而反映任何或总体饮酒的效应量则较小（OR=0.604，95%CI=0.531 至 0.687）。几个变量调节了酒精与药物依从性之间的关联。
结果支持酒精使用与药物不依从之间存在显著而可靠的关联。方法学变量似乎调节了这种关联，并可能导致研究结果不一致。未来的研究将受益于努力描述酒精与药物依从性之间的理论机制和中介和调节因素。
