HIV 感染女性的饮酒行为：对开始抗逆转录病毒治疗和生存时间的影响。
Alcohol consumption among HIV-infected women: impact on time to antiretroviral therapy and survival.
机构信息
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
出版信息
J Womens Health (Larchmt). 2011 Feb;20(2):279-86. doi: 10.1089/jwh.2010.2043. Epub 2011 Jan 31.
OBJECTIVE
Alcohol use is prevalent among HIV-infected people and is associated with lower antiretroviral adherence and high-risk sexual and injection behaviors. We sought to determine factors associated with alcohol use among HIV-infected women engaged in clinical care and if baseline alcohol use was associated with time to combination antiretroviral therapy (cART) and death in this population.
METHODS
In an observational clinical cohort, alcohol consumption at the initial medical visit was examined and categorized as heavy, occasional, past, or no use. We used multinomial logistic regression to test preselected covariates and their association with baseline alcohol consumption. We then examined the association between alcohol use and time to cART and time to death using Kaplan-Meier statistics and Cox proportional hazards regression.
RESULTS
Between 1997 and 2006, 1030 HIV-infected women enrolled in the cohort. Assessment of alcohol use revealed occasional and hazardous consumption in 29% and 17% of the cohort, respectively; 13% were past drinkers. In multivariate regression, heavy drinkers were more likely to be infected with hepatitis C than nondrinkers (relative risk ratios [RRR] 2.06, 95% confidence interval [CI] 1.29-3.44) and endorse current drug (RRR 3.51, 95% CI 2.09-5.91) and tobacco use (RRR 3.85 95% CI 1.81-8.19). Multivariable Cox regression adjusting for all clinical covariates demonstrated an increased mortality risk (hazard ratio [HR] 1.40, 95% CI 1.00-1.97, p < 0.05) among heavy drinkers compared to nondrinkers but no delays in cART initiation (1.04 95% CI 0.81-1.34)
CONCLUSIONS
Among this cohort of HIV-infected women, heavy alcohol consumption was independently associated with earlier death. Baseline factors associated with heavy alcohol use included tobacco use, hepatitis C, and illicit drug use. Alcohol is a modifiable risk factor for adverse HIV-related outcomes. Providers should consistently screen for alcohol consumption and refer HIV-infected women with heavy alcohol use for treatment.
目的
在感染 HIV 的人群中，饮酒较为普遍，并且与较低的抗逆转录病毒药物依从性以及高危性行为和注射行为相关。我们旨在确定与接受临床护理的 HIV 感染女性饮酒相关的因素，以及该人群中饮酒与开始联合抗逆转录病毒治疗（cART）和死亡之间的关系。
方法
在一项观察性临床队列研究中，我们在初次就诊时检查了饮酒情况，并将其分为重度、偶尔、过去或不饮酒。我们使用多项逻辑回归检验了预先选定的协变量及其与基线饮酒的关系。然后，我们使用 Kaplan-Meier 统计和 Cox 比例风险回归检验了饮酒与开始 cART 时间和死亡时间之间的关系。
结果
在 1997 年至 2006 年期间，共有 1030 名 HIV 感染女性入组该队列。评估饮酒情况显示，该队列中偶尔和危险饮酒者分别占 29%和 17%；13%为过去饮酒者。在多变量回归中，重度饮酒者比不饮酒者更有可能感染丙型肝炎（相对危险比 [RRR] 2.06，95%置信区间 [CI] 1.29-3.44），且目前使用毒品（RRR 3.51，95% CI 2.09-5.91）和烟草（RRR 3.85，95% CI 1.81-8.19）的可能性更高。在调整所有临床协变量的多变量 Cox 回归中，与不饮酒者相比，重度饮酒者的死亡率风险增加（风险比 [HR] 1.40，95% CI 1.00-1.97，p<0.05），但开始 cART 的时间无延迟（1.04，95% CI 0.81-1.34）。
结论
在该队列中，HIV 感染女性中重度饮酒与早逝独立相关。与重度饮酒相关的基线因素包括吸烟、丙型肝炎和非法药物使用。酒精是影响 HIV 相关不良结局的可改变风险因素。医务人员应始终筛查饮酒情况，并为重度饮酒的 HIV 感染女性提供治疗转介。
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