在乌干达农村地区接受艾滋病病毒治疗的第一年，不健康饮酒行为的减少与反弹情况：利用磷脂酰乙醇增强自我报告。
Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self-report.
作者信息
Hahn Judith A, Emenyonu Nneka I, Fatch Robin, Muyindike Winnie R, Kekiibina Allen, Carrico Adam W, Woolf-King Sarah, Shiboski Stephen
机构信息
University of California, Department of Medicine, San Francisco, CA, USA.
University of California, Department of Epidemiology and Biostatistics, San Francisco, CA, USA.
出版信息
Addiction. 2016 Feb;111(2):272-9. doi: 10.1111/add.13173. Epub 2015 Nov 5.
AIMS
We examined whether unhealthy alcohol consumption, which negatively impacts HIV outcomes, changes after HIV care entry overall and by several factors. We also compared using phosphatidylethanol (PEth, an alcohol biomarker) to augment self-report to using self-report alone.
DESIGN
A prospective 1-year observational cohort study with quarterly visits.
SETTING
Large rural HIV clinic in Mbarara, Uganda.
PARTICIPANTS
A total of 208 adults (89 women and 119 men) entering HIV care, reporting any prior year alcohol consumption.
MEASUREMENTS
Unhealthy drinking was PEth+ (≥ 50 ng/ml) or Alcohol Use Disorders Identification Test-Consumption+ (AUDIT-C+, over 3 months, women ≥ 3; men ≥ 4). We calculated adjusted odds ratios (AOR) for unhealthy drinking per month since baseline, and interactions of month since baseline with perceived health, number of HIV symptoms, antiretroviral therapy (ART), gender and self-reported prior unhealthy alcohol use.
FINDINGS
The majority of participants (64%) were unhealthy drinkers (PEth+ or AUDIT-C+) at baseline. There was no significant trend in unhealthy drinking overall [per-month AOR: 1.01; 95% confidence interval (CI) = 0.94-1.07], while the per-month AORs were 0.91 (95% CI = 0.83-1.00) and 1.11 (95% CI = 1.01-1.22) when participants were not yet on ART and on ART, respectively (interaction P-value < 0.01). In contrast, 44% were AUDIT-C+; the per-month AORs for being AUDIT-C+ were 0.89 (95% CI = 0.85-0.95) overall, and 0.84 (95% CI = 0.78-0.91) and 0.97 (95% CI = 0.89-1.05) when participants were not on and were on ART, respectively.
CONCLUSIONS
Unhealthy alcohol use among Ugandan adults entering HIV care declines prior to the start of anti-retroviral therapy but rebounds with time. Augmenting self-reported alcohol use with biomarkers increases the ability of current alcohol use measurements to detect unhealthy alcohol use.
目的
我们研究了对艾滋病病毒感染情况有负面影响的不健康饮酒行为在进入艾滋病病毒护理体系后总体上以及按多种因素划分后是否发生变化。我们还比较了使用磷脂酰乙醇（PEth，一种酒精生物标志物）辅助自我报告与仅使用自我报告的情况。
设计
一项为期1年的前瞻性观察队列研究，每季度进行随访。
地点
乌干达姆巴拉拉的一家大型农村艾滋病病毒诊所。
参与者
共有208名进入艾滋病病毒护理体系的成年人（89名女性和119名男性），报告了上一年的任何饮酒情况。
测量方法
不健康饮酒定义为PEth阳性（≥50纳克/毫升）或酒精使用障碍识别测试-消费版阳性（AUDIT-C+，超过3个月，女性≥3分；男性≥4分）。我们计算了自基线以来每月不健康饮酒的调整比值比（AOR），以及自基线以来的月份与感知健康状况、艾滋病病毒症状数量、抗逆转录病毒疗法（ART）、性别和自我报告的既往不健康饮酒情况之间的相互作用。
研究结果
大多数参与者（64%）在基线时为不健康饮酒者（PEth阳性或AUDIT-C+）。总体上不健康饮酒没有显著趋势[每月AOR：1.01；95%置信区间（CI）=0.94-1.07]，而参与者未接受ART和接受ART时，每月AOR分别为0.91（95%CI= O.83-1.00）和1.11（95%CI=1.01-1.22）（相互作用P值<0.01）。相比之下，44%的人AUDIT-C+；总体上AUDIT-C+的每月AOR为0.89（95%CI=0.85-0.95），参与者未接受ART和接受ART时，该值分别为0.84（95%CI=0.78-0.91）和0.97（95%CI=0.89-1.05）。
结论
进入艾滋病病毒护理体系的乌干达成年人中，不健康饮酒行为在开始抗逆转录病毒治疗前有所下降，但随时间推移会反弹。使用生物标志物辅助自我报告饮酒情况可提高当前饮酒量测量方法检测不健康饮酒行为的能力。
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