Department of Psychology, University of Maryland, 1147B Biology-Psychology, College Park, MD, 20742, USA.
Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA.
AIDS Behav. 2019 Jun;23(6):1656-1667. doi: 10.1007/s10461-018-2364-2.
Individuals are initiating antiretroviral therapy (ART) at earlier HIV disease stages. Unhealthy alcohol use is a known barrier to successful HIV treatment outcomes, yet it is unclear whether the problem varies by disease stage. We measured alcohol use with an objective biomarker (phosphatidylethanol [PEth]), comparing individuals (n = 401) with early (CD4 > 350 cells/mL, WHO Stage 1) versus late (CD4 < 200 cells/mL) ART initiation in HIV care in Uganda and South Africa (SA). We examined the association between CD4 count and biomarker results using multivariable regression modeling, and compared PEth results to self-report to assess underreporting. Overall, 32.2% (n = 129) had unhealthy alcohol use (PEth ≥ 50 ng/ml). Early ART initiation was significantly associated with unhealthy alcohol use in Uganda (AOR 2.65; 95% CI: 1.05-6.72), but not SA (AOR 1.00; 95% CI: 0.46-2.17). In Uganda, 23.2% underreported unhealthy alcohol use versus 11.6% in SA (χ = 9.30; p < 0.01). Addressing unhealthy alcohol use is important as patients initiate ART earlier, yet challenging due to underreporting.
个人正在更早的 HIV 疾病阶段开始接受抗逆转录病毒疗法（ART）。不健康的酒精使用是成功治疗 HIV 的已知障碍，但尚不清楚该问题是否因疾病阶段而异。我们使用客观生物标志物（磷脂酰乙醇 [PEth]）来衡量酒精使用情况，比较了在乌干达和南非（SA）接受 HIV 护理的早期（CD4 > 350 个细胞/ml，WHO 1 期）和晚期（CD4 < 200 个细胞/ml）开始接受 ART 的个体（n = 401）。我们使用多变量回归模型检查 CD4 计数与生物标志物结果之间的关联，并将 PEth 结果与自我报告进行比较，以评估漏报情况。总体而言，32.2%（n = 129）存在不健康的酒精使用（PEth ≥ 50 ng/ml）。在乌干达，早期 ART 开始与不健康的酒精使用显著相关（AOR 2.65；95%CI：1.05-6.72），但在南非则不然（AOR 1.00；95%CI：0.46-2.17）。在乌干达，有 23.2%的人漏报了不健康的酒精使用，而在南非则有 11.6%（χ ² = 9.30；p < 0.01）。由于患者更早地开始接受 ART，因此解决不健康的酒精使用问题非常重要，但由于漏报问题，这很具挑战性。
