Section of Pulmonary/Critical Care Medicine and Allergy/Immunology, Louisiana State University Health Sciences Center , New Orleans , Louisiana , USA.
Subst Abus. 2019;40(2):256-261. doi: 10.1080/08897077.2019.1576088. Epub 2019 Mar 18.
Pneumonia is common in persons living with the human immunodeficiency virus (HIV) (PLWH). Alcohol, cocaine, and marijuana impact pneumonia pathogenesis. We hypothesized that substance use was independently associated with pneumonia severity in PLWH and modified the effect of alcohol on pneumonia severity. Retrospective data analysis of PLWH admitted with a diagnosis of pneumonia was conducted. Alcohol use disorder was defined by the Alcohol Use Disorders Identification Test score ≥14. Drug use was quantified by self-report. Pneumonia severity was defined by the pneumonia severity index (PSI). Multivariable linear regression was used to test independent associations with pneumonia severity and effect modification by sex. Of 196 PLWH, the mean age was 44 (SD = 9) years and the majority were men (71%). Ten percent ( 19) of subjects met criteria for an alcohol use disorder (AUD). In subjects reporting alcohol use, 25% reported concomitant crack/cocaine use and 16% reported marijuana use. PSI scores were higher with lifetime use of crack/cocaine (mean PSI: 63.1 vs. 57.3, = .06) and/or injection drug use (68.4 vs. 54.9, = .04). PSI scores were lower with active marijuana use (51.5 vs. 62.2, = .01). There was no significant difference in clinical outcomes. Sex modified the effect of drug use on PSI, with greater PSI scores in women with an AUD (β = 58.1, 95% confidence interval [CI]: 46.7 to 69.5, < .01), whereas active marijuana use mitigated the effect of AUD on PSI in men (β = -12.7, 95% CI: -18.8 to -6.6, < .01). Active alcohol and/or crack/cocaine use was associated with increased pneumonia severity in PLWH, with less severe pneumonia with marijuana use. Alcohol and marijuana effects on pneumonia severity differed by sex, with increased PSI in women and decreased PSI in men with concomitant marijuana and AUD.
肺炎在人类免疫缺陷病毒（HIV）感染者（PLWH）中很常见。酒精、可卡因和大麻会影响肺炎的发病机制。我们假设物质使用与 PLWH 的肺炎严重程度独立相关，并改变了酒精对肺炎严重程度的影响。对因肺炎住院的 PLWH 进行回顾性数据分析。酒精使用障碍通过酒精使用障碍识别测试评分≥14 来定义。药物使用通过自我报告来量化。肺炎严重程度通过肺炎严重指数（PSI）来定义。多变量线性回归用于测试与肺炎严重程度的独立关联，并通过性别测试效应修饰。在 196 名 PLWH 中，平均年龄为 44（标准差=9）岁，大多数为男性（71%）。10%（19 人）符合酒精使用障碍（AUD）标准。在报告饮酒的受试者中，25%报告同时使用快克可卡因，16%报告使用大麻。终生使用快克可卡因（平均 PSI：63.1 与 57.3， = .06）和/或注射毒品会导致 PSI 评分更高，而使用大麻则会导致 PSI 评分降低（51.5 与 62.2， = .01）。AUD 患者的 PSI 评分较高（β = 58.1，95%置信区间 [CI]：46.7 至 69.5， < .01），而使用大麻的 AUD 患者的 PSI 评分降低（β = -12.7，95% CI：-18.8 至-6.6， < .01）。
PLWH 中主动饮酒和/或吸食快克可卡因与肺炎严重程度增加相关，而吸食大麻则与肺炎严重程度降低相关。酒精和大麻对肺炎严重程度的影响因性别而异，女性同时使用大麻和 AUD 会增加 PSI，男性则会降低 PSI。
