Section of Infectious Diseases, Boston Medical Center, Boston, MA.
Department of Psychology, University of Maryland, College Park, MD.
Int J Tuberc Lung Dis. 2020 Jan 1;24(1):73-82. doi: 10.5588/ijtld.19.0080.
Alcohol use is associated with increased risk of developing tuberculosis (TB) disease, yet the impact of alcohol use on TB treatment outcomes has not been summarized. We aimed to quantitatively review evidence of the relationship between alcohol use and poor TB treatment outcomes. We conducted a systematic review of PubMed, EMBASE, and Web of Science (January 1980-May 2018). We categorized studies as having a high- or low-quality alcohol use definition and examined poor treatment outcomes individually and as two aggregated definitions (i.e., including or excluding loss to follow-up [LTFU]). We analyzed drug-susceptible (DS-) and multidrug-resistant (MDR-) TB studies separately. Our systematic review yielded 111 studies reporting alcohol use as a predictor of DS- and MDR-TB treatment outcomes. Alcohol use was associated with increased odds of poor treatment outcomes (i.e., death, treatment failure, and LTFU) in DS (OR 1.99, 95% CI 1.57-2.51) and MDR-TB studies (OR 2.00, 95% CI 1.73-2.32). This association persisted for aggregated poor treatment outcomes excluding LTFU, each individual poor outcome, and across sub-group and sensitivity analyses. Only 19% of studies used high-quality alcohol definitions. Alcohol use significantly increased the risk of poor treatment outcomes in both DS- and MDR-TB patients. This study highlights the need for improved assessment of alcohol use in TB outcomes research and potentially modified treatment guidelines for TB patients who consume alcohol.
饮酒与结核病（TB）发病风险增加相关，但饮酒对 TB 治疗结局的影响尚未得到总结。我们旨在定量综述饮酒与 TB 治疗结局不良之间的关系。我们对 PubMed、EMBASE 和 Web of Science（1980 年 1 月至 2018 年 5 月）进行了系统综述。我们将研究分为酒精使用定义质量高或低的两类，并分别检查不良治疗结局和两个综合定义（包括或不包括失访）。我们分别分析了耐多药结核病（MDR-TB）和药物敏感性结核病（DS-TB）的研究。我们的系统综述产生了 111 项研究，这些研究报告了饮酒是 DS-TB 和 MDR-TB 治疗结局的预测因素。饮酒与 DS-TB（OR 1.99，95%CI 1.57-2.51）和 MDR-TB 研究（OR 2.00，95%CI 1.73-2.32）中不良治疗结局（即死亡、治疗失败和失访）的可能性增加相关。这种关联在排除失访的综合不良治疗结局、每种单独的不良结局以及亚组和敏感性分析中都存在。只有 19%的研究使用了高质量的酒精定义。饮酒显著增加了 DS-TB 和 MDR-TB 患者不良治疗结局的风险。本研究强调了在 TB 结局研究中需要更好地评估饮酒情况，并可能需要为饮酒的 TB 患者修改治疗指南。
