Department of Internal Medicine, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Department of Internal Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda.
PLoS One. 2020 Jul 2;15(7):e0235261. doi: 10.1371/journal.pone.0235261. eCollection 2020.
Tuberculosis (TB) is the leading cause of death among people living with HIV (PLWH), and current evidence suggests that heavy alcohol users have an increased risk of developing TB disease compared to non-drinkers. Not known is whether the increased risk for TB disease among alcohol users may reflect higher rates of latent TB infection (LTBI) among this population. We assessed the latent TB infection prevalence based on tuberculin skin testing (TST) and examined association with current alcohol use among HIV-infected persons on antiretroviral therapy (ART) in south-western Uganda.
We included PLWH at the Mbarara Regional Hospital HIV clinic, who were either current alcohol consumers (prior 3 months) or past year abstainers (2:1 enrolment ratio). Participants were recruited for a study of isoniazid preventive therapy for LTBI. TST was performed using 5 tuberculin units of purified protein derivative. The primary outcome was a positive TST reading (≥5mm induration), reflecting LTBI. We used logistic regression analyses to assess the cross-sectional association between self-reported current alcohol use and a positive TST.
Of the 295 of 312 (95%) who returned for TST reading, 63% were females and 63% were current alcohol drinkers. The TST positive prevalence was 27.5% (95% confidence interval [CI]: 22.6% - 32.9%). The odds of a positive TST for current alcohol users compared to abstainers was 0.76 (95% CI: 0.41, 1.41), controlling for gender, age, body mass index, history of smoking, and prior unhealthy alcohol use.
The prevalence of LTBI among PLWH on ART in south-western Uganda was moderate and LTBI poses a risk for future infectious TB. Although alcohol use is common, we did not detect an association between current drinking or prior unhealthy alcohol use and LTBI. Further studies to evaluate the association between LTBI and different levels of current drinking (heavy versus not) are needed.
结核病（TB）是导致艾滋病毒（HIV）感染者（PLWH）死亡的主要原因，目前的证据表明，与不饮酒者相比，重度饮酒者患结核病的风险增加。目前尚不清楚饮酒者患结核病的风险增加是否反映了该人群中潜伏性结核病感染（LTBI）的发生率较高。我们评估了基于结核菌素皮肤试验（TST）的 LTBI 患病率，并在乌干达西南部接受抗逆转录病毒治疗（ART）的 HIV 感染者中，检查了当前饮酒与 LTBI 的关联性。
我们纳入了 Mbarara 地区医院 HIV 诊所的 PLWH，他们要么是当前的酒精消费者（过去 3 个月），要么是过去一年的禁酒者（2：1 的招募比例）。参与者被招募参加一项针对 LTBI 的异烟肼预防治疗研究。使用 5 单位纯化蛋白衍生物进行 TST。主要结局是阳性 TST 读数（≥5mm 硬结），反映 LTBI。我们使用逻辑回归分析评估了自我报告的当前饮酒与阳性 TST 之间的横断面关联。
在 295 名接受 TST 读数的患者中，有 27.5%（95%置信区间[CI]：22.6% - 32.9%）呈阳性。与禁酒者相比，当前饮酒者的 TST 阳性率为 0.76（95%CI：0.41，1.41），控制了性别、年龄、体重指数、吸烟史和既往不健康的酒精使用情况。
在乌干达西南部接受 ART 的 PLWH 中，LTBI 的患病率较高，LTBI 对未来的传染性结核病构成风险。尽管饮酒很常见，但我们没有发现当前饮酒或既往不健康的酒精使用与 LTBI 之间存在关联。需要进一步研究来评估 LTBI 与不同水平的当前饮酒（重度与非重度）之间的关系。
