Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA.
AIDS. 2020 Dec 1;34(15):2285-2294. doi: 10.1097/QAD.0000000000002716.
In high-income countries, hazardous alcohol use is associated with reduced receipt of antiretroviral therapy (ART) and viral suppression among people living with HIV (PLHIV) who inject drugs. These associations are less understood in lower middle-income countries (LMIC) and upper middle-income countries.
We examined associations between hazardous alcohol use, ART receipt, and viral suppression among PLHIV who reported current or former injection drug use. Participants were from nine studies in the United States (high-income country), India (LMIC), Russia (upper middle-income country), and Vietnam (LMIC).
Hazardous alcohol use was measured via Alcohol Use Disorders Identification Test. Outcomes were HIV viral suppression (viral load of <1000 RNA copies/ml) and self-reported ART receipt. Logistic regression assessed associations between hazardous alcohol use and both outcome variables, controlling for age and sex, among participants with current and former injection drug use.
Among 2790 participants, 16% were women, mean age was 37.1 ± 9.5 years. Mean Alcohol Use Disorders Identification Test scores were 4.6 ± 8.1 (women) and 6.2 ± 8.3 (men); 42% reported ART receipt; 40% had viral suppression. Hazardous alcohol use was significantly associated with reduced ART receipt in India (adjusted odds ratio = 0.59, 95% confidence interval: 0.45-0.77, P < 0.001); and lower rates of viral suppression in Vietnam (adjusted odds ratio = 0.51, 95% confidence interval: 0.31-0.82, P = 0.006).
Associations between hazardous alcohol use, ART receipt, and viral suppression varied across settings and were strongest in LMICs. Addressing hazardous alcohol use holds promise for improving HIV continuum of care outcomes among PLHIV who inject drugs. Specific impact and intervention needs may differ by setting.
在高收入国家，危险饮酒与接受抗逆转录病毒疗法 (ART) 和艾滋病毒感染者（PLHIV）的病毒抑制率降低有关，这些感染者有注射毒品的行为。而在中低收入国家（LMIC）和中上收入国家，这些关联则不太清楚。
我们研究了在报告当前或既往注射吸毒的 PLHIV 中，危险饮酒与 ART 接受和病毒抑制之间的关联。参与者来自美国（高收入国家）、印度（LMIC）、俄罗斯（中上收入国家）和越南（LMIC）的 9 项研究。
使用酒精使用障碍识别测试来衡量危险饮酒情况。结果是 HIV 病毒抑制（病毒载量<1000 RNA 拷贝/ml）和自我报告的 ART 接受情况。在有当前和既往注射吸毒史的参与者中，通过 logistic 回归评估了危险饮酒与两个结果变量之间的关联，同时控制了年龄和性别。
在 2790 名参与者中，16%为女性，平均年龄为 37.1±9.5 岁。平均酒精使用障碍识别测试得分为 4.6±8.1（女性）和 6.2±8.3（男性）；42%报告接受了 ART；40%达到了病毒抑制。在印度，危险饮酒与 ART 接受率降低显著相关（调整后的优势比=0.59，95%置信区间：0.45-0.77，P<0.001）；在越南，危险饮酒与病毒抑制率降低显著相关（调整后的优势比=0.51，95%置信区间：0.31-0.82，P=0.006）。
在不同的环境中，危险饮酒、ART 接受和病毒抑制之间的关联存在差异，在 LMIC 中最强。解决危险饮酒问题有望改善注射吸毒的 PLHIV 的 HIV 护理连续性结果。具体的影响和干预需求可能因环境而异。
