Mbarara University of Science and Technology, Mbarara, Uganda.
Mbarara Regional Referral Hospital, Mbarara, Uganda.
J Acquir Immune Defic Syndr. 2022 Dec 15;91(5):460-468. doi: 10.1097/QAI.0000000000003082.
Unhealthy alcohol use is associated with increased progression to tuberculosis (TB) disease, but its effect on adherence to isoniazid (INH) preventive therapy is not known.
This was a prospective study of persons with HIV with latent TB in southwestern Uganda reporting any current (previous 3 months) alcohol use or no alcohol consumption in the previous year (2:1 ratio). All received INH. We defined suboptimal adherence as <90% of days with at least 1 Medication Event Monitoring System cap opening, over the previous 90 days. Alcohol use was categorized as follows: none: no self-report and phosphatidylethanol (PEth) <8 ng/mL; moderate: Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) 1-2 (women) or 1-3 (men) and/or PEth 8 ≥ 50 ng/mL; and unhealthy: AUDIT-C ≥3 (women) or ≥4 (men) and/or PEth ≥50 ng/mL. We used generalized estimating equation logistic regression analyses to assess the association between the level of alcohol use and suboptimal INH adherence.
Three hundred two persons were enrolled; 279 were on INH for 3 or more months. The prevalence of suboptimal INH adherence was 31.3% at 3 months and 43.9% at 6 months. The odds of suboptimal INH adherence were higher for unhealthy (adjusted odds ratio, 2.78; 95% confidence interval: 1.62 to 4.76) and moderate (adjusted odds ratio, 1.59; 95% confidence interval: 0.94 to 2.71) compared with no alcohol consumption.
Suboptimal adherence to INH at 3 and 6 months was high among prospective study of persons with HIV and associated with unhealthy alcohol use. Adherence support and alcohol reduction strategies are needed for this group at high risk for active TB.
不健康的饮酒行为与结核病（TB）进展的风险增加相关，但它对异烟肼（INH）预防性治疗的依从性的影响尚不清楚。
这是一项在乌干达西南部进行的前瞻性研究，研究对象为 HIV 感染者合并潜伏性结核病，他们报告了过去 3 个月内的任何当前饮酒情况（之前一年无饮酒）（2:1 比例）。所有患者均接受 INH 治疗。我们将不依从定义为过去 90 天内至少有 1 天未按医嘱服药且至少有 1 个药物事件监测系统帽打开的天数比例＜90%。饮酒情况分为以下几类：不饮酒：无自我报告且磷脂酰乙醇（PEth）＜8ng/mL；中度饮酒：酒精使用障碍识别测试-消费（AUDIT-C）得分 1-2（女性）或 1-3（男性）和/或 PEth≥8≥50ng/mL；以及不健康饮酒：AUDIT-C≥3（女性）或≥4（男性）和/或 PEth≥50ng/mL。我们使用广义估计方程逻辑回归分析评估了饮酒水平与 INH 不依从的相关性。
共纳入 302 名患者，其中 279 名患者服用 INH 治疗 3 个月以上。3 个月和 6 个月时，INH 不依从的发生率分别为 31.3%和 43.9%。与不饮酒相比，不健康饮酒（调整后的优势比，2.78；95%置信区间：1.62 至 4.76）和中度饮酒（调整后的优势比，1.59；95%置信区间：0.94 至 2.71）发生 INH 不依从的可能性更高。
前瞻性研究发现，HIV 感染者中 INH 治疗的依从性在 3 个月和 6 个月时均较差，且与不健康饮酒有关。对于这一结核病高发风险人群，需要提供依从性支持和减少饮酒策略。
