酒精使用障碍严重程度对三个国际 HIV 感染者队列中 HIV 病毒抑制和 CD4 计数的影响。
Impact of alcohol use disorder severity on human immunodeficiency virus (HIV) viral suppression and CD4 count in three international cohorts of people with HIV.
机构信息
Department of Psychiatry, Addiction Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA.
出版信息
Alcohol Clin Exp Res (Hoboken). 2023 Apr;47(4):704-712. doi: 10.1111/acer.15031. Epub 2023 Feb 17.
BACKGROUND
Alcohol use has been linked to worse human immunodeficiency virus (HIV) immunologic/virologic outcomes, yet few studies have explored the effects of alcohol use disorder (AUD). This study assessed whether AUD severity is associated with HIV viral suppression and CD4 count in the three cohorts of the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Consortium.
METHODS
People with HIV (PWH) in Uganda (n = 301), Russia (n = 400), and Boston (n = 251), selected in-part based on their alcohol use, were included in analyses. Logistic and linear regressions were used to assess the cross-sectional associations between AUD severity (number of DSM-5 diagnostic criteria) and (1) HIV viral suppression, and (2) CD4 count (cells/mm ) adjusting for covariates. Analyses were conducted separately by site.
RESULTS
The proportion of females was 51% (Uganda), 34% (Russia), and 33% (Boston); mean age (SD) was 40.7 (9.6), 38.6 (6.3), and 52.1 (10.5), respectively. All participants in Uganda and all but 27% in Russia and 5% in Boston were on antiretroviral therapy. In Uganda, 32% met criteria for AUD, 92% in Russia, and 43% in Boston. The mean (SD) number of AUD criteria was 1.6 (2.4) in Uganda, 5.6 (3.3) in Russia, and 2.4 (3.1) in Boston. Most participants had HIV viral suppression (Uganda 92%, Russia 57%, Boston 87%); median (IQR) CD4 count was 673 (506, 866), 351 (201, 542), and 591 (387, 881), respectively. In adjusted models, there were no associations between AUD severity and HIV viral suppression: adjusted odds ratios (AOR) (95%CI) per 1 additional AUD criterion in Uganda was 1.08 (0.87, 1.33); Russia 0.98 (0.92, 1.04); and Boston 0.95 (0.84, 1.08) or CD4 count: mean difference (95%CI) per 1 additional criterion: 5.78 (-7.47, 19.03), -3.23 (-10.91, 4.44), and -8.18 (-24.72, 8.35), respectively.
CONCLUSIONS
In three cohorts of PWH, AUD severity was not associated with HIV viral suppression or CD4 count. PWH with AUD in the current era of antiretroviral therapy can achieve virologic control.
背景
已有研究表明，饮酒与人类免疫缺陷病毒（HIV）免疫/病毒学结果恶化有关，但鲜有研究探讨酒精使用障碍（AUD）的影响。本研究评估了在乌干达-俄罗斯-波士顿酒精网络艾滋病研究合作（URBAN ARCH）联盟的三个队列中，AUD 严重程度与 HIV 病毒抑制和 CD4 计数之间的关系。
方法
选取了乌干达（n=301）、俄罗斯（n=400）和波士顿（n=251）的 HIV 感染者（PWH），部分参与者是根据其饮酒情况选择的。使用逻辑回归和线性回归来评估 AUD 严重程度（DSM-5 诊断标准的数量）与（1）HIV 病毒抑制和（2）CD4 计数（细胞/mm）之间的横断面关联，调整了协变量。分析分别在每个地点进行。
结果
女性比例分别为 51%（乌干达）、34%（俄罗斯）和 33%（波士顿）；平均年龄（标准差）分别为 40.7（9.6）、38.6（6.3）和 52.1（10.5）。乌干达和俄罗斯的所有参与者均接受了抗逆转录病毒治疗，而俄罗斯除 27%外，所有参与者均接受了抗逆转录病毒治疗。在乌干达，32%的参与者符合 AUD 标准，俄罗斯为 92%，波士顿为 43%。乌干达的平均（标准差）AUD 标准数为 1.6（2.4），俄罗斯为 5.6（3.3），波士顿为 2.4（3.1）。大多数参与者 HIV 病毒得到抑制（乌干达 92%，俄罗斯 57%，波士顿 87%）；中位数（IQR）CD4 计数分别为 673（506，866）、351（201，542）和 591（387，881）。在调整模型中，AUD 严重程度与 HIV 病毒抑制之间没有关联：每增加一个 AUD 标准，乌干达的调整后比值比（AOR）（95%CI）为 1.08（0.87，1.33）；俄罗斯为 0.98（0.92，1.04）；波士顿为 0.95（0.84，1.08）。CD4 计数也没有关联：每增加一个标准的平均差值（95%CI）分别为：5.78（-7.47，19.03）、-3.23（-10.91，4.44）和-8.18（-24.72，8.35）。
结论
在三个 PWH 队列中，AUD 严重程度与 HIV 病毒抑制或 CD4 计数无关。在当前接受抗逆转录病毒治疗的 HIV 感染者中，AUD 患者可以实现病毒学控制。
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