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. 2019 Jun;23(6):1656-1667.
doi: 10.1007/s10461-018-2364-2.

Biomarker-Measured Unhealthy Alcohol Use in Relation to CD4 Count Among Individuals Starting ART in Sub-Saharan Africa

Jessica F Magidson  1 , Robin Fatch  2 , Catherine Orrell  3 , Gideon Amanyire  4 , Jessica E Haberer  5 , Judith A Hahn  2 ; META team
Collaborators, Affiliations

Biomarker-Measured Unhealthy Alcohol Use in Relation to CD4 Count Among Individuals Starting ART in Sub-Saharan Africa

Jessica F Magidson et al. AIDS Behav. 2019 Jun.

Abstract
in English, Spanish

Individuals are initiating antiretroviral therapy (ART) at earlier HIV disease stages. Unhealthy alcohol use is a known barrier to successful HIV treatment outcomes, yet it is unclear whether the problem varies by disease stage. We measured alcohol use with an objective biomarker (phosphatidylethanol [PEth]), comparing individuals (n = 401) with early (CD4 > 350 cells/mL, WHO Stage 1) versus late (CD4 < 200 cells/mL) ART initiation in HIV care in Uganda and South Africa (SA). We examined the association between CD4 count and biomarker results using multivariable regression modeling, and compared PEth results to self-report to assess underreporting. Overall, 32.2% (n = 129) had unhealthy alcohol use (PEth ≥ 50 ng/ml). Early ART initiation was significantly associated with unhealthy alcohol use in Uganda (AOR 2.65; 95% CI: 1.05-6.72), but not SA (AOR 1.00; 95% CI: 0.46-2.17). In Uganda, 23.2% underreported unhealthy alcohol use versus 11.6% in SA (χ2 = 9.30; p < 0.01). Addressing unhealthy alcohol use is important as patients initiate ART earlier, yet challenging due to underreporting.

Los pacientes con VIH estan iniciando terapia antiretroviral (TAR) en estadio temprano de la enfermedad. El consumo perjudicial de alcohol es una barrera conocida para el tratamiento efectivo de el VIH, aunque todavia no esta claro si el problema varia dependiendo del estadio de la enfermedad. Evaluamos los niveles de alcohol con el marcador biologico especifico Fosfatidil-etanol (PEth), comparando individuos (n = 401) al inicio (CD4 > 350 celulas/mL, OMS estadio 1) versus tardio (CD4 < 200 celulas/mL) de la TAR en Uganda y Africa del el Sur (AS). La asociacion entre el conteo de CD4 y los resultados de PEth se realizo mediante un analisis de regresion multivariable y ademas comparamos los resultados del PEth con el reporte voluntario con el fin de medir la tasa de bajo reporte. En general, 32.2% (n = 129) tenian consumo perjudicial de alcohol (PEth ≥ 50 ng/mL). En Uganda el inicio temprano de la TAR esta significativamente ligado al consumo perjudicial de alcohol (AOR = 2.65; 95% CI: 1.05-6.72) a diferencia de Africa de el Sur (AOR = 1.00; 95% CI: 0.46-2.17). En Uganda se detecto un 23.2% de bajo reporte de consumo frente a un 11.6% en AS (χ2 = 9.30: p < 0.01). Identificar el uso perjudical de alcohol es importante debido a que los pacientes inician tempranamente la TAR, esto se dificulta debido a la baja tasa de reporte.

Keywords: Alcohol use; Biomarker; HIV treatment; Sub-Saharan Africa.

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Conflict of interest statement

Dr. Haberer has consulted with Merck and owns stock in Natera, but declares no conflicts of interest. All other authors declare that they have no conflict of interest.

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