Unhealthy alcohol use did not affect the short-term rate of CD4 cell count decline in HIV-infected, antiretroviral treatment (ART)-naive individuals in Uganda, according to research.
A prospective cohort study conducted from September 2011 to August 2014 investigated the effect of unhealthy alcohol use on CD4 cell count among patients with HIV not yet eligible for ART. Baseline measures of unhealthy alcohol use, CD4 cell count, and HIV viral load were taken from 446 adults and repeated at follow-up visits every 6 months.
Unhealthy alcohol use was determined by self-report, using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and phosphatidylethanol, an alcohol biomarker, providing an objective measure of alcohol intake. AUDIT-C ≥3 for women and ≥4 for men and/or a cut-off of phosphatidylethanol ≥50 ng/mL indicated unhealthy drinking.
At baseline, 43% of participants fit the unhealthy drinking criteria, with a median CD4 cell count of 550 cells/mm3 (interquartile range, 416-685). There was no significant difference in CD4 cell count decline per year between unhealthy drinkers and those refraining from unhealthy drinking: −14.5 cells/mm3 (95% CI, −38.6 to 9.5 cells/mm3) and −24.0 cells/mm3 (95% CI, −43.6 to −4.5 cells/mm3), respectively (P =.54).
Analysis of subgroups, such as alternative alcohol measures, participant subgroups, and time-dependent confounders, as well as adjustments for demographic factors, produced similar results.
Background: Alcohol use has been shown to accelerate disease progression in experimental studies of simian immunodeficiency virus in macaques, but the results in observational studies of HIV have been conflicting.
Methods: We conducted a prospective cohort study of the impact of unhealthy alcohol use on CD4 cell count among HIV-infected persons in southwestern Uganda not yet eligible for antiretroviral treatment (ART). Unhealthy alcohol consumption was 3-month Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) positive (≥3 for women, ≥4 for men) and/or phosphatidylethanol (PEth – an alcohol biomarker) ≥50 ng/ml, modeled as a time-dependent variable in a linear mixed effects model of CD4 count.
Results: At baseline, 43% of the 446 participants were drinking at unhealthy levels and the median CD4 cell count was 550 cells/mm3 (Interquartile Range [IQR] 416-685). The estimated CD4 cell count decline per year was -14.5 cells/mm3 (95% Confidence Interval [CI]: -38.6 to 9.5) for unhealthy drinking vs. -24.0 cells/mm3 (95% CI: -43.6 to -4.5) for refraining from unhealthy drinking, with no significant difference in decline by unhealthy alcohol use (p-value 0.54), adjusting for age, sex, religion, time since HIV diagnosis, and HIV viral load. Additional analyses exploring alternative alcohol measures, participant subgroups, and time-dependent confounding, yielded similar findings.
Conclusion: Unhealthy alcohol use had no apparent impact on the short-term rate of CD4 count decline among HIV-infected ART naïve individuals in Uganda, using biological markers to augment self-report and examining disease progression prior to ART initiation to avoid unmeasured confounding due to misclassification of ART adherence.
Hahn, Judith A; Cheng, Debbie M; Emenyonu, Nneka I; Lloyd-Travaglini, Christine; Fatch, Robin; Shade, Starley B; Ngabirano, Christine; Adong, Julian; Bryant, Kendall; Muyindike, Winnie R; Samet, Jeffrey H