Journal Article

Tuberculin skin test positivity among HIV-infected alcohol drinkers on antiretrovirals in south-western Uganda

Fatch, Robin, Adong, Julian, Jacobson, Karen R., Emenyonu, Nneka I., Muyindike, Winnie R., Linas, Benjamin P., Cheng, Debbie M., Hahn, Judith A., Ngabirano, Christine

2020

Overview

Tuberculosis (TB) is the leading cause of death among people living with HIV (PLWH), and current evidence suggests that heavy alcohol users have an increased risk of developing TB disease compared to non-drinkers. Not known is whether the increased risk for TB disease among alcohol users may reflect higher rates of latent TB infection (LTBI) among this population. We assessed the latent TB infection prevalence based on tuberculin skin testing (TST) and examined association with current alcohol use among HIV-infected persons on antiretroviral therapy (ART) in south-western Uganda. We included PLWH at the Mbarara Regional Hospital HIV clinic, who were either current alcohol consumers (prior 3 months) or past year abstainers (2:1 enrolment ratio). Participants were recruited for a study of isoniazid preventive therapy for LTBI. TST was performed using 5 tuberculin units of purified protein derivative. The primary outcome was a positive TST reading (≥5mm induration), reflecting LTBI. We used logistic regression analyses to assess the cross-sectional association between self-reported current alcohol use and a positive TST. Of the 295 of 312 (95%) who returned for TST reading, 63% were females and 63% were current alcohol drinkers. The TST positive prevalence was 27.5% (95% confidence interval [CI]: 22.6% - 32.9%). The odds of a positive TST for current alcohol users compared to abstainers was 0.76 (95% CI: 0.41, 1.41), controlling for gender, age, body mass index, history of smoking, and prior unhealthy alcohol use. The prevalence of LTBI among PLWH on ART in south-western Uganda was moderate and LTBI poses a risk for future infectious TB. Although alcohol use is common, we did not detect an association between current drinking or prior unhealthy alcohol use and LTBI. Further studies to evaluate the association between LTBI and different levels of current drinking (heavy versus not) are needed.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adult / Age / AIDS / Alcohol Drinking - epidemiology / Alcohol use / Alcohols / Anti-Retroviral Agents - therapeutic use / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Antiretroviral Therapy, Highly Active / Antiviral agents / Biology and Life Sciences / Body mass / Body mass index / Body size / Care and treatment / Complications and side effects / Confidence intervals / Cross-Sectional Studies / Diagnosis / Disease prevention / Drinking / Drinking behavior / Drug therapy / Epidemiology / Female / Forecasts and trends / Gender / Health risks / HIV / HIV infections / HIV Infections - complications / HIV Infections - drug therapy / Human immunodeficiency virus / Humans / Infections / Infectious diseases / Internal medicine / Isoniazid / Latent Tuberculosis - diagnosis / Latent Tuberculosis - etiology / Male / Medical statistics / Medicine / Medicine and Health Sciences / Middle Aged / Mortality / Patient outcomes / People and Places / Population / Prevalence / Regression analysis / Risk / Risk Factors / Skin / Skin tests / Statistical analysis / Studies / Tuberculin / Tuberculin Test / Tuberculosis / Uganda - epidemiology / Variables