Does alcohol use have a causal effect on HIV incidence and disease progression? A review of the literature and a modeling strategy for quantifying the effect.
Does alcohol use have a causal effect on HIV incidence and disease progression? A review of the literature and a modeling strategy for quantifying the effect.
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DOI：
10.1186/s12963-017-0121-9
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发表时间：
2017-02-10
影响因子：
3.3
通讯作者：
Shuper PA
中科院分区：
文献类型：
--
作者：
Rehm J;Probst C;Shield KD;Shuper PA
在本综述的第一部分中，讨论了酒精使用与艾滋病毒/艾滋病之间的关联的性质。酒精使用已被发现与艾滋病毒/艾滋病的发病率和进展密切相关，但这种关联在多大程度上是因果关系，传统上仍然存在疑问。此后，将酒精使用作为独立变量的实验帮助建立了酒精使用对无安全套性行为意图的因果影响。由于不使用避孕套的性行为的意图是实际使用避孕套行为的替代衡量标准，而实际使用避孕套行为本身又与艾滋病毒的发病率和再感染有关，因此因果链得到了证实。此外，在饮酒和艾滋病毒/艾滋病的病程之间存在着生物学途径，只有部分是通过坚持使用抗逆转录病毒药物来介导的。在贡献的第二部分，我们提供了建议的量化饮酒和艾滋病发病率之间的联系，使用来自实验数据的风险关系。鉴于目前的知识状况，酒精使用与艾滋病毒/艾滋病病程之间的生物联系难以量化，除非根据荟萃分析通过坚持服药将这种联系可操作化。建议的量化以南非为例。本文的在线版本（doi：10.1186/s12963-017-0121-9）包含补充材料，可供授权用户使用。
In the first part of this review, the nature of the associations between alcohol use and HIV/AIDS is discussed. Alcohol use has been found to be strongly associated with incidence and progression of HIV/AIDS, but the extent to which this association is causal has traditionally remained in question. Experiments where alcohol use has been manipulated as the independent variable have since helped establish a causal effect of alcohol use on the intention to engage in condomless sex. As the intention to engage in condomless sex is a surrogate measure of actual condom use behavior, which itself is linked to HIV incidence and re-infection, the causal chain has been corroborated. Moreover, there are biological pathways between alcohol use and the course of HIV/AIDS, only in part being mediated by adherence to antiretroviral medication. In the second part of the contribution, we provide suggestions on the quantification of the link between alcohol use and HIV incidence, using risk relations derived from experimental data. The biological links between alcohol use and course of HIV/AIDS are difficult to quantify given the current state of knowledge, except for an operationalization for the link via adherence to medication based on meta-analyses. The suggested quantifications are exemplified for South Africa. The online version of this article (doi:10.1186/s12963-017-0121-9) contains supplementary material, which is available to authorized users.