Alcohol use and viral suppression in HIV-positive Kenyan female sex workers on antiretroviral therapy.
Alcohol use and viral suppression in HIV-positive Kenyan female sex workers on antiretroviral therapy.
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DOI：
10.1371/journal.pone.0242817
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
McClelland RS
中科院分区：
文献类型：
--
作者：
Long JE;Richardson BA;Wanje G;Wilson KS;Shafi J;Mandaliya K;Simoni JM;Kinuthia J;Jaoko W;McClelland RS
过量饮酒与抗逆转录病毒治疗（ART）依从性差有关。酒精对病毒抑制的影响对于女性性工作者 (FSW) 等艾滋病毒传播高风险群体尤其重要。很少有研究直接评估饮酒与艾滋病毒病毒载量之间的关联。我们假设，危险或有害的酒精使用与 HIV 阳性 FSW 中可检测到的血浆病毒载量有关。在肯尼亚蒙巴萨的 HIV 阳性 FSW 中进行了一项前瞻性队列研究。每年对有害或有害的酒精使用进行评估，并将其定义为酒精使用障碍识别测试 (AUDIT) 分数≥7。每六个月评估一次可检测的病毒载量，定义为≥180 c/mL。每月收集依从性指标，包括晚期 ART 补充（>48 小时）和自我报告的依从性，使用经过验证的服药能力自评量表和上个月 ART 使用的视觉模拟量表 (VAS)。使用广义估计方程来估计调整后的相对风险 (aRR) 和 95% 置信区间 (CI)。这项分析包括 2012 年 10 月至 2018 年 3 月期间每月跟踪的 366 名参与者。在基线时，AUDIT 分数表明 14.3% 的参与者有害饮酒（AUDIT 7-15），1.4% 的参与者有害饮酒（AUDIT 16-19），1.4% 的参与者有酒精依赖（AUDIT ≥20）。调整潜在的混杂因素后，包括有害、有害和依赖性饮酒在内的综合暴露与可检测到的病毒载量（aRR 1.10，95%CI 0.63–1.92）或晚期 ART 补充（aRR 1.13，95%CI 0.82–1.56）无关，但与较低的自评服药能力相关（aRR 2.38，95%CI 1.42–3.99），并且通过 VAS 自我报告的完美 ART 依从率较低（aRR 2.62，95%CI 1.84–3.71）。在这个 FSW 队列中，虽然报告危险、有害或依赖酒精使用的参与者不太可能具有可检测到的病毒载量，但他们更有可能报告较低的 ART 依从性。这些结果表明，针对 FSW 人群饮酒的干预措施可能不会对病毒抑制产生很大影响。
Excessive alcohol intake has been associated with poor adherence to antiretroviral therapy (ART). The impact of alcohol on viral suppression is particularly important among groups at high risk of HIV transmission, such as female sex workers (FSWs). Few studies have directly evaluated the association between alcohol use and HIV viral load. We hypothesized that hazardous or harmful alcohol use is associated with detectable plasma viral load among HIV-positive FSWs. A prospective cohort study was conducted among HIV-positive FSWs in Mombasa, Kenya. Hazardous or harmful alcohol use was assessed yearly and defined as an Alcohol Use Disorders Identification Test (AUDIT) score ≥7. Detectable viral load was assessed every six months and defined as ≥180 c/mL. Adherence measures were collected monthly and included late ART refill (>48 hours) and self-reported adherence, using both a validated self-rating scale of ability to take medication and visual analog scale (VAS) of ART use in the last month. Generalized estimating equations were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI). This analysis included 366 participants followed monthly between October 2012 and March 2018. At baseline, AUDIT scores indicated hazardous alcohol use (AUDIT 7–15) in 14.3%, harmful alcohol use (AUDIT 16–19) in 1.4%, and alcohol dependency (AUDIT ≥20) in 1.4% of participants. After adjusting for potential confounders, a combined exposure including hazardous, harmful, and dependent alcohol use was not associated with detectable viral load (aRR 1.10, 95%CI 0.63–1.92) or late ART refill (aRR 1.13, 95%CI 0.82–1.56), but was associated with lower self-rated ability to take medication (aRR 2.38, 95%CI 1.42–3.99) and a lower rate of self-reported perfect ART adherence by VAS (aRR 2.62, 95%CI 1.84–3.71). In this FSW cohort, while participants reporting hazardous, harmful, or dependent alcohol use were not more likely to have a detectable viral load, they were more likely to report lower ART adherence. These results suggest that interventions targeting alcohol use among this population of FSWs may not have a large impact on viral suppression.
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