The Role of Alcohol Use in Lung Disease After Treatment for Active TB Disease Among Persons Living with HIV

艾滋病毒感染者治疗活动性结核病后饮酒对肺部疾病的影响

• 批准号: 10683771
• 负责人: Kaku So-Armah
• 金额: $ 45.2万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10683771
• 关键词: Address; Aftercare; Alcohol abuse; Alcohol consumption; Alcohols; Anatomy; Behavioral; Biological Markers; Biometry; Bronchiectasis; COVID-19; Calendar; Carbon Monoxide; Cause of Death; Collaborations; Data; Diagnosis; Diffusion; Disease; Disease Outcome; Disease Progression; Effectiveness of Interventions; Epidemiology; Ethanol toxicity; Foundations; Future; Goals; HIV; HIV/AIDS; HIV/TB; Health; Health Personnel; Heavy Drinking; High Prevalence; Immune System Diseases; Immunologics; Immunology; Infectious Agent; International; Intervention; Interview; Knowledge; Link; Lung; Lung diseases; Lung infections; Malnutrition; Measures; Methods; Observational Study; Outcome; Outcome Assessment; Perception; Persons; Physiological; Physiology; Pneumonia; Predisposition; Productivity; Pulmonary Function Test/Forced Expiratory Volume 1; Pulmonary Tuberculosis; Pulmonary function tests; Pulmonology; Readiness; Research; Respiratory Signs and Symptoms; Risk; Risk Factors; Role; Scanning; Severity of illness; Smoking; Testing; Time; Toxic effect; Translating; Tuberculosis; Tuberculosis diagnosis; Uganda; Vital capacity; Walking; Woman; Work; X-Ray Computed Tomography; active method; alcohol effect; alcohol intervention; alcohol research; alcohol use disorder; behavioral pharmacology; co-infection; exercise capacity; hazardous drinking; improved; interest; lung injury; men; modifiable risk; phosphatidylethanol; primary outcome; secondary outcome; smoking intervention; smoking prevalence; substance use; timeline; treatment adherence; tuberculosis treatment

Modified Project Summary/Abstract Section Tuberculosis (TB) is the leading cause of death from a single infectious agent and the leading cause of death in people with HIV (PWH). An estimated 8.5 million people with TB are cured every year but many do not return to full health. Up to half of those completing treatment for pulmonary TB have post-TB lung disease, a disabling under-diagnosed group of lung deficits. Lung deficits at TB treatment completion are the strongest predictors of post-TB lung disease severity up to a year later. Alcohol and HIV are associated with lung immune dysfunction and alcohol use is associated with delayed TB diagnosis, increasing the risk of lung injury during active TB disease. However, it is not known whether alcohol use is associated with post-TB lung disease in PWH. We hypothesize that hazardous drinking increases susceptibility to and worsens post-TB lung disease in PWH. Our objective is to investigate hazardous drinking (Alcohol Use Disorders Identification Test [AUDIT] ≥8) as a modifiable risk factor for post-TB lung disease in PWH. To achieve this, we propose an 18- month observational study of 200 PWH completing pulmonary TB treatment in Mbarara, Uganda. We will evaluate the following post-TB lung disease outcomes: functional exercise capacity (primary outcome assessed by 6-minute walk distance), lung physiology (pulmonary function tests), anatomy (CT scan), and lung infections. The primary exposure is past-year hazardous drinking. Secondary alcohol measures will include 30- day Timeline Followback (calendar-based method of alcohol use recall) and phosphatidylethanol (PEth; a biomarker of recent alcohol use). Our expertise spans alcohol use, HIV, TB, pulmonology, epidemiology, and biostatistics. Our primary aim (Aim 1a) is to determine the relationship between past-year hazardous drinking and post-TB lung disease. In Aim 1b we assess the association of past-month heavy drinking and post-TB lung disease progression over time. In Aim 1c we explore whether smoking modifies the association of past- month heavy drinking and post-TB lung disease progression over time. Heavy drinking in Aims 1b and 1c is defined by Timeline Followback as ≥7 drinks/week (women) or ≥14 drinks/week (men) or PEth>200 ng/mL. In Aim 2, we will qualitatively evaluate factors that can improve tailoring of pharmaco-behavioral alcohol and smoking interventions in PWH receiving TB treatment. We will conduct in-depth interviews with 24 PWH during or after TB treatment and 12 TB healthcare providers. IMPACT: We will determine the association of alcohol use and post-TB lung disease in PWH. Our quantitative and qualitative data will lay the foundation for future work to tailor alcohol and smoking interventions to improve long-term health in HIV/TB co-infection.

修改后的项目摘要/摘要部分 结核病(TB)是单一感染源导致的主要死亡原因，也是艾滋病毒携带者(PWH)的主要死亡原因。据估计，每年有850万结核病患者被治愈，但许多人并没有完全恢复健康。在完成肺结核治疗的患者中，多达一半患有肺结核后肺部疾病，这是一组诊断不足的致残肺缺陷。结核病治疗完成时的肺缺陷是结核病后一年内肺部疾病严重程度的最强预测因子。酒精和艾滋病毒与肺免疫功能障碍有关，酒精使用与结核病诊断延迟有关，从而增加了活动性结核病期间肺损伤的风险。然而，目前尚不清楚饮酒是否与威斯康星医院的结核病后肺部疾病有关。我们假设，危险饮酒增加了PWH患者结核病后肺部疾病的易感性，并使其恶化。我们的目标是调查危险饮酒(酒精使用障碍鉴定测试[AUDIT]≥8)作为威斯康星医院肺结核后肺部疾病的一个可改变的危险因素。为了实现这一目标，我们建议在乌干达的姆巴拉拉对200名完成肺结核治疗的PWH进行为期18个月的观察性研究。我们将评估以下结核病后肺部疾病的结果：功能运动能力(通过6分钟步行距离评估的主要结果)、肺生理学(肺功能测试)、解剖(CT扫描)和肺部感染。主要接触是过去一年的危险饮酒。二级酒精测量将包括30天时间线回溯(基于日历的酒精使用召回方法)和磷脂酰乙醇(peth；最近酒精使用的生物标记物)。我们的专长涵盖酒精使用、艾滋病毒、结核病、肺病学、流行病学和生物统计学。我们的主要目标(目标1a)是确定过去一年的危险饮酒与结核病后肺部疾病之间的关系。在目标1b中，我们评估了过去一个月大量饮酒与结核病后肺部疾病进展之间的关系。在目标1c中，我们探索吸烟是否改变了过去一个月大量饮酒与结核病后肺部疾病进展之间的联系。《Timeline Followback》将AIMS 1b和1c中的重度饮酒定义为每周≥7饮品(女性)或≥14饮品(男性)或Peth&gt；200纳克/毫升。在目标2中，我们将定性评估在接受结核病治疗的威斯康星医院中，可以改善药物行为酒精和吸烟干预的因素。我们将在结核病治疗期间或治疗后与24名威尔斯亲王医院和12名结核病医护人员进行深入访谈。影响：我们将确定在威斯康星医院饮酒与肺结核后肺部疾病之间的关系。我们的定量和定性数据将为未来的工作奠定基础，以量身定做酒精和吸烟干预措施，以改善艾滋病毒/结核病合并感染的长期健康。