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

基本信息

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
项目类别：
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

项目摘要

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.

修改的项目摘要/摘要部分结核病（TB）是艾滋病毒患者（PWH）的单一感染因子和死亡的主要原因的主要死亡原因。估计每年有850万人患有结核病的人可以治愈，但许多人没有恢复全部健康。在完成肺结核治疗的人中，多达一半的人患有结核病后肺部疾病，这是残疾人诊断不足的肺部缺陷组。肺部在结核病治疗完成时定义了一年后结核病后肺部疾病严重程度的有力预测指标。酒精和艾滋病毒与肺免疫功能障碍有关，酒精使用与TB诊断延迟有关，从而增加活性结核病期间肺损伤的风险。但是，尚不清楚饮酒是否与PWH中的结核病后肺部疾病有关。我们假设有害饮酒会增加对PWH中结核病后肺部病后的易感性，并恶化。目的是研究危险饮酒（酒精使用障碍识别测试[审计]≥8）是PWH中TB后肺部疾病的可修改风险因素。为了实现这一目标，我们提出了一项为期18个月的观察性研究，对乌干达姆巴拉拉（Mbarara）完成肺结核治疗的200 PWH。我们将评估以下结核病后肺部疾病结果：功能运动能力（通过6分钟步行距离评估的主要结局），肺部生理学（肺功能测试），解剖结构（CT SCAN）和肺部感染。主要接触是过去一年的危险饮酒。次级酒精度量将包括30天的时间表后卫（基于日历的酒精使用召回方法）和磷脂酰乙醇（Peth；近期酒精使用的生物标志物）。我们的专业知识涵盖了酒精的使用，艾滋病毒，结核病，肺病学，流行病学和生物统计学。我们的主要目的（AIM 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AIM 1B中，我们评估了过去月重量饮酒和结核病后肺部疾病进展的关联。在AIM 1C中，我们探讨了吸烟是否会随着时间的流逝而修饰过去月重量饮酒和结核病后肺部疾病进展的关联。 AIMS 1B和1C中的大量饮酒是由时间轴后备定义为≥7饮料/周（女性）或≥14饮料/周（男性）或Peth> 200 ng/ml。在AIM 2中，我们将定性评估可以改善接受结核病治疗的PWH的药物行为酒精和吸烟干预措施的因素。在结核病治疗和12个结核病医疗保健提供者期间，我们将对24个PWH进行深入的访谈。影响：我们将确定PWH中酒精使用和结核病后肺部疾病的关联。我们的定量和定性数据将为未来的工作奠定基础，以量身定制酒精和吸烟干预措施，以改善HIV/TB共同感染的长期健康。