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

摘要 结核病（TB）是单一传染源导致死亡的主要原因，也是导致死亡的主要原因 艾滋病毒感染者（PLWH）。据估计，每年有850万结核病患者被治愈，但许多人确实如此。 不能完全恢复健康。在完成肺结核治疗的人中，多达一半的人患有结核后肺部疾病， 一群诊断不足的肺功能缺陷患者肺结核治疗完成时的肺功能缺损最严重 结核病后肺部疾病严重程度的预测因子。酒精和艾滋病毒与肺有关 免疫功能障碍和饮酒与结核病诊断延迟有关，增加了肺损伤的风险 活动性结核病期间。然而，目前尚不清楚饮酒是否与结核病后肺结核有关。 艾滋病病毒感染者。我们假设危险的饮酒会增加对结核病的易感性和结核病后的复发率 PLWH中的肺部疾病。我们的目标是调查危险饮酒（酒精使用障碍识别 试验[AUDIT] ≥8）作为PLWH中TB后肺部疾病的可改变风险因素。为了实现这一目标，我们提出了一个 2-在彼得堡对200名完成住院肺结核治疗的PLWH进行了为期一年的观察性研究， 俄罗斯我们将评估以下结核病后肺部疾病的结果：功能性运动能力（主要 通过6分钟步行距离评估的结果），肺生理学（肺功能测试），解剖学（CT扫描）， 和肺部感染。主要接触是过去一年的危险饮酒。二级酒精措施将 包括30天时间轴追踪（基于酒精使用回忆方法）和磷脂酰乙醇 (PEth;最近饮酒的生物标志物）。我们的专业知识涵盖酒精使用，艾滋病毒，结核病，肺病， 流行病学和生物统计学。我们的主要目标（目标1a）是确定去年 危险饮酒和肺结核后肺部疾病。在目标1b中，我们评估了过去一个月重 饮酒和肺结核后肺部疾病的进展。在目标1c中，我们探讨了吸烟是否会改变 过去一个月大量饮酒与结核病后肺部疾病随时间进展的关系。大量饮酒， 目标1b和1c由时间轴随访定义为≥7杯/周（女性）或≥14杯/周（男性），或 PEth>200 ng/mL。在目标2中，我们将定性评估可以改善药物定制的因素。 在接受结核病治疗的艾滋病毒携带者中进行行为酒精和吸烟干预。深入开展 在住院结核病治疗期间或之后与24名感染者和12名结核病医疗保健提供者进行了访谈。影响：我们 将确定饮酒与肺结核后肺疾病的关系。我们的定量和 定性数据将为未来的工作奠定基础，以调整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。

ABSTRACT Tuberculosis (TB) is the leading cause of death from a single infectious agent and the leading cause of death in people living with HIV (PLWH). 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 PLWH. We hypothesize that hazardous drinking increases susceptibility to and worsens post-TB lung disease in PLWH. 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 PLWH. To achieve this, we propose a 2-year observational study of 200 PLWH completing inpatient pulmonary TB treatment in St. Petersburg, Russia. 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 PLWH receiving TB treatment. We will conduct in-depth interviews with 24 PLWH during or after inpatient TB treatment and 12 TB healthcare providers. IMPACT: We will determine the association of alcohol use and post-TB lung disease in PLWH. 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.