Background

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.

Methods

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).

Results

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).

Conclusions

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.

中文翻译：

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艾滋病毒阳性肯尼亚女性性工作者接受抗逆转录病毒疗法后的饮酒和病毒抑制作用

背景

过量饮酒与抗逆转录病毒疗法（ART）依从性差有关。酒精对病毒抑制的影响在具有高HIV传播风险的人群中，例如女性性工作者（FSW），尤其重要。很少有研究直接评估饮酒与HIV病毒载量之间的关系。我们假设有害或有害的酒精使用与HIV阳性FSW之间可检测到的血浆病毒载量有关。

方法

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情况进行评估，并将其定义为酒精使用障碍识别测试（AUDIT）得分≥7。每六个月评估一次可检测的病毒载量，并定义为≥180c / mL。每月收集一次依从性措施，包括使用有效的服药能力自评量表和最近一个月使用ART的视觉模拟量表（VAS）进行晚期ART补充（> 48小时）和自我报告的依从性。广义估计方程用于估计调整后的相对风险（aRR）和95％置信区间（CI）。

结果

该分析包括366名参与者，于2012年10月至2018年3月期间每月进行追踪。在基线时，AUDIT评分显示有害酒精使用量（AUDIT 7–15）为14.3％，有害酒精使用量（AUDIT 16–19）为1.4％，以及酒精依赖程度（ 1.4％的参与者中的AUDIT≥20）。在对潜在的混杂因素进行调整之后，包括危险，有害和依赖性饮酒在内的综合暴露与可检测的病毒载量（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。 ），但与服药的自我评价能力较低（aRR 2.38，95％CI 1.42–3.99）和通过VAS自我报告的完全抗ART依从性较低（aRR 2.62，95％CI 1.84–3.71）有关。

结论

在这个FSW队列中，虽然报告危险，有害或依赖性饮酒的参与者不太可能具有可检测的病毒载量，但他们更有可能报告较低的ART依从性。这些结果表明，针对这些FSW人群中的饮酒的干预措施可能不会对病毒抑制产生重大影响。