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AIDS Behav. 2019 Jun;23(6):1656-1667. doi: 10.1007/s10461-018-2364-2.

Biomarker-Measured Unhealthy Alcohol Use in Relation to CD4 Count Among Individuals Starting ART in Sub-Saharan Africa.

Author information

1
Department of Psychology, University of Maryland, 1147B Biology-Psychology, College Park, MD, 20742, USA. jmagidso@umd.edu.
2
Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA.
3
Desmond Tutu HIV Centre, Department of Medicine and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
4
Joint AIDS Program, Makerere University, Kampala, Uganda.
5
Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Abstract

Individuals are initiating antiretroviral therapy (ART) at earlier HIV disease stages. Unhealthy alcohol use is a known barrier to successful HIV treatment outcomes, yet it is unclear whether the problem varies by disease stage. We measured alcohol use with an objective biomarker (phosphatidylethanol [PEth]), comparing individuals (n = 401) with early (CD4 > 350 cells/mL, WHO Stage 1) versus late (CD4 < 200 cells/mL) ART initiation in HIV care in Uganda and South Africa (SA). We examined the association between CD4 count and biomarker results using multivariable regression modeling, and compared PEth results to self-report to assess underreporting. Overall, 32.2% (n = 129) had unhealthy alcohol use (PEth ≥ 50 ng/ml). Early ART initiation was significantly associated with unhealthy alcohol use in Uganda (AOR 2.65; 95% CI: 1.05-6.72), but not SA (AOR 1.00; 95% CI: 0.46-2.17). In Uganda, 23.2% underreported unhealthy alcohol use versus 11.6% in SA (χ2 = 9.30; p < 0.01). Addressing unhealthy alcohol use is important as patients initiate ART earlier, yet challenging due to underreporting.

KEYWORDS:

Alcohol use; Biomarker; HIV treatment; Sub-Saharan Africa

PMID:
30560484
PMCID:
PMC6535416
DOI:
10.1007/s10461-018-2364-2
[Indexed for MEDLINE]
Free PMC Article

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