Higher Levels of Alcohol Use Are Associated With Latent Tuberculosis Infection in Adults Living With Human Immunodeficiency Virus

Puryear, Sarah; Fatch, Robin; Beesiga, Brian; Kekibiina, Allen; Lodi, Sara; Marson, Kara; Emenyonu, Nneka; Muyindike, Winnie; Kwarisiima, Dalsone; Hahn, Judith A.; Chamie, Gabriel

doi:10.1093/cid/ciaa527

Cited by 11 publications

(9 citation statements)

References 11 publications

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“…to increase the likelihood of LTBI (41) and TB,(42) which supports our findings. The cause could be multifactorial.…”

Section: Discussionsupporting

confidence: 89%

“…(39,40) Additionally, ART is implicated in various components of metabolic syndrome, including an increased risk of hyperglycaemia and diabetes. [41] However, our study only assessed selfreported diabetes and did not measure the haemoglobin A1c (HbA1c) level to determine its association with LTBI. We hypothesised that being on ART for >3 years resulted in CD4 recovery to at least the lower end of the normal range with increased yield from IGRA testing.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and predictors of tuberculosis infection among people living with HIV in a high tuberculosis burden context

Njagi

Nduba

Mureithi

et al. 2022

Preprint

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Background: Tuberculosis (TB) is the leading cause of mortality among people living with the Human immunodeficiency virus (PLHIV), and latent TB infection (LTBI) contributes significantly to active TB. Direct diagnostic methods are the most accurate tests for establishing the LTBI burden. However, current interferon-gamma release assay (IGRA) data on LTBI prevalence in the context of near-universal access to antiretroviral therapy (ART) and widespread TB preventive therapy (TPT) implementation are lacking. We estimated the prevalence and determinants of LTBI among PLHIV within a high TB and HIV burden context. Methods: This cross-sectional analysis of a prospectively collected observational study data included adult PLHIV, in whom QuantiFERON-TB Gold Plus assay, an IGRA, was performed. LTBI was defined as a positive or indeterminate IGRA. Participants with TB and those who had used TB preventive therapy in the past were excluded. Regression analysis was performed to identify independent predictors of LTBI. Results Of 121 PLHIV with IGRA results, females were 74.4% (90/121), and the mean age was 38.4 (standard deviation [SD] 10.8) years. Overall, 47.9% (58/121) were classified as LTBI (IGRA positive and indeterminate results were 39.7% [48/121] and 8.3% [10/121], respectively), with mean ages of 38.7 (SD 10.30) vs 38.2 (SD 11.3) years, respectively (p=0.602). Being obese/overweight (body mass index ≥ 25; p=0.046, adjusted odds ratio (aOR) 2.65, 95% confidence interval [CI] 1.02-6.89), alcohol usage (p=0.036, aOR 3.93, 95% CI 1.10-14.13), and ART usage for >3 years (p=0.012, aOR 2.65, 95% CI 1.23-5.69) were independently associated with LTBI. Conclusion: There was a high LTBI prevalence among PLHIV. A longer period of ART and alcohol consumption were independently associated with LTBI. The relationship between obesity/overweight and LTBI may be related to ART and immune reconstitution and requires further investigation. Recommending IGRA to ascertain LTBI status in PLHIV previously unexposed to TPT may be necessary.

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“…to increase the likelihood of LTBI (41) and TB,(42) which supports our findings. The cause could be multifactorial.…”

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors of tuberculosis infection among people living with HIV in a high tuberculosis burden context

Njagi

Nduba

Mureithi

et al. 2022

Preprint

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“…The prevalence of LTBI in this study was found to be as high as 65%. Among persons living with HIV in western Uganda who are engaged in hazardous alcohol use, the prevalence of LTBI based on TST positivity was reported at 35% [ 18 ]. In this study, the prevalence of LTBI among women was 33.9%.…”

Section: Discussionmentioning

confidence: 99%

Latent Tuberculosis Infection Status of Pregnant Women in Uganda Determined Using QuantiFERON TB Gold-Plus

Bongomin

Ssekamatte

Nattabi

et al. 2021

Open Forum Infectious Diseases

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Background The risk of progression of latent tuberculosis (TB) infection (LTBI) to active disease increases with pregnancy. This study determined the prevalence and risk factors associated with LTBI among pregnant women in Uganda. Methods We enrolled 261 pregnant women, irrespective of gestation age. Participants who had known or suspected active TB on the basis of clinical evaluation or who had recently received treatment for TB were excluded. LTBI was defined as an interferon- gamma (IFN-γ) concentration ≥0.35 IU/mL (calculated as either TB1 (eliciting CD4 + T-cell responses) or TB2 [eliciting CD8 + T-cell responses] antigen minus nil) using QuantiFERON TB Gold-Plus (QFT-plus) assay. Results LTBI prevalence was 37.9% (n=99) (95% Confidence Interval (CI): 32.3 - 44.0). However, 24 (9.2%) subjects had indeterminate QFT-plus results. Among participants with LTBI, TB1 and TB2 alone were positive in 11 (11.1%) and 18 (18.2%) participants, respectively. In multivariable analysis, HIV-infection (adjusted odds ratio (aOR): 4.4; 95% CI: 1.1 – 18.0; p=0.04) and age group 30-39 years (aOR: 4.0; 95% CI: 1.2 – 12.7; p=0.02) were independently associated with LTBI. Meanwhile, smoking status, alcohol use, nature of residence, crowding index, and TB contact were not associated with LTBI. Conclusion Our findings are in keeping with the evidence that HIV infection and advancing age are important risk factors for LTBI in pregnancy. In our setting, we recommend routine screening for LTBI and TB preventive therapy among eligible pregnant women.

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“…The risk of both latent TB infection (LTBI) and active TB disease is higher among persons with alcohol use disorders (AUD) than those without AUD ( 17 ). For example, one study in New York City found a 28-fold higher rate of active TB disease among those with AUD as compared to age-matched individuals without AUD ( 18 ).…”

Section: Alcohol and Tb Epidemiologymentioning

confidence: 99%

The Impact of Alcohol Use Disorder on Tuberculosis: A Review of the Epidemiology and Potential Immunologic Mechanisms

et al. 2022

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Globally, an estimated 107 million people have an alcohol use disorder (AUD) leading to 2.8 million premature deaths each year. Tuberculosis (TB) is one of the leading causes of death globally and over 8% of global TB cases are estimated to be attributable to AUD. Social determinants of health such as poverty and undernutrition are often shared among those with AUD and TB and could explain the epidemiologic association between them. However, recent studies suggest that these shared risk factors do not fully account for the increased risk of TB in people with AUD. In fact, AUD has been shown to be an independent risk factor for TB, with a linear increase in the risk for TB with increasing alcohol consumption. While few studies have focused on potential biological mechanisms underlying the link between AUD and TB, substantial overlap exists between the effects of alcohol on lung immunity and the mechanisms exploited by Mycobacterium tuberculosis (Mtb) to establish infection. Alcohol misuse impairs the immune functions of the alveolar macrophage, the resident innate immune effector in the lung and the first line of defense against Mtb in the lower respiratory tract. Chronic alcohol ingestion also increases oxidative stress in the alveolar space, which could in turn facilitate Mtb growth. In this manuscript, we review the epidemiologic data that links AUD to TB. We discuss the existing literature on the potential mechanisms by which alcohol increases the risk of TB and review the known effects of alcohol ingestion on lung immunity to elucidate other mechanisms that Mtb may exploit. A more in-depth understanding of the link between AUD and TB will facilitate the development of dual-disease interventions and host-directed therapies to improve lung health and long-term outcomes of TB.

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Higher Levels of Alcohol Use Are Associated With Latent Tuberculosis Infection in Adults Living With Human Immunodeficiency Virus

Cited by 11 publications

References 11 publications

Prevalence and predictors of tuberculosis infection among people living with HIV in a high tuberculosis burden context

Prevalence and predictors of tuberculosis infection among people living with HIV in a high tuberculosis burden context

Latent Tuberculosis Infection Status of Pregnant Women in Uganda Determined Using QuantiFERON TB Gold-Plus

The Impact of Alcohol Use Disorder on Tuberculosis: A Review of the Epidemiology and Potential Immunologic Mechanisms

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