Presence of an Alcohol Use Disorder is Associated with Greater Pneumonia Severity in Hospitalized HIV-Infected Patients

Abstract

Purpose Pneumonia is common and more severe in human immunodeficiency virus (HIV)-infected patients. Alcohol consumption in pneumonia patients without HIV is associated with excess mortality and morbidity. However, studies are lacking on the impact of alcohol on pneumonia and HIV. Our goal was to determine if alcohol use was an independent risk factor for pneumonia severity in HIV-infected patients. Methods Secondary analysis of prospective cohort study data evaluating early bronchoscopy for pneumonia diagnosis in HIV patients between 2007 and 2011 was conducted. We defined AUDs using an alcohol use disorder identification test (AUDIT) score as follows: ≥8 indicates hazardous drinking and ≥14 indicates dependence. We quantified pneumonia severity using the pneumonia severity index (PSI). Multivariable linear regression was used to investigate the independent association between alcohol and pneumonia severity. Results A total of 196 HIV+ individuals comprised our cohort. Most cohort subjects were middle-aged African American men. Most subjects (70 %) reported not taking antiretroviral therapy. The overall prevalence of hazardous drinking was 24 % in our cohort (48/196) with 10 % (19/196) meeting the criteria for alcohol dependence. Alcohol consumption was significantly associated with pneumonia severity (r = 0.25, p < 0.001). Hazardous drinking (β-coefficient 10.12, 95 % CI 2.95–17.29, p = 0.006) and alcohol dependence (β-coefficient 12.89, 95 % CI 2.59–23.18, p = 0.014) were independent risk factors for pneumonia severity. Reported homelessness and men who have sex with men (MSM) status remained independent risk factors for more severe pneumonia after adjustment for the effects of alcohol. Conclusions In a cohort of HIV patients with pneumonia, presence of an AUD was an independent risk factor for pneumonia severity. Homelessness and MSM status were associated with greater pneumonia severity in AUD patients.

Alcohol use disorder: A pre-existing condition for COVID-19?

“…High risk alcohol misuse is an established problem in the HIV population ( Justice et al, 2006 ; Lewden et al, 2005 ). Such alcohol misuse is known to be associated with poor outcomes related to lung infections in HIV patients ( Jolley, Alkhafaf, Hough, & Welsh, 2016 ). Recent studies implicate the effect of alcohol on altering gut microbiota as a mechanism for this HIV-associated susceptibility to lung infection ( Samuelson et al, 2019 ).…”

Association between alcohol consumption trajectories and clinical profiles among women and men living with HIV

“…Heavy drinking in this population is also associated with engagement in risky health behavior, such as cigarette (18,19) and substance use (20), which can lead to other chronic illnesses. Some studies have found that PLWH who use alcohol have increased chronic comorbidity (5,10,21,22), while other studies have found no such association (3,23–25). Others have found a J-curve association between alcohol consumption and risk for chronic illness.…”

“…Alcohol use is common among persons living with HIV (PLWH) and is reported among 39–81% (1–5). Prevalence of heavy drinking has been reported in as much as 25–45% (1,6,7) of PLWH, with alcohol dependence ranging from 5.5 to 10% (4,8–10). Alcohol consumption, in general, is negatively associated with completing the steps of the HIV care continuum (11) and heavy alcohol use is associated with poor retention in HIV care and lower visit adherence, compared to those who do not drink 1 .…”

Alcohol Use and Abuse Conspires With HIV Infection to Aggravate Intestinal Dysbiosis and Increase Microbial Translocation in People Living With HIV: A Review

“…Non-hazardous alcohol consumption once per week or more was reported to decrease survival in PLWH by 1 year, and by 6.4 years for those with daily hazardous consumption (38). In addition, alcohol consumption independently increases the risk for several comorbidities in PLWH, including the risk of dementia (8), cardiovascular disease (39,40), hepatic cirrhosis (41), and pneumonia (42). A study by Freiberg et al, showed that compared with infrequent and moderate drinking, hazardous drinking and alcohol abuse were associated with a higher prevalence of cardiovascular diseases (39).…”