Title

Effects of sex and alcohol use on antiretroviral therapy outcomes in Botswana: a cohort study.

Year of Publication

2017

Number of Pages

73-81

Date Published

2017 Jan

ISSN Number

1360-0443

Abstract

<p><strong>AIMS: </strong>To determine alcohol use effect on HIV treatment success and whether alcohol use mediates the relation between male sex and treatment failure.</p>

<p><strong>DESIGN: </strong>Longitudinal cohort study.</p>

<p><strong>SETTING: </strong>Eight HIV clinics in and near Gaborone, Botswana.</p>

<p><strong>PARTICIPANTS: </strong>A total of 938 HIV-infected treatment-naive adults initiating regimens containing the antiretroviral medication efavirenz between June 2009 and February 2013, including 478 (51%) males, median age 38&nbsp;years, and plasma HIV RNA 4.9 logcopies/ml.</p>

<p><strong>MEASUREMENTS: </strong>Primary outcome was a composite of treatment failure over 6&nbsp;months including death, lost to care or plasma HIV RNA &gt; 25 copies/ml. Exposures included alcohol use and gender.</p>

<p><strong>FINDINGS: </strong>Failure in 339 (36%) participants included 40 (4%) deaths, 194 (21%) lost to care and 105 (11%) with HIV RNA&nbsp;&gt;&nbsp;25 copies/ml. Both hazardous alcohol use in the past year [adjusted odds ratio (aOR)&nbsp;=&nbsp;1.4, 95% confidence interval (CI)&nbsp;=&nbsp;1.0, 1.9] and male sex (aOR&nbsp;=&nbsp;2.1, 95% CI&nbsp;=&nbsp;1.5, 2.9) were associated with failure. Hazardous alcohol use in the year prior to enrollment was more common in men (57%) than women (24%), P&nbsp;&lt;&nbsp;0.001. There was no difference in alcohol use effect on failure between sexes (P for interaction&nbsp;&gt;&nbsp;0.5). Controlling for hazardous alcohol use did not change the relation between sex and failure.</p>

<p><strong>CONCLUSION: </strong>Alcohol use among HIV-infected adults in Botswana appears to worsen HIV treatment outcomes. Alcohol use does not appear to have either a mediating or a moderating effect on the relation between gender and HIV treatment outcome failure.</p>

DOI

10.1111/add.13538

Alternate Title

Addiction

PMID

27447841

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