Abstract
SettingAlcohol use increases the risk of tuberculosis (TB) disease and is associated with worse outcomes.ObjectiveTo determine whether alcohol use affects TB severity at diagnosis in a high-burden setting.DesignParticipants were smear-positive people living with TB (PLWTB) in India. Disease severity was assessed as 1) high versus low smear grade, 2) time to positivity (TTP) on liquid culture, 3) chest radiograph cavitation, and 4) percent lung affected. Alcohol use and being at-risk for alcohol use disorders (AUD) were assessed using the AUDIT-C. Univariable and multivariable analyses were conducted.ResultsOf 1166 PLWTB, 691 (59.3%) were drinkers; of those, 518/691 (75.0%) were at-risk for AUD. Drinkers had more lung affected than non-drinkers (adjusted mean difference 10.8%, p<0.0001); this was not significant for those at-risk for AUD (adjusted mean difference 3.7%, p = 0.11). High smear grade (aOR 1.0, 95%CI: 0.7–1.4), cavitation (aOR 0.8, 95%CI 0.4–1.8), and TTP (mean difference 5.2 hours, p = 0.51) did not differ between drinkers and non-drinkers, nor between those at-risk and not at-risk for AUD.ConclusionsA large proportion of PLWTB were drinkers and were at-risk for AUD. Alcohol drinkers had more lung affected than non-drinkers. Studies are needed to explore mechanisms of this association.
Highlights
Despite global efforts, tuberculosis (TB) remains a significant cause of death and long-term disability [1]
Studies have shown an association between alcohol use and both lung cavitation and smear positivity, but these studies are limited to low-burden settings and results have been conflicting [9,10,11]
Alcohol use has been associated with altered immune responses which may lead to higher disease burden and increased lung pathology
Summary
Participants were smear-positive people living with TB (PLWTB) in India. Disease severity was assessed as 1) high versus low smear grade, 2) time to positivity (TTP) on liquid culture, 3) chest radiograph cavitation, and 4) percent lung affected. Alcohol use and being at-risk for alcohol use disorders (AUD) were assessed using the AUDIT-C.
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