Hazardous alcohol consumption is not associated with CD4+ T-cell count decline among PLHIV in Kampala Uganda: A prospective cohort study

There is limited data on the effects of alcohol on immunological response among persons living with HIV (PLHIV) in sub-Saharan Africa. We assessed the relationship between hazardous alcohol use and CD4+ T-cell count, among PLHIV in Uganda. PLHIV aged ≥ 18 years were enrolled in a cohort study at the...

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Bibliographic Details
Published in:PloS one 2017-06, Vol.12 (6), p.e0180015-e0180015
Main Authors: Wandera, Bonnie, Tumwesigye, Nazarius M, Nankabirwa, Joaniter I, Kambugu, Andrew D, Mafigiri, David K, Kapiga, Saidi, Sethi, Ajay K
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adhesion
Adult
AIDS
Alcohol Drinking
Alcohol use
Alcohols
Anti-HIV Agents - therapeutic use
Antiretroviral drugs
Biology and Life Sciences
CD4 antigen
CD4 Lymphocyte Count
Cohort analysis
Comparative analysis
Complications and side effects
Disorders
Drinking (Alcoholic beverages)
Female
Genetic aspects
HIV
HIV Infections - drug therapy
HIV Infections - immunology
HIV Infections - physiopathology
Human immunodeficiency virus
Humans
Immune response
Immunology
Infectious diseases
Lymphocytes T
Male
Mediation
Medicine and Health Sciences
Middle Aged
Patient Compliance
People and Places
Physical Sciences
Physiological aspects
Prospective Studies
Regression analysis
Statistical analysis
Strata
Studies
T cells
Uganda
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Summary:There is limited data on the effects of alcohol on immunological response among persons living with HIV (PLHIV) in sub-Saharan Africa. We assessed the relationship between hazardous alcohol use and CD4+ T-cell count, among PLHIV in Uganda. PLHIV aged ≥ 18 years were enrolled in a cohort study at the Infectious diseases clinic Kampala, Uganda. Alcohol consumption was assessed at enrolment (baseline) and 6 monthly thereafter using the alcohol use disorders identification test (AUDIT). The CD4+ T-cell counts, assessed at baseline and over the next 12 months were compared between alcohol use strata, using linear mixed effects regression. Using longitudinal mediation analysis methods, we estimated the effect of alcohol induced ART non-adherence on CD4+ T-cell count. Of the 1566 participants enrolled, 863(44.1%) were non-alcohol users (AUDIT score = 0), 433(27.7%) were non-hazardous (AUDIT score 1-7) alcohol users while 270 (17.2%) were hazardous (AUDIT score ≥ 8) alcohol users. The overall median (IQR) baseline CD4+ T-cell count was 356 (243-516) cells/μl. There were no differences in the median baseline CD4+ T-cell count between hazardous and non-hazardous alcohol users compared to non-alcohol users in both the non-ART (p = 0.43) and ART group (p = 0.77). The mean CD4+ T-cell count over 12 months was not different between hazardous alcohol users and non-alcohol users (non-ART group p = 0.88 and ART group p = 0.62), nor between non-hazardous alcohol users and non-alcohol users (and non-ART group p = 0.66 and ART group p = 0.20). Alcohol use was not associated with a significant natural direct effect on CD4+ T-cell count (1.37 95%CI [-1.78, 4.52] cells/μl, p = 0.39) but had a statistically significant natural indirect effect on reduction of CD4+ T-cell count (-0.91 cells/μl [-1.36, -0.45], p < 0.001) mediated through ART non-adherence. Hazardous alcohol use among PLHIV was not directly associated with lower CD4+ T-cell count but had a significant natural indirect effect on CD4+ T-cell count mediated through ART non-adherence. Among PLHIV with lower than expected CD4+ T-cell count, alcohol consumption should be excluded as an underlying factor for non-adherence to ART and any interventions targeting alcohol use should tackle possible ART non-adherence.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0180015