Presence of an Alcohol Use Disorder is Associated with Greater Pneumonia Severity in Hospitalized HIV-Infected Patients
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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.
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.
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.
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.
KeywordsPneumonia severity Alcohol use disorder HIV/AIDS Respiratory illness
Alcohol use disorder
Alcohol use disorders identification test
Highly active antiretroviral therapy
Human immunodeficiency virus
People living with HIV
Pneumonia severity index
SJ, QA, and DW conceived of the study and generated the study design. SJ completed the data analysis. SJ, QA, DW, CH, and SJ contributed to drafting and revision of the manuscript.
This work was funded by the following National Institutes of Health Grants: P60 AA009803, R24AA19661, PO1 HL076100, and U54 GM104940 (LA CaTS Center).
Compliance with Ethical Standards
Conflicts of interest
The authors have no significant conflicts of interest to report.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
- 2.Prevention CfDCa: today’s HIV/AIDS Epidemic. In: CDC (ed) (2015)Google Scholar
- 5.Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, Pickering RP, Ruan WJ, Smith SM, Huang B et al (2015) Epidemiology of DSM-5 alcohol use disorder: results from the national epidemiologic survey on alcohol and related conditions III. JAMA Psychiatry 72(8):757–766CrossRefPubMedGoogle Scholar
- 11.Babor T, Higgins-Biddle JC, Saunders JB, Monteiro MG (2001) The alcohol use disorder identification test: guidelines for use in primary care. In: WHO Publication, vol 01.6a. World Health Organization, GenevaGoogle Scholar
- 15.Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA (1998) The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory care quality improvement project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med 158(16):1789–1795CrossRefPubMedGoogle Scholar
- 18.Curran A, Falco V, Crespo M, Martinez X, Ribera E, Villar del Saz S, Imaz A, Coma E, Ferrer A, Pahissa A (2008) Bacterial pneumonia in HIV-infected patients: use of the pneumonia severity index and impact of current management on incidence, aetiology and outcome. HIV Med 9(8):609–615CrossRefPubMedGoogle Scholar
- 24.Galvan FH, Bing EG, Fleishman JA, London AS, Caetano R, Burnam MA, Longshore D, Morton SC, Orlando M, Shapiro M (2002) The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: results from the HIV Cost and Services Utilization Study. J Stud Alcohol 63(2):179–186CrossRefPubMedGoogle Scholar
- 31.Mandrekar P, Dolganiuc A, Bellerose G, Kodys K, Romics L, Nizamani R, Szabo G (2002) Acute alcohol inhibits the induction of nuclear regulatory factor kappa B activation through CD14/toll-like receptor 4, interleukin-1, and tumor necrosis factor receptors: a common mechanism independent of inhibitory kappa B alpha degradation? Alcohol Clin Exp Res 26(11):1609–1614PubMedGoogle Scholar
- 36.Boe DM, Richens TR, Horstmann SA, Burnham EL, Janssen WJ, Henson PM, Moss M, Vandivier RW (2010) Acute and chronic alcohol exposure impair the phagocytosis of apoptotic cells and enhance the pulmonary inflammatory response. Alcohol Clin Exp Res 34(10):1723–1732CrossRefPubMedPubMedCentralGoogle Scholar