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Lung

, Volume 194, Issue 5, pp 755–762 | Cite as

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

  • Sarah E. Jolley
  • Qasim Alkhafaf
  • Catherine Hough
  • David A. WelshEmail author
Article

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.

Keywords

Pneumonia severity Alcohol use disorder HIV/AIDS Respiratory illness 

Abbreviations

AUD

Alcohol use disorder

AUDIT

Alcohol use disorders identification test

HAART

Highly active antiretroviral therapy

HIV

Human immunodeficiency virus

IQR

Interquartile range

OI

Opportunistic infection

PLWH

People living with HIV

PSI

Pneumonia severity index

SpO2

Oxygen saturation

Notes

Acknowledgments

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.

Funding

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.

Ethical Approval

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.

Supplementary material

408_2016_9920_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sarah E. Jolley
    • 1
  • Qasim Alkhafaf
    • 1
  • Catherine Hough
    • 2
  • David A. Welsh
    • 1
    Email author
  1. 1.Section of Pulmonary/Critical Care Medicine and Allergy/ImmunologyLouisiana State University Health Sciences CenterNew OrleansUSA
  2. 2.Division of Pulmonary and Critical Care MedicineUniversity of WashingtonSeattleUSA

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