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

Lung volume 194, pages 755–762 (2016)Cite this 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.

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Fig. 1
Fig. 2

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

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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).

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Author notes

    Affiliations

    1. Section of Pulmonary/Critical Care Medicine and Allergy/Immunology, Louisiana State University Health Sciences Center, 1901 Perdido Street, Suite 3205, New Orleans, LA, 70112, USA

      Sarah E. Jolley, Qasim Alkhafaf & David A. Welsh

    2. Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA

      Catherine Hough

    Authors
    1. Sarah E. Jolley
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    2. Qasim Alkhafaf
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    3. Catherine Hough
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    4. David A. Welsh
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    Correspondence to David A. Welsh.

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    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.

    Additional information

    Sarah E. Jolley and Qasim Alkhafaf have contributed equally.

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    Jolley, S.E., Alkhafaf, Q., Hough, C. et al. Presence of an Alcohol Use Disorder is Associated with Greater Pneumonia Severity in Hospitalized HIV-Infected Patients. Lung 194, 755–762 (2016). https://doi.org/10.1007/s00408-016-9920-1

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    • DOI: https://doi.org/10.1007/s00408-016-9920-1

    Keywords

    • Pneumonia severity
    • Alcohol use disorder
    • HIV/AIDS
    • Respiratory illness