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Point-of-Care Urine Ethyl Glucuronide Testing to Detect Alcohol Use Among HIV-Hepatitis B Virus Coinfected Adults in Zambia

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Abstract

In an HIV-hepatitis B virus (HIV-HBV) coinfection cohort in Zambia, we piloted a qualitative point-of-care (POC) test for urine Ethyl glucuronide (uEtG), assessed concordance between uEtG and alcohol use disorders identification test-consumption (AUDIT-C), and identified epidemiological factors associated with underreporting (defined as uEtG-positivity with last reported drink > 7 days prior). Among 211 participants (40.8% women), there were 44 (20.8%) lifetime abstainers, 32 (15.2%) former drinkers, and 135 (64.0%) current drinkers, including 106 (50.2%) with unhealthy drinking per AUDIT-C. Eighty-seven (41.2%) were uEtG-positive including 64 of 65 (98.5%) who drank ≤ 3 days prior and 17 of 134 (12.7%) underreported, all of whom admitted to recent drinking when results were discussed. uEtG was moderately concordant with AUDIT-C. Past drinking (versus lifetime abstinence) and longer time on antiretrovirals (≥ 12 months) were associated with underreporting. These data support further use of POC alcohol biomarkers in HIV and hepatitis research and clinical settings.

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References

  1. Hahn JA, Woolf-King SE, Muyindike W. Adding fuel to the fire: alcohol’s effect on the HIV epidemic in Sub-Saharan Africa. Current HIV/AIDS Reports. 2011;8(3):172–80.

    Article  PubMed  Google Scholar 

  2. Kalichman SC, Simbayi LC, Kaufman M, Cain D, Jooste S. Alcohol use and sexual risks for HIV/AIDS in sub-Saharan Africa: systematic review of empirical findings. Prev Sci. 2007;8(2):141.

    Article  PubMed  Google Scholar 

  3. Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr. 2009;52(2):180.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jaquet A, Ekouevi DK, Bashi J, Aboubakrine M, Messou E, Maiga M, et al. Alcohol use and non-adherence to antiretroviral therapy in HIV-infected patients in West Africa. Addiction. 2010;105(8):1416–21.

    Article  PubMed  Google Scholar 

  5. Kahler CW, Liu T, Cioe PA, Bryant V, Pinkston MM, Kojic EM, et al. Direct and indirect effects of heavy alcohol use on clinical outcomes in a longitudinal study of HIV patients on ART. AIDS Behav. 2017;21(7):1825–35.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Canan C, Lau B, McCaul M, Keruly J, Moore R, Chander G. Effect of alcohol consumption on all-cause and liver-related mortality among HIV-infected individuals. HIV Med. 2017;18:332–41.

    Article  PubMed  CAS  Google Scholar 

  7. Justice AC, McGinnis KA, Tate JP, Braithwaite RS, Bryant KJ, Cook RL, et al. Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men. Drug Alcohol Depend. 2016;161:95–103.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Salmon-Ceron D, Lewden C, Morlat P, Bévilacqua S, Jougla E, Bonnet F, et al. Liver disease as a major cause of death among HIV infected patients: role of hepatitis C and B viruses and alcohol. J Hepatol. 2005;42(6):799–805.

    Article  PubMed  CAS  Google Scholar 

  9. Jee SH, Ohrr H, Sull JW, Samet JM. Cigarette smoking, alcohol drinking, hepatitis B, and risk for hepatocellular carcinoma in Korea. J Natl Cancer Inst. 2004;96(24):1851–6.

    Article  PubMed  Google Scholar 

  10. Asiimwe SB, Fatch R, Emenyonu NI, Muyindike WR, Kekibiina A, Santos GM, et al. Comparison of traditional and novel self-report measures to an alcohol biomarker for quantifying alcohol consumption among HIV-infected adults in sub-Saharan Africa. Alcoholism. 2015;39(8):1518–27.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Del Boca FK, Darkes J. The validity of self-reports of alcohol consumption: state of the science and challenges for research. Addiction. 2003;98(s2):1–12.

    Article  PubMed  Google Scholar 

  12. Sundararajan R, Wyatt MA, Woolf-King S, Pisarski EE, Emenyonu N, Muyindike WR, et al. Qualitative study of changes in alcohol use among HIV-infected adults entering care and treatment for HIV/AIDS in rural southwest Uganda. AIDS Behav. 2015;19(4):732–41.

    Article  PubMed  Google Scholar 

  13. Anton RF. Commentary on: ethylglucuronide and ethyl sulfate assays in clinical trials, interpretation 1 and limitations: results of a dose ranging alcohol challenge study and two clinical trials. Alcohol Clin Exp Res. 2014;38(7):1826.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Jatlow PI, Agro A, Wu R, Nadim H, Toll BA, Ralevski E, et al. Ethyl glucuronide and ethyl sulfate assays in clinical trials, interpretation, and limitations: results of a dose ranging alcohol challenge study and 2 clinical trials. Alcoholism. 2014;38(7):2056–65.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Leickly E, McDonell MG, Vilardaga R, Angelo FA, Lowe JM, McPherson S, et al. High levels of agreement between clinic-based ethyl glucuronide (EtG) immunoassays and laboratory-based mass spectrometry. Am J Drug Alcohol Abuse. 2015;41(3):246–50.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hahn JA, Emenyonu NI, Fatch R, Muyindike WR, Kekiibina A, Carrico AW, et al. Declining and rebounding unhealthy alcohol consumption during the first year of HIV care in rural Uganda, using phosphatidylethanol to augment self-report. Addiction. 2016;111(2):272–9.

    Article  PubMed  Google Scholar 

  17. Papas RK, Gakinya BN, Mwaniki MM, Keter AK, Lee H, Loxley MP, et al. Associations between the phosphatidylethanol alcohol biomarker and self-reported alcohol use in a sample of HIV-infected outpatient drinkers in western Kenya. Alcoholism. 2016;40(8):1779–87.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Wandeler G, Musukuma K, Zuercher S, Vinikoor MJ, Llenas J, Musa A, et al. Hepatitis B infection, viral load and resistance in HIV-infected patients in Mozambique and Zambia. PLoS ONE. 2016;11:e0152043.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Zambian Ministry of Health. Zambia consolidated guidelines for the treatment and prevention of HIV infection. Zambia: Lusaka; 2014.

    Google Scholar 

  20. Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcoholism. 2007;31(7):1208–17.

    Article  PubMed  Google Scholar 

  21. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med. 1998;158(16):1789–95.

    Article  PubMed  CAS  Google Scholar 

  22. Arndt T, Grüner J, Schröfel S, Stemmerich K. False-positive ethyl glucuronide immunoassay screening caused by a propyl alcohol-based hand sanitizer. Forensic Sci Int. 2012;223(1):359–63.

    Article  PubMed  CAS  Google Scholar 

  23. Chishinga N, Kinyanda E, Weiss HA, Patel V, Ayles H, Seedat S. Validation of brief screening tools for depressive and alcohol use disorders among TB and HIV patients in primary care in Zambia. BMC Psychiatry. 2011;11(1):1.

    Article  Google Scholar 

  24. Parry CD, Kekwaletswe C, Shuper PA, Nkosi S, Myers BJ, Morojele NK. Heavy alcohol use in patients on highly active antiretroviral therapy: what responses are needed? SAMJ. 2016;106(6):567–8.

    Article  Google Scholar 

  25. Frezza M, di Padova C, Pozzato G, Terpin M, Baraona E, Lieber CS. High blood alcohol levels in women: the role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism. N Engl J Med. 1990;322(2):95–9.

    Article  PubMed  CAS  Google Scholar 

  26. Crane HM, Nance RM, Merrill JO, Hutton H, Chander G, McCaul ME, et al. Not all non-drinkers with HIV are equal: demographic and clinical comparisons among current non-drinkers with and without a history of prior alcohol use disorders. AIDS Care. 2017;29(2):177–84.

    Article  PubMed  Google Scholar 

  27. McDonell MG, Graves MC, West II, Ries RK, Donovan DM, Bumgardner K, et al. Utility of point-of-care urine drug tests in the treatment of primary care patients with drug use disorders. J Addict Med. 2016;10(3):196–201.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  28. McDonell MG, Leickly E, McPherson S, Skalisky J, Srebnik D, Angelo F, et al. A randomized controlled trial of ethyl glucuronide-based contingency management for outpatients with co-occurring alcohol use disorders and serious mental illness. Am J Psychiatry. 2017;174(4):370–7.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We acknowledge the CIDRZ Hep Team for their dedication to the HIV-HBV coinfection cohort and their specific role in Ethyl glucuronide testing and alcohol reduction counseling for this study. This study was funded by the Fogarty International Center (K01TW009998) and the National Institute of Allergy and Infectious Diseases (U01AI120796) at the U.S. National Institutes of Health.

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Authors and Affiliations

  1. Centre for Infectious Disease Research in Zambia, 5032 Great North Road, PO Box 34681, Lusaka, Zambia

    Michael J. Vinikoor, Zude Zyambo & Monde Muyoyeta

  2. Department of Medicine, University of Alabama at Birmingham, Birmingham, USA

    Michael J. Vinikoor & Michael S. Saag

  3. School of Medicine, University of Zambia, Lusaka, Zambia

    Michael J. Vinikoor & Monde Muyoyeta

  4. Department of Medicine, Johns Hopkins University, Baltimore, USA

    Geetanjali Chander

  5. Department of Psychiatry, University of Alabama at Birmingham, Birmingham, USA

    Karen Cropsey

Authors
  1. Michael J. Vinikoor
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  2. Zude Zyambo
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  4. Geetanjali Chander
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  5. Michael S. Saag
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Correspondence to Michael J. Vinikoor.

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Vinikoor, M.J., Zyambo, Z., Muyoyeta, M. et al. Point-of-Care Urine Ethyl Glucuronide Testing to Detect Alcohol Use Among HIV-Hepatitis B Virus Coinfected Adults in Zambia. AIDS Behav 22, 2334–2339 (2018). https://doi.org/10.1007/s10461-018-2030-8

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  • DOI: https://doi.org/10.1007/s10461-018-2030-8

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