title: The association between alcohol use, alcohol use disorders and tuberculosis (TB). A systematic review.
abstract: BACKGROUND
  In 2004, tuberculosis (TB) was responsible for 2.5% of global mortality (among men 3.1%; among women 1.8%) and 2.2% of global burden of disease (men 2.7%; women 1.7%). The present work portrays accumulated evidence on the association between alcohol consumption and TB with the aim to clarify the nature of the relationship.
  
  
  METHODS
  A systematic review of existing scientific data on the association between alcohol consumption and TB, and on studies relevant for clarification of causality was undertaken.
  
  
  RESULTS
  There is a strong association between heavy alcohol use/alcohol use disorders (AUD) and TB. A meta-analysis on the risk of TB for these factors yielded a pooled relative risk of 2.94 (95% CI: 1.89-4.59). Numerous studies show pathogenic impact of alcohol on the immune system causing susceptibility to TB among heavy drinkers. In addition, there are potential social pathways linking AUD and TB. Heavy alcohol use strongly influences both the incidence and the outcome of the disease and was found to be linked to altered pharmacokinetics of medicines used in treatment of TB, social marginalization and drift, higher rate of re-infection, higher rate of treatment defaults and development of drug-resistant forms of TB. Based on the available data, about 10% of the TB cases globally were estimated to be attributable to alcohol.
  
  
  CONCLUSIONS
  The epidemiological and other evidence presented indicates that heavy alcohol use/AUD constitute a risk factor for incidence and re-infection of TB. Consequences for prevention and clinical interventions are discussed.
authors: Public Health and Regulatory Policies, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. jtrehm@aol.com
authors: Jürgen
authors: J
authors: Rehm
authors: Andriy V
authors: AV
authors: Samokhvalov
authors: Manuela G
authors: MG
authors: Neuman
authors: Robin
authors: R
authors: Room
authors: Charles
authors: C
authors: Parry
authors: Knut
authors: K
authors: Lönnroth
authors: Jayadeep
authors: J
authors: Patra
authors: Vladimir
authors: V
authors: Poznyak
authors: Svetlana
authors: S
authors: Popova
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects*; D019973:Alcohol-Related Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis; D015995:Prevalence; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D014376:Tuberculosis / Q000209:etiology* / Q000401:mortality; D014455:Ukraine / Q000453:epidemiology