title: Phosphatidylethanol (PEth) as a biomarker of alcohol consumption in HIV-positive patients in sub-Saharan Africa.
abstract: BACKGROUND
  Alcohol is heavily consumed in sub-Saharan Africa and affects HIV transmission and treatment and is difficult to measure. Our goal was to examine the test characteristics of a direct metabolite of alcohol consumption, phosphatidylethanol (PEth).
  
  
  METHODS
  Persons infected with HIV were recruited from a large HIV clinic in southwestern Uganda. We conducted surveys and breath alcohol concentration (BRAC) testing at 21 daily home or drinking establishment visits, and blood was collected on day 21 (n = 77). PEth in whole blood was compared with prior 7-, 14-, and 21-day alcohol consumption.
  
  
  RESULTS
  (i) The receiver operator characteristic area under the curve (ROC-AUC) was highest for PEth versus any consumption over the prior 21 days (0.92; 95% confidence interval [CI]: 0.86 to 0.97). The sensitivity for any detectable PEth was 88.0% (95% CI: 76.0 to 95.6) and the specificity was 88.5% (95% CI: 69.8 to 97.6). (ii) The ROC-AUC of PEth versus any 21-day alcohol consumption did not vary with age, body mass index, CD4 cell count, hepatitis B virus infection, and antiretroviral therapy status, but was higher for men compared with women (p = 0.03). (iii) PEth measurements were correlated with several measures of alcohol consumption, including number of drinking days in the prior 21 days (Spearman r = 0.74, p < 0.001) and BRAC (r = 0.75, p < 0.001).
  
  
  CONCLUSIONS
  The data add support to the body of evidence for PEth as a useful marker of alcohol consumption with high ROC-AUC, sensitivity, and specificity. Future studies should further address the period and level of alcohol consumption for which PEth is detectable.
authors.affiliation: Department of Medicine, University of California, San Francisco, 94143-0886, USA. judy.hahn@ucsf.edu
authors.forename: Judith A
authors.initials: JA
authors.lastname: Hahn
authors.forename: Loren M
authors.initials: LM
authors.lastname: Dobkin
authors.forename: Bernard
authors.initials: B
authors.lastname: Mayanja
authors.forename: Nneka I
authors.initials: NI
authors.lastname: Emenyonu
authors.forename: Isaac M
authors.initials: IM
authors.lastname: Kigozi
authors.forename: Stephen
authors.initials: S
authors.lastname: Shiboski
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: Heike
authors.initials: H
authors.lastname: Gnann
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Weinmann
authors.forename: Friedrich M
authors.initials: FM
authors.lastname: Wurst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000097:blood* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D001944:Breath Tests; D005260:Female; D020404:Glycerophospholipids / Q000097:blood*; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020404:Glycerophospholipids; C051521:phosphatidylethanol