title: Alcohol use and immune reconstitution among HIV-infected patients on antiretroviral therapy in Nairobi, Kenya.
abstract: Studies on the effects of alcohol use on HIV disease progression have been contradictory, with at least one study finding a positive effect of low alcohol consumption on CD4 count. In addition, most such studies have taken place in the developed West. We investigated the association between alcohol use and immune reconstitution through CD4 count response among HIV-infected individuals on antiretroviral therapy (ART) at an urban sub-Saharan African clinic. This was a retrospective cohort study of treatment-naïve HIV-infected adults initiating ART in Nairobi, Kenya and followed for 12 months between January 2009 and December 2012. At enrollment, a standardized questionnaire was used to collect data on sociodemographic variables and alcohol consumption. CD4 count was measured every six months. Linear regression models assessed the association between CD4 count and alcohol consumption, categorized as abstinent, moderate, or hazardous. Overall, 854 participants were included, 522 of which were women, with 85 (25.6%) men and 50 (9.6%) women reporting any alcohol use, and 8 (2.4%) men and 7 (1.3%) women reporting hazardous drinking. At baseline, alcohol use was associated with higher education and socioeconomic status. Median CD4 count was higher among alcohol users compared to those who abstained at baseline and at 6 and 12 months post-ART initiation, although this was only significant at 6 months. There were no differences in adherence between abstainers and drinkers. While overall alcohol use was significantly associated with higher CD4 counts, moderate and hazardous use treated separately were not. We conclude that, while alcohol use was associated with higher CD4 counts at 12 months post-ART, the mechanism for this association is unclear but may reflect unmeasured socioeconomic or nutritional differences. Additional research is required on the specific drinking patterns of this population and the types of alcoholic beverages consumed to clarify this relationship.
authors.affiliation: a Department of Global Health , University of Washington , Seattle , WA , USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Cagle
authors.affiliation: b Department Obstetrics & Gynecology , University of Texas Medical Branch , Galveston , TX , USA.
authors.forename: Christine
authors.initials: C
authors.lastname: McGrath
authors.affiliation: a Department of Global Health , University of Washington , Seattle , WA , USA.|c Department of Biostatistics , University of Washington , Seattle , WA , USA.|d Vaccine and Infectious Disease Division , Fred Hutchinson Cancer Research Center , Seattle , WA , USA.
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.affiliation: e Alcohol and Drug Abuse Institute, University of Washington , Seattle , WA , USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Donovan
authors.affiliation: f Coptic Hope Center, Coptic Hospital , Nairobi , Kenya.
authors.forename: Sameh
authors.initials: S
authors.lastname: Sakr
authors.affiliation: f Coptic Hope Center, Coptic Hospital , Nairobi , Kenya.
authors.forename: Nelly
authors.initials: N
authors.lastname: Yatich
authors.affiliation: f Coptic Hope Center, Coptic Hospital , Nairobi , Kenya.
authors.forename: Richard
authors.initials: R
authors.lastname: Ngomoa
authors.affiliation: g Centers for Disease Control and Prevention , Nairobi , Kenya.
authors.forename: Agnes
authors.initials: A
authors.lastname: Chepngeno Langat
authors.affiliation: a Department of Global Health , University of Washington , Seattle , WA , USA.|h Department of Epidemiology , University of Washington , Seattle , WA , USA.|i Department of Medicine , University of Washington , Seattle , WA , USA.
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
authors.affiliation: a Department of Global Health , University of Washington , Seattle , WA , USA.|h Department of Epidemiology , University of Washington , Seattle , WA , USA.|i Department of Medicine , University of Washington , Seattle , WA , USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Chung
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D000554:Ambulatory Care Facilities; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D000074243:Immune Reconstitution; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population
keywords: Africa; CD4 count; HIV; alcohol; antiretroviral therapy