S R Cox1, A N Gupte1, B Thomas2, S Gaikwad3, V Mave4, C Padmapriyadarsini2, T R Sahasrabudhe5, D Kadam3, N Gupte4, L E Hanna2, A Kagal3, M Paradkar6, K Thiruvengadam2, D Jain7, S Atre8, K Sekar2, S Raskar6, S V B Y Shivakumar9, R Santhappan2, S Deshmukh6, N Pradhan6, V Kulkarni6, A Kakrani5, M S Barthwal5, T Sawant5, A DeLuca1, N Suryavanshi6, G Chander1, R Bollinger1, J E Golub1, A Gupta1. 1. Johns Hopkins University (JHU), School of Medicine, Baltimore, USA. 2. National Institute of Research in Tuberculosis (NIRT), Chennai. 3. Byramjee Jeejeebhoy Government Medical College (BJGMC) and Sassoon General Hospital, Pune. 4. Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune. 5. Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune. 6. Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India. 7. BJGMC Clinical Research Site, Pune. 8. Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune, Johns Hopkins India Private Limited, Pune, India. 9. Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, Johns Hopkins India Private Limited, Pune, India.
Abstract
BACKGROUND: Approximately 10% of incident TB cases worldwide are attributable to alcohol. However, evidence associating alcohol with unfavorable TB treatment outcomes is weak. METHODS: We prospectively evaluated men (≥18 years) with pulmonary TB in India for up to 24 months to investigate the association between alcohol use and treatment outcomes. Unhealthy alcohol use was defined as a score of ≥4 on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) scale at entry. Unfavorable TB treatment outcomes included failure, recurrence, and all-cause mortality, analyzed as composite and independent endpoints. RESULTS: Among 751 men, we identified unhealthy alcohol use in 302 (40%). Median age was 39 years (IQR 28-50); 415 (55%) were underweight (defined as a body mass index [BMI] <18.5 kg/m²); and 198 (26%) experienced an unfavorable outcome. Unhealthy alcohol use was an independent risk factor for the composite unfavorable outcome (adjusted incidence rate ratio [aIRR] 1.47, 95% CI 1.05-2.06; P = 0.03) and death (aIRR 1.90, 95% CI 1.08-3.34; P = 0.03), specifically. We found significant interaction between AUDIT-C and BMI; underweight men with unhealthy alcohol use had increased risk of unfavorable outcomes (aIRR 2.22, 95% CI 1.44-3.44; P < 0.001) compared to men with BMI ≥18.5 kg/m² and AUDIT-C <4. CONCLUSION: Unhealthy alcohol use was independently associated with unfavorable TB treatment outcomes, highlighting the need for integrating effective alcohol interventions into TB care.
BACKGROUND: Approximately 10% of incident TB cases worldwide are attributable to alcohol. However, evidence associating alcohol with unfavorable TB treatment outcomes is weak. METHODS: We prospectively evaluated men (≥18 years) with pulmonary TB in India for up to 24 months to investigate the association between alcohol use and treatment outcomes. Unhealthy alcohol use was defined as a score of ≥4 on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) scale at entry. Unfavorable TB treatment outcomes included failure, recurrence, and all-cause mortality, analyzed as composite and independent endpoints. RESULTS: Among 751 men, we identified unhealthy alcohol use in 302 (40%). Median age was 39 years (IQR 28-50); 415 (55%) were underweight (defined as a body mass index [BMI] <18.5 kg/m²); and 198 (26%) experienced an unfavorable outcome. Unhealthy alcohol use was an independent risk factor for the composite unfavorable outcome (adjusted incidence rate ratio [aIRR] 1.47, 95% CI 1.05-2.06; P = 0.03) and death (aIRR 1.90, 95% CI 1.08-3.34; P = 0.03), specifically. We found significant interaction between AUDIT-C and BMI; underweight men with unhealthy alcohol use had increased risk of unfavorable outcomes (aIRR 2.22, 95% CI 1.44-3.44; P < 0.001) compared to men with BMI ≥18.5 kg/m² and AUDIT-C <4. CONCLUSION: Unhealthy alcohol use was independently associated with unfavorable TB treatment outcomes, highlighting the need for integrating effective alcohol interventions into TB care.