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Open Access The impact of alcohol use on tuberculosis treatment outcomes: a systematic review and meta-analysis

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Alcohol use is associated with increased risk of developing tuberculosis (TB) disease, yet the impact of alcohol use on TB treatment outcomes has not been summarized. We aimed to quantitatively review evidence of the relationship between alcohol use and poor TB treatment outcomes. We conducted a systematic review of PubMed, EMBASE, and Web of Science (January 1980–May 2018). We categorized studies as having a high- or low-quality alcohol use definition and examined poor treatment outcomes individually and as two aggregated definitions (i.e., including or excluding loss to follow-up [LTFU]). We analyzed drug-susceptible (DS-) and multidrug-resistant (MDR-) TB studies separately. Our systematic review yielded 111 studies reporting alcohol use as a predictor of DS- and MDR-TB treatment outcomes. Alcohol use was associated with increased odds of poor treatment outcomes (i.e., death, treatment failure, and LTFU) in DS (OR 1.99, 95% CI 1.57–2.51) and MDR-TB studies (OR 2.00, 95% CI 1.73–2.32). This association persisted for aggregated poor treatment outcomes excluding LTFU, each individual poor outcome, and across sub-group and sensitivity analyses. Only 19% of studies used high-quality alcohol definitions. Alcohol use significantly increased the risk of poor treatment outcomes in both DS- and MDR-TB patients. This study highlights the need for improved assessment of alcohol use in TB outcomes research and potentially modified treatment guidelines for TB patients who consume alcohol.
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Keywords: alcohol use disorder; drug-susceptible TB; multidrug-resistant TB; risk factors

Document Type: Research Article

Affiliations: 1: Section of Infectious Diseases, Boston Medical Center, Boston, MA 2: Department of Psychology, University of Maryland, College Park, MD 3: Department of Biostatistics, Boston University, Boston, MA 4: Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA 5: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa 6: Section of Infectious Diseases, Boston Medical Center, Boston, MA, Department of Biostatistics, Boston University, Boston, MA, Department of Global Health, Department of Epidemiology, Boston University, Boston, MA, USA 7: Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

Publication date: January 1, 2020

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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