Alcohol interventions for persons with HIV: Meta-analysis of randomized controlled trials using phosphatidylethanol and self-report

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence Pub Date : 2025-09-12 DOI:10.1016/j.drugalcdep.2025.112879

Judith A. Hahn , Jeremy C. Kane , Robin Fatch , Cristina Espinosa da Silva , Nneka I. Emenyonu , Aaron Scheffler , Priya Chirayil , Kaku So-Armah , Christopher W. Kahler , Amy A. Conroy , E. Jennifer Edelman , Sarah Woolf-King , Charles DH Parry , Susan M. Kiene , Gabriel Chamie , Winnie R. Muyindike , Julian Adong , Vivian F. Go , Robert L. Cook , Neo K. Morojele , Isabel Elaine Allen

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引用次数: 0

Abstract

Background

Interventions are needed to reduce alcohol use for people living with HIV (PWH), but prior randomized controlled trials (RCT) evaluated efficacy by self-reported alcohol use, potentially hampering validity. We aimed to determine alcohol intervention efficacy using the alcohol biomarker, phosphatidylethanol (PEth), combined with self-report, and compare results to each analysed alone.

Methods

We conducted a systematic review of alcohol intervention RCTs to April 2023, followed by an individual participant data meta-analysis (IPD-MA) using two-step random effects modeling. Our primary outcome was unhealthy alcohol use defined as PEth/self-report (binary), i.e., PEth≥ 50 ng/mL or Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) ≥ 3 (women) and ≥ 4 (men). We also evaluated PEth and self-report alone.

Results

We screened 280 studies, found 20 eligible, and obtained IPD for 16 (N = 3559, median age=41, 72.8 % male). Participants receiving an alcohol intervention had significantly lower odds of follow-up unhealthy alcohol use by PEth/self-report (OR=0.69, 95 % CI: 0.55–0.86; Cohen’s d=0.21; I²=29.4 %, 95 % CI: 0.0 %-62.8 %). Risk-of-bias assessment indicated low or moderate risk. The certainty of evidence was moderate. Findings for PEth alone (OR=0.81, 95 % CI: 0.69–0.97; Cohen’s d=0.12; I²=5.7 %, 95 % CI: 0.0 %-49.5 %) and self-report alone (OR=0.67, 95 % CI: 0.50–0.89; Cohen’s d=0.22; I²=68.7 %, 95 % CI: 6.6 %-84.5 %) outcomes were similar, but heterogeneity was greater for self-report alone. Findings were robust to higher PEth/self-report cutoffs and continuous measures.

Conclusions

Results confirm prior findings of significant efficacy of alcohol interventions for PWH. Effect sizes were small across measurements, while heterogeneity was high when using self-report alone. Combined PEth/self-report is a useful primary outcome for alcohol intervention studies.

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酒精对HIV感染者的干预：使用磷脂酰乙醇和自我报告的随机对照试验的荟萃分析

背景：需要采取干预措施来减少艾滋病毒感染者（PWH）的酒精使用，但之前的随机对照试验（RCT）通过自我报告的酒精使用来评估疗效，这可能会阻碍有效性。我们的目的是利用酒精生物标志物磷脂酰乙醇（PEth）结合自我报告来确定酒精干预效果，并将结果与单独分析的结果进行比较。方法对截至2023年4月的酒精干预随机对照试验进行系统回顾，随后采用两步随机效应模型进行个体参与者数据荟萃分析（IPD-MA）。我们的主要结局是不健康的酒精使用，定义为PEth/自我报告（二进制），即PEth≥50 ng/mL或酒精使用障碍识别测试-消费(AUDIT-C)≥3（女性）和≥4（男性）。我们还单独评估了PEth和自我报告。结果我们筛选了280项研究，发现20项符合条件，并获得了16项IPD （N = 3559，中位年龄=41，男性占72.8%）。通过PEth/自我报告，接受酒精干预的参与者在随访中不健康饮酒的几率显著降低（OR=0.69, 95% CI: 0.55-0.86; Cohen’s d=0.21; I2= 29.4%, 95% CI: 0.0% - 62.8%）。偏倚风险评估显示为低或中等风险。证据的确定性是中等的。单独使用PEth （OR=0.81, 95% CI: 0.69-0.97; Cohen’s d=0.12; I2= 5.7%, 95% CI: 0.0% - 49.5%）和单独使用自我报告（OR=0.67, 95% CI: 0.50-0.89; Cohen’s d=0.22; I2= 68.7%, 95% CI: 6.6% - 84.5%）的结果相似，但单独使用自我报告的异质性更大。研究结果对于更高的PEth/自我报告截止值和持续测量是稳健的。结论：结果证实了先前的研究结果，即酒精干预对PWH有显著的疗效。测量结果的效应量很小，而单独使用自我报告时，异质性很高。联合PEth/自我报告是酒精干预研究的一个有用的主要结果。

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来源期刊

Drug and alcohol dependence 医学-精神病学

CiteScore

7.40

自引率

7.10%

发文量

409

审稿时长

41 days

期刊介绍： Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.