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Effects of Sex and Alcohol Use on Antiretroviral Therapy Outcomes in Botswana: A Cohort Study.

Effects of Sex and Alcohol Use on Antiretroviral Therapy Outcomes in Botswana: A Cohort Study.
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Gross R, Bellamy SL, Ratshaa B, Han X, Steenhoff AP, Mosepele M, Bisson GP,


Gross R, Bellamy SL, Ratshaa B, Han X, Steenhoff AP, Mosepele M, Bisson GP, (click to view)

Gross R, Bellamy SL, Ratshaa B, Han X, Steenhoff AP, Mosepele M, Bisson GP,

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Addiction (Abingdon, England) 2016 7 22() doi 10.1111/add.13538

Abstract
AIMS
To determine alcohol use’s effect on HIV treatment success and whether alcohol use mediates the relation between male sex and treatment failure.

DESIGN
Longitudinal cohort study.

SETTING
Eight HIV clinics in and near Gaborone, Botswana.

PARTICIPANTS
938 HIV-infected treatment naïve adults initiating regimens containing the antiretroviral medication efavirenz between June 2009 and February 2013, including 478 (51%) males, median age 38 years, and plasma HIV RNA 4 · 9 log10 copies/ml.

MEASUREMENTS
Primary outcome was a composite of treatment failure over 6 months including death, loss to care, or plasma HIV RNA >25 copies/ml. Exposures included alcohol use and gender.

FINDINGS
Failure in 339 (36%) participants included 40 (4%) deaths, 194 (21%) lost to care, and 105 (11%) with HIV RNA > 25 copies/ml. Both hazardous alcohol use in the past year [aOR 1 · 4 (95% CI: 1 · 0, 1 · 9)] and male sex [aOR 2 · 1 (95% CI: 1 · 5, 2 · 9)] were associated with failure. Alcohol use was more common among men (51%) than women (19%), p < 0 · 001. There was no difference in alcohol use's effect on failure between sexes (p for interaction > 0.5). Controlling for hazardous alcohol use did not change the relation between sex and failure.

CONCLUSION
Alcohol use among HIV-infected adults in Botswana appears to worsen HIV treatment outcomes. Alcohol use does not appear to have either a mediating or a moderating effect on the relation between gender and HIV treatment outcome failure.

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