A new study by researchers at Boston University School of Medicine (BUSM) has found that a common health screening test used to detect unhealthy drinking patterns is rather unreliable in identifying alcohol use problems among HIV-infected patients.
The screening, favored by clinicians, measures patients’ carbohydrate-deficient transferring (CDT) biomarker and is capable of detecting heavy drinking among patients. However, it has never really been established whether this same test is effective in detecting dangerous alcohol use among people with HIV—a population that can be significantly affected by unhealthy alcohol use. According to the study’s lead researcher Jeffrey Samet, MD, MA, MPH, a professor of medicine at BUSM and his team, problem alcohol use is commonly experienced by HIV-infected individuals, even though their unhealthy drinking behavior can adversely hinder the effects of their HIV medication, lower their CD4 cell count, and lead to hepatic injury. Additionally, if HIV-infected patients have a comorbid viral hepatitis infection, both conditions are exacerbated by alcohol use. Identifying risky alcohol consumption among HIV-infected individuals, therefore, is pertinent to their safety and clinical care.
In the study, the research team analyzed whether the CDT test (measured in %CDT) was capable of detecting three varying levels of hazardous drinking among HIV-infected patients, rated as “at-risk,” “frequently heavy,” and “heavy” drinking. Among 300 HIV-infected patients, the researchers calculated participants’ %CDT and gamma glutamyltransferase levels, and compared these results to participants’ responses on the Timeline Followback questionnaire in which participants were asked to describe their current and past 30-day alcohol consumption as a reference standard.
Overall, 103 participants reported having “at risk” alcohol consumption, and 47 others reported having “heavy” alcohol consumption. However, based on the %CDT testing, detecting “at risk” drinking was only found among 28% of all participants with the hazardous drinking behavior. Additionally, the CDT test detected “heavy” drinking among just 36% of those with the unhealthy behavior. In particular, the CDT test’s sensitivity in detecting unhealthy alcohol use among women as well as those with viral hepatitis was low. Based on the results, the researchers concluded that the CDT test—which is otherwise effective in detecting hazardous drinking among normally healthy individuals—is not sensitive enough to detect unhealthy alcohol use among HIV-infected individuals.
The researchers describe that, while early intervention is successful in treating problem alcohol use, the early clinical signs of unhealthy alcohol consumption often go undiagnosed among patients with HIV infection. The CDT screening is not sufficient enough in providing accurate results from which clinicians can detect the problem behavior among their patients and offer treatment. The researchers recommend investigating whether other screening options are more reliable in detecting unhealthy alcohol use among this population. Meanwhile, the researchers advise that self-reported questionnaires are possibly the most resourceful and accurate source from which clinicians can screen for problem alcohol use among HIV-infected patients.
The new study, funded by the HRSA and NIH’s National Institute of Alcohol Abuse and Alcoholism, is currently available online in the journal AIDS Care.
Source: Medical News Today, The Importance Of Detecting Unhealthy Alcohol Use In The Clinical Care Of HIV-Infected Individuals, June 22, 2011