# The Role of Alcohol Use in Lung Disease After Treatment for Active TB Disease Among Persons Living with HIV

> **NIH NIH P01** · BOSTON MEDICAL CENTER · 2021 · $459,981

## Abstract

ABSTRACT
Tuberculosis (TB) is the leading cause of death from a single infectious agent and the leading cause of death
in people living with HIV (PLWH). An estimated 8.5 million people with TB are cured every year but many do
not return to full health. Up to half of those completing treatment for pulmonary TB have post-TB lung disease,
a disabling under-diagnosed group of lung deficits. Lung deficits at TB treatment completion are the strongest
predictors of post-TB lung disease severity up to a year later. Alcohol and HIV are associated with lung
immune dysfunction and alcohol use is associated with delayed TB diagnosis, increasing the risk of lung injury
during active TB disease. However, it is not known whether alcohol use is associated with post-TB lung
disease in PLWH. We hypothesize that hazardous drinking increases susceptibility to and worsens post-TB
lung disease in PLWH. Our objective is to investigate hazardous drinking (Alcohol Use Disorders Identification
Test [AUDIT] ≥8) as a modifiable risk factor for post-TB lung disease in PLWH. To achieve this, we propose a
2-year observational study of 200 PLWH completing inpatient pulmonary TB treatment in St. Petersburg,
Russia. We will evaluate the following post-TB lung disease outcomes: functional exercise capacity (primary
outcome assessed by 6-minute walk distance), lung physiology (pulmonary function tests), anatomy (CT scan),
and lung infections. The primary exposure is past-year hazardous drinking. Secondary alcohol measures will
include 30-day Timeline Followback (calendar-based method of alcohol use recall) and phosphatidylethanol
(PEth; a biomarker of recent alcohol use). Our expertise spans alcohol use, HIV, TB, pulmonology,
epidemiology, and biostatistics. Our primary aim (Aim 1a) is to determine the relationship between past-year
hazardous drinking and post-TB lung disease. In Aim 1b we assess the association of past-month heavy
drinking and post-TB lung disease progression over time. In Aim 1c we explore whether smoking modifies the
association of past-month heavy drinking and post-TB lung disease progression over time. Heavy drinking in
Aims 1b and 1c is defined by Timeline Followback as ≥7 drinks/week (women) or ≥14 drinks/week (men) or
PEth>200 ng/mL. In Aim 2, we will qualitatively evaluate factors that can improve tailoring of pharmaco-
behavioral alcohol and smoking interventions in PLWH receiving TB treatment. We will conduct in-depth
interviews with 24 PLWH during or after inpatient TB treatment and 12 TB healthcare providers. IMPACT: We
will determine the association of alcohol use and post-TB lung disease in PLWH. Our quantitative and
qualitative data will lay the foundation for future work to tailor alcohol and smoking interventions to improve
long-term health in HIV/TB co-infection.

## Key facts

- **NIH application ID:** 10303987
- **Project number:** 1P01AA029541-01
- **Recipient organization:** BOSTON MEDICAL CENTER
- **Principal Investigator:** Kaku So-Armah
- **Activity code:** P01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $459,981
- **Award type:** 1
- **Project period:** 2021-09-10 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10303987

## Citation

> US National Institutes of Health, RePORTER application 10303987, The Role of Alcohol Use in Lung Disease After Treatment for Active TB Disease Among Persons Living with HIV (1P01AA029541-01). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10303987. Licensed CC0.

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