Phosphatidylethanol (PEth) as a Biomarker of Alcohol Consumption in HIV-Positive Patients in Sub-Saharan Africa

Judith A. Hahn, Loren M. Dobkin, Bernard Mayanja, Nneka I. Emenyonu, Isaac M. Kigozi, Stephen Shiboski, David Bangsberg, Heike Gnann, Wolfgang Weinmann, Friedrich M. Wurst

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Abstract

Background: Alcohol is heavily consumed in sub-Saharan Africa and affects HIV transmission and treatment and is difficult to measure. Our goal was to examine the test characteristics of a direct metabolite of alcohol consumption, phosphatidylethanol (PEth). Methods: Persons infected with HIV were recruited from a large HIV clinic in southwestern Uganda. We conducted surveys and breath alcohol concentration (BRAC) testing at 21 daily home or drinking establishment visits, and blood was collected on day 21 (n=77). PEth in whole blood was compared with prior 7-, 14-, and 21-day alcohol consumption. Results: (i) The receiver operator characteristic area under the curve (ROC-AUC) was highest for PEth versus any consumption over the prior 21days (0.92; 95% confidence interval [CI]: 0.86 to 0.97). The sensitivity for any detectable PEth was 88.0% (95% CI: 76.0 to 95.6) and the specificity was 88.5% (95% CI: 69.8 to 97.6). (ii) The ROC-AUC of PEth versus any 21-day alcohol consumption did not vary with age, body mass index, CD4 cell count, hepatitis B virus infection, and antiretroviral therapy status, but was higher for men compared with women (p=0.03). (iii) PEth measurements were correlated with several measures of alcohol consumption, including number of drinking days in the prior 21days (Spearman r=0.74, p<0.001) and BRAC (r=0.75, p<0.001). Conclusions: The data add support to the body of evidence for PEth as a useful marker of alcohol consumption with high ROC-AUC, sensitivity, and specificity. Future studies should further address the period and level of alcohol consumption for which PEth is detectable.

Original languageEnglish (US)
Pages (from-to)854-862
Number of pages9
JournalAlcoholism: Clinical and Experimental Research
Volume36
Issue number5
DOIs
StatePublished - May 2012
Externally publishedYes

Fingerprint

Africa South of the Sahara
Biomarkers
Alcohol Drinking
Alcohols
HIV
Area Under Curve
Confidence Intervals
Drinking
Blood
Uganda
phosphatidylethanol
Virus Diseases
CD4 Lymphocyte Count
Hepatitis B virus
Metabolites
Viruses
Body Mass Index
Sensitivity and Specificity
Therapeutics
Testing

Keywords

  • Africa
  • Alcohol
  • Biomarker
  • HIV
  • Phosphatidylethanol

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health
  • Toxicology

Cite this

Phosphatidylethanol (PEth) as a Biomarker of Alcohol Consumption in HIV-Positive Patients in Sub-Saharan Africa. / Hahn, Judith A.; Dobkin, Loren M.; Mayanja, Bernard; Emenyonu, Nneka I.; Kigozi, Isaac M.; Shiboski, Stephen; Bangsberg, David; Gnann, Heike; Weinmann, Wolfgang; Wurst, Friedrich M.

In: Alcoholism: Clinical and Experimental Research, Vol. 36, No. 5, 05.2012, p. 854-862.

Research output: Contribution to journalArticle

Hahn, JA, Dobkin, LM, Mayanja, B, Emenyonu, NI, Kigozi, IM, Shiboski, S, Bangsberg, D, Gnann, H, Weinmann, W & Wurst, FM 2012, 'Phosphatidylethanol (PEth) as a Biomarker of Alcohol Consumption in HIV-Positive Patients in Sub-Saharan Africa', Alcoholism: Clinical and Experimental Research, vol. 36, no. 5, pp. 854-862. https://doi.org/10.1111/j.1530-0277.2011.01669.x
Hahn, Judith A. ; Dobkin, Loren M. ; Mayanja, Bernard ; Emenyonu, Nneka I. ; Kigozi, Isaac M. ; Shiboski, Stephen ; Bangsberg, David ; Gnann, Heike ; Weinmann, Wolfgang ; Wurst, Friedrich M. / Phosphatidylethanol (PEth) as a Biomarker of Alcohol Consumption in HIV-Positive Patients in Sub-Saharan Africa. In: Alcoholism: Clinical and Experimental Research. 2012 ; Vol. 36, No. 5. pp. 854-862.
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abstract = "Background: Alcohol is heavily consumed in sub-Saharan Africa and affects HIV transmission and treatment and is difficult to measure. Our goal was to examine the test characteristics of a direct metabolite of alcohol consumption, phosphatidylethanol (PEth). Methods: Persons infected with HIV were recruited from a large HIV clinic in southwestern Uganda. We conducted surveys and breath alcohol concentration (BRAC) testing at 21 daily home or drinking establishment visits, and blood was collected on day 21 (n=77). PEth in whole blood was compared with prior 7-, 14-, and 21-day alcohol consumption. Results: (i) The receiver operator characteristic area under the curve (ROC-AUC) was highest for PEth versus any consumption over the prior 21days (0.92; 95{\%} confidence interval [CI]: 0.86 to 0.97). The sensitivity for any detectable PEth was 88.0{\%} (95{\%} CI: 76.0 to 95.6) and the specificity was 88.5{\%} (95{\%} CI: 69.8 to 97.6). (ii) The ROC-AUC of PEth versus any 21-day alcohol consumption did not vary with age, body mass index, CD4 cell count, hepatitis B virus infection, and antiretroviral therapy status, but was higher for men compared with women (p=0.03). (iii) PEth measurements were correlated with several measures of alcohol consumption, including number of drinking days in the prior 21days (Spearman r=0.74, p<0.001) and BRAC (r=0.75, p<0.001). Conclusions: The data add support to the body of evidence for PEth as a useful marker of alcohol consumption with high ROC-AUC, sensitivity, and specificity. Future studies should further address the period and level of alcohol consumption for which PEth is detectable.",
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AU - Kigozi, Isaac M.

AU - Shiboski, Stephen

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