Beer And Tb: What You Need To Know

Tuberculosis (TB) is an infectious disease that can be fatal if left untreated. It is spread when infected individuals cough, sneeze, or spread their saliva to others. While alcohol is unlikely to affect the results of a TB test, it is still advised that patients refrain from drinking for two to three days after the skin test. If a patient tests positive for TB, they are typically prescribed a combination of four antibiotics, and alcohol consumption is not recommended during this time as it can cause serious liver damage. Globally, approximately 10% of TB deaths are attributed to problematic alcohol use, and heavy alcohol use is associated with poor treatment adherence and loss of follow-up.

Alcohol consumption during TB treatment can lead to liver damage

Alcohol consumption is one of the leading causes of liver damage. When liver damage occurs due to alcohol, it is called alcohol-related liver disease. This disease can take three different forms: alcoholic fatty liver disease, alcoholic hepatitis, and alcoholic cirrhosis.

Alcoholic fatty liver disease is the most common form of alcohol-related liver disease, affecting up to 90% of heavy drinkers. It occurs when fat builds up in the liver, inhibiting its ability to break down fats. This condition typically has no symptoms, but can cause discomfort in the liver area and unexplained weight loss. Alcoholic fatty liver disease can be reversed by abstaining from alcohol, though for some, abstinence must be permanent.

If excessive alcohol consumption continues, inflammation levels can increase in the liver, leading to alcoholic hepatitis. This condition can be mild or severe, with severe cases being life-threatening. Alcoholic hepatitis can cause pain in the liver area, jaundice, and fatigue. As with alcoholic fatty liver disease, alcoholic hepatitis can be reversed by abstaining from alcohol, along with dietary changes and medications to reduce inflammation. In severe cases, a liver transplant may be necessary.

Continued liver damage due to alcohol consumption can lead to the formation of scar tissue, which replaces healthy liver tissue. This is known as fibrosis, and when extensive fibrosis occurs, it develops into alcoholic cirrhosis. Alcoholic cirrhosis can cause similar symptoms to alcoholic hepatitis, as well as portal hypertension, ascites, hepatic encephalopathy, bleeding from veins in the upper digestive tract, and an increased risk of infection. Alcoholic cirrhosis cannot be reversed, and treatment focuses on minimizing further liver damage and addressing any complications. In advanced cases, a liver transplant may be required.

To improve liver health, it is important to reduce alcohol consumption and make lifestyle changes such as eating a healthy diet, exercising regularly, and maintaining a healthy weight.

Problematic alcohol use is a key driver of poor TB treatment response

Alcohol use disorders (AUD) are characterised by a pattern of alcohol consumption that results in significant adverse consequences. People with AUD drink to excess, endangering themselves and others. Problem drinking, or alcohol abuse, refers to a pattern of alcohol use that leads to negative consequences such as relationship issues or arrests for driving under the influence (DUIs). Binge drinking and heavy alcohol use can increase the risk of developing AUD.

Problem drinking can lead to addiction, as chronic excessive alcohol use can result in physiological dependence. This means that an individual's body has adapted to the presence of alcohol, and they need it to feel normal and function. Those with AUD are unable to stop drinking once they start and often drink to avoid or minimise withdrawal symptoms.

AUD can have severe negative impacts on an individual's health, including short-term effects such as memory loss, hangovers, and blackouts, as well as long-term problems like stomach ailments, heart issues, cancer, brain damage, serious memory loss, and liver cirrhosis. Heavy drinking is also associated with an increased risk of death from automobile accidents, homicide, and suicide.

Problematic alcohol use can also worsen existing mental health conditions such as depression or induce new problems like anxiety and serious memory loss. Additionally, it can negatively impact interpersonal relationships, with spouses and children of heavy drinkers facing family violence, abuse, and neglect.

The negative consequences of problematic alcohol use can interfere with tuberculosis (TB) treatment response. TB treatment often requires strict adherence to a medication regimen, and alcohol abuse can impair an individual's ability to consistently take their medication as directed. Additionally, the physiological effects of alcohol abuse can compromise the body's ability to effectively absorb and utilise the TB medication. Furthermore, the social and interpersonal issues associated with problematic alcohol use can hinder access to adequate healthcare and support systems, which are crucial for successful TB treatment.

Heavy alcohol use impacts retention in care and is associated with missed DOT visits

Alcohol consumption is a major contributor to the global burden of disease and injury, and is a necessary underlying cause for more than 30 conditions, including infectious diseases, cancer, diabetes, neuropsychiatric diseases, cardiovascular disease, liver and pancreas disease, and unintentional and intentional injury.

Heavy alcohol use is associated with worse retention in HIV care. In a study of 9,694 people living with HIV, 25% reported heavy drinking, and 89% of the patients were retained. Heavy drinking was associated with inferior retention (adjusted OR (aOR) 0.78, 95% CI 0.69, 0.88), and daily/weekly binge drinking was associated with lower visit adherence (aOR=0.90, 95% CI 0.82, 0.98).

The study also found that current drug use was not significantly associated with worse retention for the alcohol drinking category model (OR=0.88, 95% CI 0.77, 1.00) but was significantly associated with worse retention in the binge frequency model (OR= 0.87, 95% CI 0.76, 0.99). Depressive symptoms were associated with improved retention (OR= 1.15, 95% CI 1.02, 1.30), while panic symptoms were not associated with retention.

These findings suggest that identifying and treating heavy and binge drinking in HIV clinical care settings may improve retention in HIV care, with downstream effects of improved clinical outcomes and decreased HIV transmission.

Alcohol use is associated with higher TB treatment failure, relapse and death rates

Alcohol use is associated with higher TB treatment failure, relapse, and death rates. Globally, an estimated 10% of TB deaths are attributable to problematic alcohol use. Problem alcohol use is a key driver of poor TB treatment response. Compared to patients who do not consume alcohol, those who do, especially those who engage in heavy episodic drinking, have been shown to have delayed culture conversion and higher rates of treatment failure, relapse, and death.

The causal pathways through which problem alcohol use impacts TB treatment outcomes are not well understood. This is largely due to the difficulties in studying patients with alcohol-related problems and a lack of detailed data on their TB medication adherence. Heavy alcohol use impacts retention in care and is associated with missed directly observed therapy (DOT) visits. One study showed that multidrug-resistant TB patients who consumed alcohol during treatment missed, on average, 18 more intensive phase doses.

Mouse models have shown that compared to controls, ethanol-consuming mice have significantly higher mycobacterial burden and impaired granuloma formation, as well as an impaired response to BCG vaccination. Alcohol has also been shown to inhibit phagocytic and bactericidal activity in macrophages, decrease the number and function of dendritic cells and neutrophils, and modulate T cell function, B cells, cytokine production, and the interferon gamma pathway. Furthermore, chronic heavy drinking is associated with inhibition of phagocytosis and decreased production of growth factors among innate immune cells.

Another hypothesized biological mechanism to explain the harmful impact of problem alcohol use on TB clinical outcomes is alcohol's influence on the pharmacokinetics (PK) and pharmacodynamics (PD) of TB drugs. A recent meta-analysis concluded that studies with lower default rates did not differ significantly in microbiologic failure, acquired drug resistance, or relapse compared to studies with higher default rates. This suggests that rather than adherence, the bioavailability of antituberculosis medications plays an important role in TB outcomes.

Alcohol has been shown to alter the intestinal absorption of second-line antituberculosis medications. However, the pathway to bioavailability is further complicated by protein binding and first-pass metabolism, which may also be affected by alcohol use. Studies on the impact of alcohol on the bioavailability of isoniazid have been contradictory. A detailed analysis of the PK and PD of all four TB drugs in patients with problem alcohol use will allow for a better understanding of which TB drugs are most impacted.

Alcohol use may cause biological mechanisms that contribute to poor TB clinical outcomes

Alcohol consumption is linked to a wide range of health issues and is a contributing factor to more than 200 diseases, injuries, and health conditions. While drinking alcohol can carry risks even at low levels, heavy episodic or continuous drinking is the primary cause of alcohol-related harm.

Alcohol use has been associated with an increased risk of developing noncommunicable diseases such as liver disease, heart disease, and various types of cancer. It is also a known carcinogen, increasing the likelihood of breast, liver, head and neck, oesophageal, and colorectal cancers. Furthermore, alcohol consumption can lead to mental health issues such as depression, anxiety, and alcohol use disorders.

In addition to the direct health risks, alcohol can also cause social problems, including family issues, difficulties at work, financial troubles, and unemployment.

The impact of alcohol consumption on an individual's health is influenced by several factors, including the amount consumed, drinking frequency, health status, age, sex, and personal characteristics.

Biological mechanisms resulting from alcohol use may contribute to poor TB clinical outcomes. Alcohol is known to suppress the immune system, impairing the body's ability to fight off infections. This suppression can hinder the body's defence mechanisms against TB, making it more challenging to achieve a successful clinical outcome.

Alcohol can also negatively affect the lungs, causing inflammation and reducing their ability to clear out harmful particles. This can exacerbate the symptoms of TB and make it more difficult for the body to recover.

Additionally, alcohol use can lead to malnutrition, which further weakens the body's ability to fight off infections and recover from TB. Alcohol can interfere with the absorption of nutrients, affecting the body's ability to utilise vitamins and minerals effectively.

Alcohol's impact on the digestive system can also contribute to poor TB clinical outcomes. Alcohol can damage the mucosal lining of the intestines, impairing nutrient absorption and disrupting the balance of gut bacteria. This can lead to gastrointestinal issues, further compromising the body's ability to recover from TB.

Furthermore, alcohol use can increase the risk of developing multidrug-resistant TB (MDR-TB). Alcohol can interfere with the effectiveness of TB medications, reducing their ability to eradicate the TB bacteria. This can lead to the development of drug-resistant strains, making the treatment more challenging and decreasing the likelihood of a successful clinical outcome.

In conclusion, alcohol use may cause biological mechanisms that contribute to poor TB clinical outcomes. The suppression of the immune system, negative effects on the lungs, malnutrition, gastrointestinal issues, and the development of MDR-TB are all factors that can hinder the body's ability to fight off TB and achieve a successful recovery.

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