Comments(1)

Alcohol and Tuberculosis, what is the confounder?

Nico Nagelkerke   (20 April 2009)  United Arab Emirates University

I read with great interest and pleasure the excellent review on the association between alcohol and tuberculosis by Lönnroth et al. The authors recognize that the association between alcohol (ab)use may not be directly causal but may also be caused by confounding. Nevertheless the authors seem to favour a, possible indirect, causal effect.

There is however an obvious potential confounder that the authors seem to overlook entirely. It has been hypothesized (Emerg Infect Dis. 2004 Nov;10(11):2055-6) that an as yet unidentified sexually transmitted virus may cause susceptibility to pulmonary tuberculosis after infection with M.tuberculosis. If so, then factors associated with sexual risk taking should also be associated with tuberculosis. The finding that alcohol abuse is associated with TB seems to fit this pattern perfectly. Alcohol (ab)use is also correlated with sexual risk taking. Thousands of publications on this association can easily be identified via PubMed. This association is very well established, is strong, is found across many cultures, and may thus confound the relationship between alcohol and tuberculosis.

Competing interests

None declared

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