COVID-19 Pandemic-Related Changes in Alcohol use among Persons with HIV

COVID-19大流行及其导致的居家限制可能会严重影响酒精使用， 由于由此产生的心理痛苦、焦虑、无聊和社会孤立。我们在此提议， 研究正在进行的人群中酒精使用的变化以及对抗逆转录病毒（ART）依从性的影响 在美国（波士顿）和乌干达大流行期间和之后有饮酒史的艾滋病毒感染者（PWH） （姆巴拉拉）。在美国，酒类销售、工作日饮酒和提及饮酒都出现了激增 在网上乌干达COVID-19限制措施的影响尚不清楚。有些轶事 报告称，由于酒精的可及性低，饮酒量减少，但当限制饮酒时， 被解除了。威尔斯亲王有高水平的酒精使用和其他精神健康共病，因此可能在 在任何情况下增加或复发的风险都很高。因此，迫切需要进行研究，以量化大流行- 在不同环境下，重度饮酒的威尔斯亲王医院酒精使用的相关变化。此外，酒精使用 是抗逆转录病毒（ART）依从性差和病毒抑制效果差的一个持续强烈的风险因素;变化 酒精使用与艾滋病毒控制不良有关; 药物依从性未知。社会期望和回忆偏差阻碍了使用自我报告的调查 酒精和药物依从性，但药物水平和酒精消费的直接代谢产物作为 客观标记物，为剂量反应研究提供定量结果， 回溯测量因此，我们将使用酒精代谢物来测量先前的酒精使用情况。 干血斑（DBS）中的磷脂酰乙醇（PEth）（测量2-3周的酒精使用）和乙基 头发中的葡萄糖醛酸苷（EtG）（测量1-3个月的酒精使用），以及头发中的ART浓度 （测量数周至数月的ART），以补充自我报告。我们将利用正在进行的队列， NIAAA资助的URBAN头发分析联盟，以及UCSF头发分析实验室（HAL）， 丰富的经验，测量艺术在头发，以适应现有的实验室协议，头发EtG测试， 为PEth开发自动化DBS处理。我们的目标是（1）确定饮酒者的比例， 乌干达和美国的PWH在居家限制之前、期间和之后的重度酒精使用（n=125 每个），并描述每个队列中饮酒的变化;（2）检查头发和病毒中的ART水平是否 抑制率从COVID前到居家限制取消后的变化， （3）调整现有的HAL ART毛发分析方案，用于分析EtG，以实现上述目的，以及 开发和验证自动化DBS处理，以创建高通量PEth测试。这项工作将 进一步了解COVID-19大流行对酒精使用的影响及其在ART中的作用 坚持和病毒抑制，同时扩大酒精生物标志物检测能力的标本， 易于收集和运输，以改善未来对酒精使用的客观监测。

The COVID-19 pandemic and the resulting stay-home restrictions are likely to drastically impact alcohol use, due to the resulting psychological distress, anxiety, boredom, and social isolation. We propose here to examine changes in alcohol use and the impact on antiretroviral (ART) adherence in ongoing cohorts of people with HIV (PWH) with histories of alcohol use during and after the pandemic in the US (Boston) and Uganda (Mbarara). In the US, there has been a surge in alcohol sales, weekday drinking, and references to alcohol use on the internet. The impact of the COVID-19 restrictions in Uganda is not yet known. There are anecdotal reports of decreased drinking due to low accessibility of alcohol, but drinking may rebound when restrictions are lifted. PWH have high levels of alcohol use and other mental health co-morbidities, and therefore may be at high risk for increases or relapses in any setting. Research is hence urgently needed to quantify pandemic- related changes in alcohol use among PWH with heavy alcohol use in various settings. In addition, alcohol use is a consistently strong risk factor for poor antiretroviral (ART) adherence and poor viral suppression; changes in alcohol use are associated with poor HIV viral control; and the impact of the stay-home measures on medication adherence is unknown. Social desirability and recall bias impede investigations using self-report of alcohol and medication adherence, but drug levels and direct metabolites of alcohol consumption serve as objective markers, yielding quantitative results for dose-response investigations, with long half-lives for retrospective measurement. Thus, we will measure prior alcohol use using alcohol metabolite phosphatidylethanol (PEth) in dried blood spots (DBS) (measuring 2-3 weeks' alcohol use) and ethyl glucuronide (EtG) in hair (measuring 1-3 months' alcohol use), as well as ART concentrations in hair (measuring weeks to months' ART), to supplement self-report. We will leverage ongoing cohorts that are part of the NIAAA-funded URBAN ARCH consortium, as well as the UCSF Hair Analytic Laboratory (HAL), with vast experience measuring ART in hair, to adapt existing laboratory protocols to hair EtG testing, and to develop automated DBS processing for PEth. We aim to (1) determine the proportion of drinkers with regular heavy alcohol use before, during, and after stay-home restrictions among PWH in Uganda and the US (n=125 each), and characterize changes in drinking in each cohort; (2) examine whether ART levels in hair and viral suppression rates change from pre-COVID to after stay-home restrictions are lifted, and the role of changing alcohol use; and (3) adapt existing HAL ART hair assay protocols for analysis of EtG for the above aims, and to develop and validate automated DBS processing to create high-throughput PEth testing. This work will advance our understanding of the impact of the COVID-19 pandemic on alcohol use and its role in ART adherence and viral suppression, while expanding alcohol biomarker testing capability in specimens which are easy-to-collect and ship to improve objective monitoring of alcohol use into the future.