Effects of experimentally-induced reductions in alcohol consumption on brain cognitive, and clinical outcomes and motivation for changing drinking in older persons with HIV infection

摘要 艾滋病毒感染者（PLWH）是COVID-19大流行中特别脆弱的人群，因为他们 免疫系统受损和合并症（例如，物质使用，心理健康问题）。当前没有任何 研究已经研究了COVID-19的广泛影响（例如，长期的社会孤立、焦虑、家庭 损失）正在影响PLWH中的酒精使用和护理参与。此外，目前还不清楚这些影响是否 影响认知或大脑。这一紧急补充将使我们能够抓住这一机会之窗， 及时收集数据，以弥补这些差距。我们正在进行的U 01研究的队列组成的PLWH和人 如果没有艾滋病毒，重点是使用应急管理协议，以减少酒精消费， 许多独特的优势来支持这种补充。这项补助属于父母补助金的范围 但通过将COVID-19相关问题/措施纳入正在进行的数据来扩展母研究 收藏.我们将通过问卷调查、电子在家认知测试、 CANTAB Connect，通过头发样本的皮质醇分析进行压力严重程度量化， 采访我们还将进行COVID-19抗体检测（通过血液样本）和我们进行的MRI 作为家长授权程序的一部分该补充的具体目标包括：1）确定 特定心理社会因素的影响（例如，社会孤立、孤独、焦虑、食物和住房 不安全）对酒精使用轨迹和艾滋病毒相关的健康行为和结果（ART依从性， 及保持社交距离。我们还将研究哪些 基线因素（例如，临床、人口统计学、神经影像学、认知）最能预测 结果; 2）评估（1）在家，电子传递神经认知的可行性和可接受性 在CANTAB Connect系统上进行评估和（2）参与者邮寄头发样本。对于那些愿意和 能够完成这些措施中的一项或两项，我们将检查心理社会因素的关系 目标1中评估的认知表现和/或压力严重程度（通过毛发中的皮质醇水平测量） 从参与者获得的样本; 3）从参与者获得额外的神经成像，以确保我们有 冠状病毒危机前后的数据，以及（如果有足够的流行率），确定 被发现感染COVID-19的参与者（有或没有症状）是否有更大的 FLAIR脑MRI上的白色超敏反应（WMH）程度，沿着其他相关结构， 功能性和代谢性脑变化（fMRI，MRS）;以及探索性目的， 访谈，以探讨主观判断为干扰戒酒和艾滋病毒的因素 药物依从性，以及在这方面可能有帮助的方法。这些结果将提供有价值的证据， COVID-19大流行除了影响认知和大脑的变化外，还影响酒精使用和艾滋病毒护理， 这可以潜在地在未来的紧急情况期间通知未来的预防和治疗方案。

Abstract Persons living with HIV (PLWH) are an especially vulnerable population in the COVID-19 pandemic given their compromised immune system and comorbidities (e.g., substance use, mental health issues). Currently, no research has examined how the broad impacts of COVID-19 (e.g., extended social isolation, anxiety, family loss) are affecting alcohol use and care engagement in PLWH. Further, it is unclear whether these impacts affect cognition or the brain. This urgent supplement will allow us to capture this window of opportunity and collect timely data to address these gaps. Our ongoing U01 study of a cohort consisting of PLWH and persons without HIV focusing on using a contingency management protocol to reduce alcohol consumption provides many unique strengths to support this supplement. This supplement is within the scope of the parent grant but extents the parent study by incorporating COVID-19-related questions/measures into the ongoing data collection. We will collect additional data through questionnaires, electronic at-home cognitive testing via CANTAB Connect, stress severity quantification via cortisol analysis of hair samples, and qualitative interviews. We will also conduct COVID-19 antibody tests (through blood samples) and MRIs that we conduct as part of the parent grant procedure. The specific aims of this supplement include: 1) Determine the influence of specific psychosocial factors (e.g., social isolation, loneliness, anxiety, and food and housing insecurity) on alcohol use trajectory and HIV-related health behavior and outcomes (ART adherence, and health care engagement) during the period of the pandemic and social distancing. We will also examine which baseline factors (e.g., clinical, demographic, neuroimaging, cognitive) best predict individual differences in outcome; 2) Assess the feasibility and acceptability of (1) an at-home, electronically delivered neurocognitive assessment on the CANTAB Connect system and (2) participant mail-in hair samples. For those willing and able to complete one or both of these measures, we will examine the relationships of the psychosocial factors assessed in Aim 1 on cognitive performance and/or stress severity as measured by cortisol levels from hair samples obtained from participants; 3) Obtain additional neuroimaging from participants to ensure we have data from both before and after the coronavirus crisis, and (should there be sufficient prevalence), determine whether participants found to have been infected with COVID-19 (with or without symptoms) have a greater extent of white matter hypersensitivity (WMH) on FLAIR brain MRI, along with other associated structural, functional, and metabolic brain changes (fMRI, MRS); and an exploratory aim to will conduct a qualitative interview to explore factors that are subjectively judged to be interfering with drinking abstinence and HIV medication adherence, and what might help in this regard. These results will provide valuable evidence on how the COVID-19 pandemic affects alcohol use and HIV care, in addition to changes in cognition and the brain, which can potentially inform future prevention and treatment programs during future emergency situations.