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 HIV 感染者 (PLWH) 是 COVID-19 大流行中特别脆弱的人群，因为他们的 免疫系统受损和合并症（例如药物滥用、心理健康问题）。目前，没有 研究探讨了 COVID-19 的广泛影响（例如，长期的社会隔离、焦虑、家庭 损失）正在影响 PLWH 的饮酒和护理参与。此外，尚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个机会之窗 及时收集数据以弥补这些差距。我们正在进行的 U01 研究由 PLWH 和人员组成 没有艾滋病毒，专注于使用应急管理协议来减少酒精消费提供了 许多独特的优势支持这种补充剂。该补助属于家长补助范围 但通过将与 COVID-19 相关的问题/措施纳入持续数据中来扩展家长研究 收藏。我们将通过问卷调查、电子家庭认知测试来收集更多数据 CANTAB Connect，通过头发样本的皮质醇分析来量化压力严重程度，并定性 采访。我们还将进行 COVID-19 抗体测试（通过血液样本）和我们进行的 MRI 作为家长资助程序的一部分。本补充的具体目标包括： 1) 确定 特定心理社会因素（例如，社会孤立、孤独、焦虑、食物和住房）的影响 不安全感）影响酒精使用轨迹以及与艾滋病毒相关的健康行为和结果（ART 依从性和 医疗保健参与）在大流行和社会疏远期间。我们还将检查哪些 基线因素（例如临床、人口统计学、神经影像学、认知）最能预测个体差异 结果； 2) 评估 (1) 家用电子传递神经认知的可行性和可接受性 对 CANTAB Connect 系统的评估和 (2) 参与者邮寄的头发样本。对于那些愿意并且 能够完成其中一项或两项措施，我们将检查心理社会因素的关系 目标 1 评估认知表现和/或压力严重程度（通过头发中的皮质醇水平测量） 从参与者处获得的样本； 3）从参与者那里获得额外的神经影像，以确保我们有 冠状病毒危机之前和之后的数据，以及（如果有足够的流行率），确定 被发现感染了 COVID-19（有或没有症状）的参与者是否有更大的 FLAIR 脑 MRI 上白质超敏反应 (WMH) 的程度，以及其他相关的结构、 大脑功能和代谢变化（fMRI、MRS）；并以探索性目标进行定性研究 访谈，探讨主观判断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因素。这些结果将为如何提供有价值的证据 除了认知和大脑的变化外，COVID-19 大流行还影响饮酒和艾滋病毒护理， 这可能为未来紧急情况下的预防和治疗计划提供信息。

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.