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 艾滋病毒携带者是新冠肺炎大流行中的一个特别脆弱的人群，因为他们 免疫系统受损和合并症(例如，药物使用、精神健康问题)。目前，没有 研究考察了新冠肺炎的广泛影响(例如，延长社交孤立、焦虑、家庭 损失)正在影响PLWH的酒精使用和护理参与度。此外，目前还不清楚这些影响是否 影响认知或大脑。这份紧急补充材料将使我们能够抓住这一机会之窗，并 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和人类组成的队列 在没有艾滋病毒的情况下，专注于使用应急管理方案来减少酒精消费提供了 许多独特的优势支持这一补充。这项补充属于家长补助的范围。 但通过将与新冠肺炎相关的问题/措施纳入正在进行的数据来扩展父研究的范围 收集。我们将通过问卷调查、电子家庭认知测试等方式收集更多数据 CantabConnect，通过头发样本的皮质醇分析来量化压力严重程度，以及定性 采访。我们还将进行新冠肺炎抗体测试(通过血液样本)和我们进行的核磁共振成像 作为父母资助程序的一部分。本补充文件的具体目的包括：1)确定 特定心理社会因素(例如，社会孤立、孤独、焦虑以及食物和住房)的影响 不安全)对酒精使用轨迹和艾滋病毒相关健康行为和结果的影响(ART依从性，以及 在大流行期间和社会距离期间的医疗保健参与)。我们还将研究哪一个 基线因素(例如，临床、人口统计学、神经成像、认知)最能预测个体在 结果；2)评估(1)家庭电子传递神经认知的可行性和可接受性 对CantabConnect系统的评估和(2)参与者邮寄的头发样本。对于那些愿意和 能够完成其中一项或两项测量，我们将检查心理社会因素之间的关系 在目标1中通过头发皮质醇水平评估认知表现和/或压力严重程度 从参与者那里获得样本；3)从参与者那里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 无论被发现感染了新冠肺炎的参与者(有没有症状)都有更大的 FLAIR脑MRI上白质过敏(WMH)的程度，以及其他相关的结构， 功能性和代谢性脑改变(fMRI，MRS)；以及探索性目标将进行定性 面谈探讨主观判断为干扰戒酒和HIV的因素 服药依从性，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，说明 新冠肺炎大流行影响饮酒和艾滋病毒护理，除了认知和大脑的变化， 这可能会在未来紧急情况下为未来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.