EVALUATION OF TREATMENTS OF OPIOID DEPENDENCE IN HIV PATIENTS

HIV 患者阿片类药物依赖治疗的评估

• 批准号: 2571620
• 负责人: K L PRESTON
• 金额: --
• 依托单位: NATIONAL INSTITUTE ON DRUG ABUSE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/2571620
• 关键词: HIV infections; buprenorphine; clinical research; clinical trials; clonidine; cognitive behavior therapy; coping; drug abuse chemotherapy; drug abuse prevention; drug addiction; drug withdrawal; high risk behavior /lifestyle; human subject; human therapy evaluation; methadone; opiate alkaloid; oral administration; urban area; virus replication

This project assesses the safety and efficacy of pharmacological and behavioral treatments of opioid dependence in HIV-infected patients and in methods for decreasing high risk HIV transmission behaviors in substance abusers. The AIDS epidemic has rapidly extended to injection drug users, many of them dependent on opioids; these patients represent a challenge to the health care system, as they require medical care and hospitalization for chronic medical disorders. Withdrawal syndromes represent added stresses that may negatively affect the outcome of medical treatments in compromised patients. We are currently conducting a study to compare the effectiveness of clonidine, methadone, and buprenorphine for short opioid detoxification and to develop guidelines for opioid detoxification in opioid-dependent patients, hospitalized for acute AIDS-related illnesses. Subjective and objective measures are recorded, including withdrawal and pain variables. The hypothesis is that patients receiving buprenorphine will show lower withdrawal and pain scores and fewer disruptive behaviors. The study is designed as a double-blind, double-dummy, randomized trial of oral clonidine, oral methadone and parental buprenorphine (IM) for short opioid detoxification. Opioids may have detrimental effects on the immune system and enhance HIV replication according to laboratory findings. Epidemiologic studies, however, fail to confirm a deleterious effect of continuous illicit drug use or of methadone maintenance on the progression of HIV diseases. Methadone maintenance appears to decrease HIV transmission risk behaviors which protect drug users from HIV seroconversion and may help contain the HIV epidemic. We are evaluating the effects of methadone maintenance on immune function (CD4, viral load) in HIV-infected drug users. A third study will examine whether sustained HIV protective behavior can be achieved by adding a cognitive-behavioral coping skills and relapse prevention intervention to voucher-based contingency management. In a randomized clinical trial with inner city methadone-maintained cocaine- dependent subjects, patients will be taught self-control skills: 1) to increase non-drug sources of reinforcement to compete with reinforcing effects of drug use; and 2) to develop adaptive problem-focused and emotion-focused coping responses to manage drug specific and general life stressors related to drug use and HIV risk transmission.

该项目评估药理学和药物的安全性和有效性 HIV 感染者阿片类药物依赖的行为治疗 减少艾滋病毒高危传播行为的方法 药物滥用者。 艾滋病流行已迅速蔓延至注射剂 吸毒者，其中许多人依赖阿片类药物；这些患者代表 对医疗保健系统的挑战，因为他们需要医疗护理和 因慢性疾病住院。 戒断综合症 代表可能对结果产生负面影响的额外压力 对受损患者进行医疗治疗。 我们目前正在进行 一项比较可乐定、美沙酮和 丁丙诺啡用于短期阿片类药物解毒并制定指南 用于阿片类药物依赖患者的阿片类药物戒毒，住院时间 与艾滋病相关的急性疾病。 主观和客观措施是 记录，包括戒断和疼痛变量。 假设是 接受丁丙诺啡的患者会表现出较低的戒断症状和疼痛 分数和更少的破坏性行为。 该研究被设计为 口服可乐定的双盲、双模拟、随机试验 美沙酮和亲本丁丙诺啡 (IM) 用于短期阿片类药物 排毒。 阿片类药物可能对免疫系统产生有害影响并增强艾滋病毒 根据实验室结果进行复制。 流行病学研究， 然而，未能证实持续使用非法药物的有害影响 使用或维持美沙酮对艾滋病毒疾病进展的影响。 美沙酮维持治疗似乎可以减少艾滋病毒传播风险行为 它可以保护吸毒者免受艾滋病毒血清转化，并可能有助于遏制 艾滋病毒流行。 我们正在评估美沙酮维持治疗的效果 HIV 感染吸毒者的免疫功能（CD4、病毒载量）。 第三项研究将检验持续的艾滋病毒保护行为是否可以 通过增加认知行为应对技巧和复发来实现 基于凭证的应急管理的预防干预。 在一个 内城美沙酮维持可卡因的随机临床试验 依赖对象，患者将被教导自我控制技能：1） 增加非药物强化来源以与强化竞争 药物使用的影响； 2）开发以问题为中心的适应性和 以情绪为中心的应对反应，以管理特定药物和一般生活 与吸毒和艾滋病毒传播风险相关的压力源。