SCIENTIFIC REVIEW AND EVALUATION AWARD

艾滋病毒流行是美国的一个主要公共卫生问题， 整个世界。神经系统疾病是导致发病和死亡的常见原因。 对于美国最近100多万感染艾滋病毒的人来说， 随着蛋白水解酶抑制剂治疗的成功 全身性HIV疾病与蛋白酶抑制剂的有限渗透性 进入神经系统，有一种不断发展的意识，即中枢神经系统疾病 可能在艾滋病毒的临床管理中变得更加重要 疾病和艾滋病毒流行。尽管大量饮酒，这有它的 自身的CNS和PNS毒性，在艾滋病毒高危人群中很常见 感染，几乎没有研究直接解决重感染的影响 酒精使用对艾滋病毒疾病严重程度和进展的影响。的主要目标是 该计划项目是为了确定慢性重酒的影响 用来研究中枢神经系统和三叉神经节在HIV疾病中的发病率。这种影响可能由以下原因引起 长期饮酒对行为和生物的影响 整个艾滋病毒疾病进程的进展速度或 减少对艾滋病毒治疗的反应和酒精本身的紧张 系统毒性。这些机制及其效果将在#年进行评估。 HIV+和HIV慢性重度饮酒者(HIV+HDs&)的纵向研究 HIV-HDs)和少量/不饮酒(HIV+L/NDS和HIV-L/NDS)。该计划 项目目标是： 。确定艾滋病毒携带者是否减少了寻求护理和艾滋病毒治疗 坚持，无保护措施的性行为增加，营养不良， 和/或减少艾滋病毒治疗药物的药物水平。 。确定a)HIV+HDs是否具有更高的HIV全身性感染率 疾病进展或治疗反应降低，以及b)达到以下程度 慢性重度饮酒对行为和药物代谢的影响 艾滋病毒系统性疾病进展的任何增加或减少的基础 治疗反应。 。确定HIV+HDs是否有更高的CNS和PNS发病率，以及 这种发病率的进展情况比艾滋病毒+腰椎间盘突出症更严重。确定这些是否 长期大量饮酒的影响是相加的或超过相加的 效果。 。确定CNS和PNS发病率对患者生活质量的影响 HIV+的个人。 。在HIV+受试者中，确定CNS和PNS发病率和 它的进展与病毒载量、免疫抑制的系统性措施有关 和营养状况，并与中枢神经系统疾病的脑脊液措施，以及 确定这些关联在重度慢性酒精之间是否有所不同 饮酒者和轻饮者/不饮酒者。 我们将研究四组对象：120例HIV+HD，120例HIV+L/NDS，60例 HIV-HDs和60例HIV-L/NDS。

The HIV epidemic is a major public health problem in the United States and the world. Nervous disease is a frequent cause of morbidity and mortality for the more than 1 million people infected with HIV in the U.S. Recently, with the success of protease inhibitor therapy in the treatment of systemic HIV disease and the limited penetration of protease inhibitors into the nervous system, there is a developing awareness that CNS disease may become of even more importance in the clinical management of HIV disease and the HIV epidemic. Although heavy alcohol use, which has its own CNS and PNS toxicity, is common in populations at high risk for HIV infection, almost no research directly addresses the effect of heavy alcohol use on HIV disease severity and progression. The primary goal of this Program Project is to determine the effect of chronic heavy alcohol use on CNS and PNS morbidity in HIV disease. This effect may result from behavioral and biological effects of chronic alcohol use increasing the rapidity of the progression of the overall HIV disease process or decreasing the response to HIV treatment and from alcohol's own nervous system toxicity. These mechanisms and their effects will be evaluated in a longitudinal study of HIV+ and HIV-chronic heavy drinkers (HIV+ HDs & HIV-HDs) and light/non-drinkers (HIV + L/NDs & HIV-L/NDs). The Program Project goals are to: . Determine whether HIV+ HDs have decrease care seeking and HIV treatment adherence, an increased prevalence of unprotected sex, poorer nutrition, and/or decreased drug levels of HIV treatment medications. . Determine whether a) HIV + HDs have a greater rate of HIV systemic disease progression or reduced treatment response, and b) the degree to which the behavioral and drug metabolism effects of chronic heavy drinking underlie any increased rate of HIV systemic disease progression or reduced treatment response. . Determine whether HIV+ HDs have greater CNS and PNS morbidity and progression of such morbidity than HIV+ LDs. Determine whether these effects of chronic heavy alcohol use are additive or exceed additive effects. . Determine the impact of CNS and PNS morbidity on the quality of life of HIV+ individuals. . In HIV+ subjects, determine the association of CNS and PNS morbidity and its progression with systemic measures of viral load, immune suppression and nutritional status, and with CSF measures of CNS disease, and determine whether these associations differ between heavy chronic alcohol drinkers and light/non-drinkers. We will study four groups of subjects: 120 HIV+ HDs, 120 HIV+ L/NDs, 60 HIV-HDs, and 60 HIV-L/NDs.