OPTIMIZING AURICULAR ACUPUNCTURE FOR HIV+ DRUG ABUSERS

艾滋病毒阳性者滥用可卡因是将艾滋病毒传播给艾滋病毒阴性人群的一个主要因素；因此，在艾滋病毒阳性患者中开发和测试有效的治疗方法是一个紧迫的公共卫生问题。来自我们网站的初步数据表明，一种替代疗法--耳针疗法--可能会减少艾滋病毒阳性患者中的可卡因滥用，但在进行全面临床试验之前，必须解决一些问题。拟议的一系列研究将调查耳穴方案的三个关键方面--剂量、人际环境以及治疗的急性生理和主观影响--这可能会影响艾滋病毒阳性患者的结果。所有研究都将纳入HIV阳性、滥用可卡因、服用美沙酮的患者。研究1的目的是：在一项为期8周的试验中，招募40名患者，比较非交互和交互的针灸医生风格在耳针治疗中的滞留和临床结果；研究2的目标：在一系列单次研究中，每项研究招募12名患者，确定插入耳廓的针的数量(1，3或5)是否相互比较，以及放松和插针控制是否影响β-内啡肽水平和急性主观效应；研究3的目的是：在一项为期8周的随机试验中，招募40名患者，比较标准的5针耳针方案和“滴定剂量”方案(第一个月一针，第二个月三针)的临床疗效和线索诱导的可卡因渴求，在研究一中被发现最有益的患者-针灸师互动水平。其他目的：探索：(A)耳针对认知功能测量的影响，以及这种互动对治疗保持的影响；(B)耳针对艾滋病毒相关症状的影响，以及(C)抗逆转录病毒药物与耳针治疗反应之间的联系。这些研究的结果将指导设计耳针治疗艾滋病毒阳性患者滥用可卡因的全面临床试验，并将为产生关于耳针作用机制的假说提供信息。

Cocaine abuse by HIV-positive individuals is a major factor in the transmission of HIV to the HIV-negative population; consequently, developing and testing effective treatments for this disorder among HIV- positive patients is an urgent public health concern. Preliminary data from our site suggest that an alternative therapy, auricular acupuncture, may reduce cocaine abuse among HIV-positive patients, but that a number of issues must be addressed before conducting a full-scale clinical trial. The proposed series of studies will investigate three critical dimensions of the auricular protocol -- dose, interpersonal context, and acute physiological and subjective effects of treatment -- that may influence outcome in HIV-positive patients. All studies will enroll HIV-positive cocaine-abusing, methadone-maintained patients. Study number 1 Aim: In an 8-week trial enrolling 40 patients, to compare a non-interactive and an interactive acupuncturist style on retention in, and clinical outcome of, auricular acupuncture; Study number 2 Aims: In a series of single session studies, each enrolling 12 patients, to determine whether the number of needles inserted into the auricle (1,3,or 5), compared to each other and to relaxation and needle insertion controls, influences beta-endorphin levels and acute subjective effects; Study number 3 Aims: In an 8-week randomized trial enrolling 40 patients, to compare the standard 5-needle auricular acupuncture protocol to a "titrating dose" protocol (one needle in month one; three needles in month two), on clinical efficacy and cue-elicited cocaine craving, when delivered using the level of patient-acupuncturist interaction found to be most beneficial in Study number 1. Additional aims: To explore: (a) auricular acupuncture's effects on measures of cognitive functioning, and the influence of this interaction upon treatment retention; (b) auricular acupuncture's effects on HIV-related symptoms, and (c) the association between antiretroviral medications and response to auricular acupuncture treatments. Findings from these studies will guide the design of a full-scale clinical trial of auricular acupuncture for cocaine abuse in HIV-positive patients, and will provide information for generating hypotheses concerning auricular acupuncture's mechanism of action.