HIV-Infected IDU Living with HCV Coinfection

描述（由申请人提供）：高效抗逆转录病毒治疗（HAART）延长了许多感染人类免疫缺陷病毒（HIV）的患者的生存期。因此，这些人正在经历其他感染或共病的发病率和死亡率，在HAART之前，患者没有足够长的时间来面对这些疾病。因此，我们认为，我们正处于某种范式转变之中，将艾滋病毒感染作为一种慢性疾病来思考和管理，将转向把重点放在艾滋病毒感染作为一种必须与一种或多种其他重大慢性疾病或病症一起进行临床管理和心理社会调整的并发疾病。在许多方面，与丙型肝炎（HCV）合并感染证实了新的范式。这是一种共病，影响了美国约三分之一的HIV+患者和超过80%的HIV+注射毒品使用者（IDUs），他们已经注射了多年。此外，HCV影响所有年龄组的HIV+成人。虽然在医学文献中关于HIV/HCV合并感染的文章迅速增加，但在关于HIV/AIDS的心理社会和行为文献中，合并感染的问题几乎被忽视了。然而，这一人群的重要性将日益增加，因为它将成为两种流行病的中心，艾滋病流行病和HCV感染的“影子流行病”-因为它代表了越来越多的HIV+个体现象，随着生存时间的继续延长，他们将同时生活和应对另一种严重的慢性疾病或病症。合并感染的患者也给医生带来了许多挑战，因为他们同时管理两种严重的病毒感染，而且疾病轨迹往往是不可预测的。为了开始解决这些重要的差距，在现存的艾滋病毒/艾滋病心理社会文献，我们建议定性研究如何与HCV共同感染阻碍或复杂化的几个关键疾病相关的适应性任务，艾滋病毒+个人面临的掌握，以及确定任何独特的适应性挑战，它构成。研究样本将由140名有注射吸毒史的HIV/HCV合并感染成人组成。为了开始了解他们在照顾合并感染患者时所面临的挑战如何影响患者的适应，还将对在艾滋病诊所治疗患者的所有14名医生进行访谈，患者样本将从这些诊所招募。

DESCRIPTION (provided by applicant): Highly active antiretrovial therapy (HAART) has extended survival for many people infected with human immunodeficiency virus (HIV). As a result, these individuals are experiencing morbidity and mortality from other infections or co-morbid diseases that, prior to HAART, patients did not live long enough to confront. Consequently we believe that we are in the midst of something of a paradigm shift in which thinking about, and managing HIV infection as a chronic illness, will shift to a focus on HIV infection as a co-morbid medical condition that must be clinically managed, and psychosocially adjusted to, alongside one or more other signficant chronic illnesses or conditions. In many ways co-infection with hepatitis C (HCV) exemplifies the new paradigm. It is a co-morbidity that affects approximately a third of all HIV+ persons in the US and upwards of 80% of HIV+ injecting drug users (IDUs) who have been injecting for a number of years. Moreover, HCV impacts all age groups of HIV+ adults. While there has been a rapid proliferation of articles in the medical literature on HIV/HCV co-infection, the problems of living with co-infection have been virtually overlooked in the psychosocial and behavioral literature on HIV/AIDS. Yet this population promises to be one of growing importance, both because it will be at the center of two epidemics, the AIDS epidemic and the "shadow epidemic" of HCV infection - and because it is representative of the growing phenomenon of HIV+ individuals who, as survival continues to extend, will simultaneously be living and coping with another serious chronic illness or condition. Co-infected patients also present many challenges for physicians as they simultaneously manage two serious viral infections with often, unpredictable disease trajectories. To begin addressing these important gaps in the extant HIV/AIDS psychosocial literature, we propose to qualitatively investigate how co-infection with HCV impedes or complicates the mastery of several key illness-related adaptive tasks that HIV+ individuals confront, as well as to identify any unique adaptive challenges that it poses. The study sample will be composed of 140 HIV/HCV-co-infected adults with a history of injecting drug use. To begin to understand how the challenges they face in caring for co-infected patients impact patient adjustment, all 14 physicians treating patients at the AIDS clinics from which the patient sample will be recruited will also be interviewed.