HIV Infection in Drug Users in Two International Sites

描述(由申请人提供)：本申请是对题为“国际药物成瘾研究合作”(PA-06050)的项目公告的回应。我们建议在两个国家--印度和越南--进行纵向观察研究，每个国家都存在严重的药物滥用和艾滋病毒发病率上升的问题。在这两个国家，艾滋病毒流行正迅速成为注射吸毒的直接结果。此外，两国政府最近启动了向艾滋病毒感染患者提供联合抗逆转录病毒治疗的计划。这项建议的一个重要目标是在这些国家启动研究，以在广泛获得HAART之前建立艾滋病毒感染患者的基线营养和代谢状态，并跟踪那些开始采用HAART一线方案的参与者，以记录这些国家接受治疗的艾滋病毒感染的自然历史。这是进行拟议研究的一个重要机会之窗，因为随着时间的推移，接触HAART幼稚患者的机会可能会减少，治疗方案将变得更加复杂。我们的具体目标如下：1)从以下方面对HIV阴性和HIV阳性(HAART和非HAART)注射吸毒者(IDU)进行特征和比较：a)非法药物使用的类型、频率和模式，b)共病，c)营养和代谢异常，以及d)临床结果；2)检查坚持使用HIV药物、心理社会因素(例如抑郁症)和社会经济因素(例如食物不安全)对营养和代谢异常的发展或持续的独立贡献；以及3)在这些国家建立基础设施和持续存在，以便随着艾滋病毒干预措施的增加，我们将拥有可用于未来研究的人口。这些国际研究的结果不仅将为这些国家的艾滋病毒感染者提供重要数据，还将作为美国研究的比较。美国和国际研究结果的比较将有助于扩大我们对美国慢性艾滋病毒感染中代谢并发症的原因和后果的了解。此外，该项目的结果将有助于确定当地人口中可能适合于营养干预以延缓艾滋病毒疾病进展的普遍营养不良或特定的微量营养素缺乏。这些措施可能包括补充维生素和/或饮食咨询，以提高食物摄入量的质量。

DESCRIPTION (provided by applicant): This application is in response to the program announcement entitled, "International Research Collaboration on Drug Addiction" (PA-06050). We propose to conduct longitudinal observational studies in two countries - India and Vietnam - each with significant problems of drug abuse and increasing incidence of HIV. In both countries the HIV epidemic is rapidly emerging as a direct result of injection drug use. Furthermore, the governments of both countries have recently initiated programs to provide combination antiretroviral therapy to HIV-infected patients. An important goal of this proposal is to initiate research in these countries to establish baseline nutrition and metabolic status of HIV-infected patients prior to widespread access to HAART and to follow participants who start on a first-line HAART regimen to document the natural history of treated HIV infection in these countries. This is an important window of opportunity to conduct the proposed studies as, over time, access to patients who are HAART-naive may be diminished and regimens will become more complicated. Our specific aims are as follows: 1) To characterize and compare HIV-negative and HIV-positive (HAART and non-HAART) injecting drug users (IDUs) in terms of: a) types, frequency and patterns of illicit drug use, b) co-morbidities, c) nutritional and metabolic abnormalities, and d) clinical outcomes; 2) To examine the independent contributions of adherence to HIV medications, psychosocial factors (e.g. depression), and socioeconomic factors (e.g. food insecurity) to the development or persistence of nutritional and metabolic abnormalities; and 3) To establish an infrastructure and ongoing presence in these countries so that with the increasing availability of interventions for HIV, we will have populations on which to build future studies. Results from these international studies will not only provide important data for HIV-infected patients within these countries, but will also serve as comparisons for U.S. based studies. Comparison of findings between U.S. and international studies will help expand our understanding of the causes and consequences of metabolic complications in chronic HIV infection in the U.S. Furthermore, the results of this project will help to identify generalized malnutrition or specific micronutrient deficiencies in the local populations that may be amenable to nutritional interventions for delaying HIV disease progression. These might include vitamin supplementation and/or dietary counseling to improve the quality of food intake.