Quality of Sleep in HIV-Infection: associations with treatment and adherence

描述（由申请人提供）：抗逆转录病毒（ARV）药物治疗大大降低了艾滋病毒疾病的死亡率，并将艾滋病毒感染者的临床护理从急性疾病管理改为慢性疾病管理。为了达到最大的疗效，需要对抗逆转录病毒治疗方案有很高的依从性，而不太理想的依从性与存活率下降以及出现抗逆转录病毒耐药株的风险增加有关。与依从性降低相关的因素很复杂，但文献中一致的发现是不良反应是不依从的原因。 据报道，睡眠障碍在艾滋病毒感染者中高达73%。这种影响的潜在机制包括与免疫功能改变、精神疾病、非法药物或酒精使用以及抗逆转录病毒药物的副作用有关。尽管对HIV阳性个体的睡眠障碍进行了研究，但关于ARV对睡眠质量（QOS）的影响以及睡眠不良对依从性的影响知之甚少。 本提案的主要目的是比较开始抗逆转录病毒治疗前后HIV感染受试者队列的QOS，并确定QOS对抗逆转录病毒治疗依从性的影响。这项研究的长期目标是通过揭示可能与不依从和治疗失败相关的未探索因素来改善对艾滋病毒感染者的护理。该奖学金将支持候选人在四项研究中的努力，以及完成临床研究硕士学位。前两个项目是对两个已完成的临床试验的次要数据分析，这将确定QOS对依从性的影响，并确定特定抗逆转录病毒药物对QOS的影响。第三项研究将是一项前瞻性队列研究，嵌套在R01资助的试验中，将比较ARV启动对QOS的影响，并比较接受依法韦仑（EFV）与非EFV方案的受试者之间的QOS。第四个项目是一个定性的QOS试点研究，主要目的是探索艾滋病毒感染，抗逆转录病毒药物的不良反应，物质使用和抑郁症与艾滋病毒感染者的QOS之间的关联。该提案符合该机构的使命，即“确定疾病阶段、个体差异特征、治疗反应和依从性之间的关系 公共卫生相关性：由于治疗选择减少，不依从治疗可能导致抗逆转录病毒病毒耐药病毒传播风险增加和艾滋病毒流行病恶化。这项研究的结果将有利于公共卫生，有助于确定影响因素的遵守和最大限度地减少不遵守的后遗症。

DESCRIPTION (provided by applicant): Treatment with antiretroviral (ARV) medications has substantially decreased mortality rates due to HIV illness and modified the clinical care of HIV-infected individuals from an acute to a chronic disease management. High rates of adherence to ARV regimens are required in order to achieve maximal efficacy and less than optimal adherence has been associated with decreased survival rates as well as increased risk of developing ARV-resistant strains. Factors associated with reduced adherence are complex, but a consistent finding in the literature as reason for non-adherence is adverse effects. Sleep disturbances are reported to be as high as 73% in HIV-infected subjects. Potential mechanisms of this effect include correlations with altered immune function, psychiatric illness, illicit drugs or alcohol use, and adverse effects of ARVs. Despite studies on sleep disturbances in HIV-positive individuals, little is known about the effect of ARVs on quality of sleep (QOS) and consequences of poor sleep on adherence. The primary aims of this proposal are to compare QOS in a cohort of HIV-infected subjects before and after ARV initiation and establish the effect of QOS on ARV adherence. The long-term objective of this research is to improve the care for HIV-infected individuals by shedding light on unexplored factors which may be associated with non-adherence and treatment failure. This fellowship will support the candidate's efforts in four studies as well as the completion of the Master's Degree in Clinical Research. The first two projects are secondary data analyses of two completed clinical trials, which will establish the effect of QOS on adherence and determine the effect of specific ARVs on QOS. The third study will be a prospective cohort study, nested into an R01-funded trial, and will compare the effect of ARV-initiation on QOS and compare QOS between subjects on efavirenz (EFV) versus non-EFV-based regimens. The fourth project is a qualitative QOS pilot study with the primary aim of exploring the association between HIV infection, ARV adverse effects, substance use, and depression with QOS of HIV-infected individuals. This proposal fits the agency's mission of "determine the relationship(s) among disease stage, individual difference characteristics, treatment response, and how adherence is related to treatment outcomes throughout the course of the treatment, illness, and interventions".PUBLIC HEALTH RELEVANCE: Non-adherence can result in increased risk of ARV-resistant virus transmission and exacerbation of the HIV epidemic due to decreased treatment options. The results of this study will benefit public health by helping to identify factors influencing adherence and by minimizing the sequelae of non-adherence.