Addressing Alcohol/HIV Consequences in Substance Dependence - Boston ARCH Cohort

描述（由申请人提供）：不健康饮酒在艾滋病毒感染者中很常见，对健康有不利影响。注射吸毒占艾滋病毒感染病例的五分之一，因此阿片类药物依赖也很常见。超过三分之一的艾滋病毒感染者和其他吸毒者饮酒过量。研究的重点是艾滋病毒感染者的酒精或药物使用情况，但对酒精对受多种滥用物质影响的艾滋病毒感染者的健康影响知之甚少。这项建议是乌干达-俄罗斯-波士顿酒精研究艾滋病毒/艾滋病合作网络（URBAN ARCH）联盟的一个组成部分，该联盟的目标是审查酒精对艾滋病毒疾病的后果并减轻其危害。本建议的目标是准确描述受多种物质影响的艾滋病毒感染者的酒精使用和后果，并开展观察和干预研究，以了解和减少酒精的危害。该提案有3个具体目标：1)扩大并继续现有队列，建立纵向波士顿ARCH队列，其中包括250名受多种物质影响的艾滋病毒感染的男性和女性-酒精使用范围，所有人都有物质依赖或注射药物使用。2)用一种药物同时治疗重度饮酒和阿片类药物依赖。使用阿片类药物治疗酒精风险（TWOFER）试验将在一项随机双盲安慰剂对照试验中评估高剂量丁丙诺啡（32mg）是否比标准剂量（16mg）在3个月时减少大量饮酒，该试验在100名患有阿片类药物依赖和大量饮酒的hiv感染成年队列参与者中进行。丁丙诺啡是一种治疗阿片类药物依赖的药物，如果有效，可以很容易地作为治疗艾滋病毒感染者和阿片类药物依赖者不健康饮酒的方法传播，因为只需要调整剂量。3)由于酒精、阿片类药物使用、艾滋病毒感染和抗逆转录病毒治疗可能影响骨骼健康并增加骨折风险，因此对队列数据的分析将确定所有队列参与者在12-42个月内饮酒对骨矿物质密度和微结构变化的独立影响（通过高分辨率计算机断层扫描）。该队列将提供酒精对骨骼影响的数据，这对于确定艾滋病毒感染者的危险饮酒量以及就酒精相关风险向他们提供建议是重要的信息。因此，这些研究将为减轻受多种物质影响的艾滋病毒感染成人的酒精后果提供大量新知识。

DESCRIPTION (provided by applicant): Unhealthy alcohol use is common among HIV-infected persons and it adversely affects health. Injection drug use accounts for 1 in 5 cases of HIV infection, thus opioid dependence is also common. More than one-third of those with HIV infection and other drug use drink too much alcohol. Research has focused on either alcohol or drug use in HIV-infected individuals, but much less is known about alcohol's health effects in HIV- infected people affected by multiple substances of abuse. This proposal is a component of the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Consortium, whose goal is to examine the consequences of alcohol on HIV disease and to mitigate its harms. The objective of this proposal is to accurately characterize alcohol use and consequences in people with HIV infection affected by multiple substances, and to implement observational and intervention studies to understand and reduce alcohol's harm. The proposal has 3 specific aims: 1) To expand and continue an existing cohort to establish the longitudinal Boston ARCH Cohort of 250 HIV-infected men and women affected by multiple substances-a spectrum of alcohol use, and all with substance dependence or Injection drug use. 2) To treat both heavy drinking and opioid dependence with one medication. The Treating With Opioids For Ethanol Risks (TWOFER) trial will assess if high-dose buprenorphine (32mg) reduces heavy drinking compared to standard-dose (16mg) at 3 months in a randomized double-blind placebo-controlled trial among 100 HIV-infected adult Cohort participants with opioid dependence and heavy drinking. If efficacious, buprenorphine, a treatment for opioid dependence, could be easily disseminated as a treatment for unhealthy alcohol use in people with HIV infection and opioid dependence as only dose adjustment is required. 3) Because alcohol, opioid use, HIV infection and antiretroviral therapy may affect bone health and increase fracture risk, analysis of cohort data will determine the independent effect of alcohol consumption on changes in bone mineral density and microarchitecture (by high-resolution computed tomography) prospectively in all Cohort participants over 12-42 months. The Cohort will yield data on alcohol effects on bone, important information for defining risky drinking amounts in people with HIV infection and for advising them on alcohol-related risks. Thus, these studies will provide substantial new knowledge for mitigating alcohol consequences among HIV-infected adults affected by multiple substances.