Cigarette Smoking and Tuberculosis among Injection Drug Users in Tijuana, Mexico

描述（由申请人提供）：拟议研究的目的是描述吸烟的流行病学及其与注射毒品使用者（IDUs）中结核病（TB）的相关性，同时考虑HIV感染和非法药物使用模式的影响。吸烟与多种结核病结局相关，包括活动性结核病、复发和结核病死亡率。然而，尽管注射吸毒者中吸烟的流行率很高，但吸烟是否与注射吸毒者中结核病感染的增加有关尚不清楚，其中许多人由于艾滋病毒感染和使用非法药物已经处于结核病的高风险之中。此外，关于注射吸毒者的吸烟行为模式和戒烟意愿知之甚少。2010年10月，墨西哥颁布了一项新的药物改革法，将大幅度扩大对阿片成瘾者的美沙酮维持治疗，这为在药物治疗方案中预防注射吸毒者中的结核病提供了一个及时的机会。该研究旨在通过实现以下目标，为将烟草依赖治疗纳入药物治疗计划提供信息：1）确定在墨西哥蒂华纳的注射吸毒者中，吸烟是否与结核病感染有关，与艾滋病毒状况和非法药物使用模式无关，包括注射非法药物和吸食大麻，快克可卡因和甲基苯丙胺; 2）描述吸烟剂量和持续时间与结核病感染之间的关系，并评估是否存在剂量-反应关系; 3）描述目前吸烟的注射吸毒者的吸烟行为和戒烟意愿。我们将通过使用一项正在进行的关于墨西哥蒂华纳注射吸毒者中艾滋病毒风险和药物使用的大型队列研究的基线数据来实现这些目标（PI：Strathdee，NIH R37 DA 019829）。母研究包括关于艾滋病毒状况的数据和关于非法药物使用模式的广泛问题，这将使我们能够检查吸烟与结核病感染之间的关联，同时调整艾滋病毒状况和非法药物使用（目标1和2）。我们还将通过对350名参与者的子集采用吸烟（半定量尿可替宁测定）和TB感染（干扰素γ释放测定）的生物学测量来解决先前吸烟和TB感染研究的重要局限性。对于目标3，我们将利用母研究（N=815）的完整基线数据集，成为第一个描述注射吸毒者烟草依赖和戒烟准备的数据集。PI将在其论文委员会和其他导师的监督下进行拟议的研究，作为其博士论文的一部分。开展这项研究将有助于PI获得药物和烟草依赖与艾滋病毒和结核病等传染病之间相互作用的专业知识，并将为独立研究人员的成功职业生涯奠定坚实的基础。此外，拟议的研究将提供必要的数据，为墨西哥和其他地方的注射吸毒者制定烟草依赖治疗计划提供信息。

DESCRIPTION (provided by applicant): The goal of the proposed research is to describe the epidemiology of cigarette smoking and its association with tuberculosis (TB) among injection drug users (IDUs) while accounting for the effect of HIV infection and patterns of illicit drug use Cigarette smoking is associated with multiple TB outcomes, including active TB disease, relapse, and TB mortality. However, despite the high prevalence of cigarette smoking among IDUs, it is unknown whether cigarette smoking is associated with increased TB infection among IDUs, many of whom are already at high risk of TB due to HIV infection and the use of illicit drugs. Furthermore, little is known regarding the patterns of cigarette smoking behavior and readiness to quit smoking among IDUs. In October 2010, Mexico enacted a new drug reform law that will significantly expand methadone maintenance treatment for opiate-addicted persons, which presents a timely opportunity to prevent TB among IDUs in drug treatment programs. The proposed research seeks to inform the integration of tobacco dependence treatment into drug treatment programs by accomplishing the following aims: 1) determine whether cigarette smoking is associated with TB infection among IDUs in Tijuana, Mexico, independent of HIV status and patterns of illicit drug use, including injecting illicit drugs and smoking marijuana, crack cocaine, and methamphetamines; 2) describe the relationship between the dosage and duration of cigarette smoking and TB infection and to evaluate whether a dose-response relationship exists; and 3) describe cigarette smoking behavior and readiness to quit among IDUs who currently smoke cigarettes. We will accomplish these aims by using the baseline data of a large, ongoing cohort study of HIV risk and drug use among IDUs in Tijuana, Mexico (PI: Strathdee, NIH R37 DA019829). The parent study includes data on HIV status and extensive questions on illicit drug use patterns, which will allow us to examine the association between cigarette smoking and TB infection while adjusting for HIV status and the use of illicit drugs (Aims 1 and 2). We will also address an important limitation of previous studies of cigarette smoking and TB infection by employing biological measures for cigarette smoking (a semi- quantitative urinary cotinine assay) and TB infection (an interferon gamma release assay) for a subset of 350 participants. For Aim 3, we will take advantage of the full baseline dataset of the parent study (N=815) to be among the first to describe tobacco dependence and readiness to quit among IDUs. The PI will conduct the proposed research as part of his doctoral dissertation under the supervision of his dissertation committee and other mentors. Conducting this research will help the PI gain expertise in the interaction between drug and tobacco dependence and infectious diseases such as HIV and TB, and will provide a strong foundation for a successful career as an independent researcher. Furthermore, the proposed research will provide essential data to inform the development of tobacco dependence treatment programs for IDUs in Mexico and elsewhere.