HIV/AIDS & Alcohol-Related Outcomes:Translational Evidence-Based Interventions

描述(申请人提供)：长期饮酒是美国最常见和最昂贵的药物滥用形式。酒精使用障碍(AUD)在艾滋病毒/艾滋病患者(PLWHA)中很常见，与抗逆转录病毒治疗(ART)的依从性和有效性降低以及对感染和病毒复制的易感性增加密切相关。路易斯安那州立大学健康科学中心(LSUHSC)综合酒精研究中心(CARC)的科学家使用猿猴免疫缺陷病毒感染的非人类灵长类动物模型进行的研究结果提供了更多证据，证明长期饮酒对疾病进展的生物医学后果。我们的结果表明，长期饮酒提高了病毒的设定点；在细菌感染期间增加了肺部病毒的水平；促进了肠道内CD4+和CD8+T淋巴细胞数量的变化，有利于疾病的传播；对骨骼代谢、氮平衡和骨骼肌萎缩产生了负面影响。最终，这些因素导致疾病加速发展为终末期疾病。因此，临床和临床前证据支持这一假设，即针对PLWHA中AUD的干预措施有可能显著和积极地影响患有AUD的艾滋病毒/艾滋病患者的结局。具体地说，我们建议将整体健康恢复计划(HHRP+)--一种最初针对HIV+静脉吸毒者与性和药物相关的风险行为开发的循证行为干预(EBI)--可以调整为针对AUD。此外，在一种真正的翻译方法中，我们建议使用我们的基础科学知识来丰富HHRP+的健康信息内容。本申请中提出的研究将遵循Adapt-ITT模型来调整HHRP+以靶向AUD。我们将对新型EBI进行试点测试，以确定其在实现和/或维持病毒载量抑制、减少AUD和HIV危险行为以及提高住院HIV+门诊患者对ART的依从性方面的有效性。这一干预措施的成功适应及其未来的实施将通过提高患者对在PLWHA中使用酒精的生物医学和心理社会后果的认识，并通过加强必要的知识、动机和技能来改变对艾滋病毒疾病进展产生负面影响的行为，从而改善临床结果(即抑制病毒)。干预的效果将导致提高抗逆转录病毒疗法的依从性和有效性，改善生活质量，并减少促进艾滋病毒传播的危险行为。

DESCRIPTION (provided by applicant): Chronic alcohol consumption is the most common and costly form of substance abuse in the United States. Alcohol use disorders (AUD) are frequent in people living with HIV/AIDS (PLWHA) and are strongly associated with decreased adherence to and effectiveness of antiretroviral therapy (ART), and enhanced susceptibility to infection and viral replication. Results from studies conducted by scientists at the Louisiana State University Health Sciences Center (LSUHSC) Comprehensive Alcohol Research Center (CARC) using the Simian Immunodeficiency Virus infected non-human primate model have provided additional evidence of the biomedical consequences of chronic alcohol consumption on disease progression. Our results show that chronic alcohol consumption elevates viral set point; increases lung viral levels during bacterial infection; promotes intestinal CD4+ and CD8+ T lymphocyte population changes that favor disease transmission; negatively affects bone metabolism, nitrogen balance, and skeletal muscle wasting. Ultimately these factors lead to accelerated disease progression to end-stage disease. Thus, clinical and preclinical evidence supports the hypothesis that interventions targeting AUDs in PLWHA have the potential to significantly and positively impact outcomes in HIV/AIDS patients with AUD. Specifically, we propose that the Holistic Health Recovery Program (HHRP+); an evidence-based behavioral intervention (EBI) originally developed to target sex- and drug-related risk-taking in HIV+ intravenous drug users, can be adapted to target AUD. Furthermore, in a truly translational approach, we propose to use our basic science derived knowledge to enrich the health information content of the HHRP+. Studies proposed in this application will follow the ADAPT-ITT model in adapting the HHRP+ to target AUD. We will pilot-test the novel EBI for efficacy in achieving and/or maintaining viral load suppression, reducing AUD and HIV risk behaviors, and improving ART adherence among in- care HIV+ outpatients. The successful adaptation of this intervention and its future implementation will improve clinical outcomes (i.e. viral suppression) by enhancing patients' awareness of the biomedical and psychosocial consequences of alcohol use in PLWHA, and by enhancing the knowledge, motivation, and skills necessary to modify behaviors negatively impacting on HIV disease progression. Efficacy of the intervention will lead to improved adherence to and effectiveness of ART, improved quality of life, and decreased risky behaviors that promote HIV transmission.