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

HIV爱滋病

• 批准号: 8700690
• 负责人: PATRICIA E. MOLINA
• 金额: $ 5.14万
• 依托单位: LSU HEALTH SCIENCES CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-15 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8700690
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adherence; Affect; Alcohol abuse; Alcohol consumption; Alcohols; Ambulatory Care Facilities; Area; Awareness; Bacterial Infections; Basic Science; Behavior; Behavior Therapy; CD8-Positive T-Lymphocytes; Caring; Chronic; Clinic; Clinical; Communities; Consequences of HIV; Diagnosis; Disease Progression; Effectiveness; Epidemic; Evidence based intervention; Foundations; Future; Goals; HIV; HIV Infections; HIV risk; Health; Health Sciences; Holistic Health; Incidence; Individual; Infection; Intervention; Intestines; Knowledge; Lead; Life; Louisiana; Lung; Modeling; Motivation; Outcome; Outpatients; Patients; Persons; Pharmaceutical Preparations; Population; Predisposition; Preparation; Prevalence; Primary Health Care; Production; Public Health; Public Hospitals; Quality of life; Recovery; Research Personnel; Risk; Risk Behaviors; Risk-Taking; SIV; Science; Scientist; Services; Substance abuse problem; Testing; Training; Translating; Treatment Efficacy; United States; Universities; Viral; Viral Load result; Virus Diseases; alcohol effect; alcohol research; alcohol use disorder; antiretroviral therapy; base; bone metabolism; chronic alcohol ingestion; disease transmission; effective intervention; end stage disease; evidence base; improved; intravenous drug user; knowledge base; metropolitan; multidisciplinary; nitrogen balance; nonhuman primate; novel; pre-clinical; programs; psychosocial; reduced alcohol use; sex; skeletal muscle wasting; skills; therapy adherence; translational approach; transmission process

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.

描述（由申请人提供）：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（PLWHA）感染者中很常见，并且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强密切相关。路易斯安那州立大学健康科学中心（LSUHSC）酒精综合研究中心（CARC）的科学家利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，为慢性饮酒对疾病进展的生物医学后果提供了额外的证据。我们的研究结果表明，长期饮酒会提高病毒设定点；细菌感染时增加肺部病毒水平；促进肠道CD4+和CD8+ T淋巴细胞群改变，有利于疾病传播；对骨代谢、氮平衡和骨骼肌萎缩有负面影响。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样的假设，即针对艾滋病毒/艾滋病AUD患者的干预措施有可能显著和积极地影响AUD患者的预后。具体来说，我们建议全面健康恢复计划（HHRP+）；一种基于证据的行为干预（EBI）最初是针对HIV阳性静脉吸毒者中与性和药物相关的冒险行为而开发的，可以适用于AUD。此外，在真正的转化方法中，我们建议使用我们的基础科学衍生知识来丰富HHRP+的健康信息内容。本申请中提出的研究将遵循ADAPT-ITT模型，使HHRP+适应AUD。我们将对新型EBI在实现和/或维持病毒载量抑制、减少AUD和艾滋病毒风险行为以及提高艾滋病毒阳性门诊患者抗逆转录病毒治疗依从性方面的有效性进行试点测试。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艾滋病毒感染中酒精使用的生物医学和社会心理后果的认识，以及通过提高改变对艾滋病毒疾病进展产生负面影响的行为所必需的知识、动机和技能，改善临床结果（即病毒抑制）。干预措施的有效性将提高抗逆转录病毒治疗的依从性和有效性，改善生活质量，减少促进艾滋病毒传播的危险行为。