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

不健康的饮酒在艾滋病毒感染者中很常见，并对健康造成不利影响。注射用药 使用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 那些感染艾滋病毒和使用其他药物的人饮酒过多。研究主要集中在以下两个方面 酒精或药物对艾滋病毒感染者的影响，但人们对酒精对艾滋病毒健康的影响知之甚少。 感染者受到多种物质滥用的影响。这项提议是乌干达 俄罗斯波士顿酒精网络关于艾滋病毒/艾滋病的酒精研究合作(城市ARCH) 该联盟的目标是研究酒精对艾滋病毒疾病的影响，并减轻其 伤害。这项提议的目标是准确地描述人们饮酒及其后果 艾滋病毒感染受到多种物质的影响，并实施观察性和干预性研究 了解并减少酒精的危害。该提案有3个具体目标：1)扩大和延续 现有队列，以建立由250名艾滋病毒感染男性和女性组成的波士顿纵向拱形队列 受多种物质的影响--酒精使用的范围，以及所有的物质依赖或注射 吸毒。2)同时用一种药物治疗酗酒和阿片依赖。用来治疗 阿片类药物对乙醇风险的试验将评估大剂量丁丙诺啡(32毫克)是否能减轻体重 一项随机、双盲、安慰剂对照的3个月饮酒与标准剂量(16毫克)的比较 对100名有阿片类药物依赖和酗酒的HIV感染成人队列参与者进行试验。如果 丁丙诺啡是一种治疗阿片类药物依赖的有效药物，很容易作为一种治疗方法传播。 对于HIV感染者和阿片类药物依赖者使用不健康的酒精，因为唯一的剂量调整是 必填项。3)因为酒精、阿片类药物的使用、艾滋病毒感染和抗逆转录病毒治疗可能会影响骨骼健康和 增加骨折风险，队列数据分析将确定饮酒的独立影响 骨密度和微结构的变化(高分辨率计算机断层扫描) 在所有队列参与者中预期在12-42个月内。该队列将产生酒精对人的影响的数据 骨骼，确定HIV感染者危险饮酒量和建议的重要信息 与酒精相关的风险。因此，这些研究将为缓解气候变化提供实质性的新知识 受多种物质影响的艾滋病毒感染成人中的酒精后果。 相关性(请参阅说明)： 艾滋病是可以有效治疗的，但饮酒过多会干扰治疗，导致骨质流失， 尤其是那些滥用其他药物的人。这项研究将研究艾滋病毒感染者 发现多少酒精会增加骨折的风险，以及一种药物是否用于药物 上瘾还可以减少大量饮酒。研究结果将有助于建议艾滋病毒感染者注意 限制饮酒以防止骨折，并可能找到一种新的治疗方法来减少饮酒和改善健康。 项目/绩效团队(S)(如果需要额外空间，请使用项目/绩效 项目/绩效站点主要位置 组织名称：波士顿医疗中心 DUNS：00-549-2160 一号街：波士顿医疗中心广场一号街二号： 城市：波士顿县：S所在的L 省：国家：U S A

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 antlretroviral 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. RELEVANCE (See instructions): HIV disease can be treated effectively, but drinking too much interferes with treatment and causes bone loss, especially among those who abuse other drugs. This research will study people with HIV infection to discover what amounts of alcohol increase risk of fractures, and to see whether a medication used for drug addiction can also reduce heavy drinking. Findings will be useful for advising people with HIV infection about drinking limits to prevent fractures and may identify a new treatment to reduce drinking and improve health. PROJECT/PERFORMANCE StTE(S) (if additional space is needed, use Project/Performance Project/Perfomiance Site Primary Location Organizational Name: Boston Medical Center DUNS: 00-549-2160 street 1: One Boston Medical Center Place street 2: City: Boston County: S u f f o l k Province: Country: U S A