HIV-1 Infection in Methamphetamine Abusers: Endocrine Outcomes

描述（由申请人提供）：HIV-1感染与内分泌系统的不良结局相关。非法药物滥用是感染HIV-1的一个主要危险因素，也与异常内分泌结果有关。包括我们在内的几项研究报告了吸毒HIV-1+个体的内分泌异常加剧。但这些调查是在可卡因和/或阿片类药物成瘾者中进行的，美国的药物滥用文化正在发生变化。甲基苯丙胺（冰毒）正在成为全国各地的首选药物，在南佛罗里达，特别是在男男性行为者中的滥用情况急剧上升。然而，关于甲基苯丙胺对HIV-1感染者内分泌影响的调查很少。据推测，肾上腺活动将增加，将有一个高活性的甲状腺以及胰岛素抵抗的发病率增加，在HIV-1+甲基滥用MSM。为了检验这些假设，这项为期5年的申请提出调查三组共450名男性的肾上腺、甲状腺和胰岛素活性：HIV-1+冰毒滥用者（n=150）、HIV-1-冰毒滥用者（n = 150）、HIV-1 -非冰毒滥用者（n =150），分布在非洲裔美国人、高加索人和西班牙裔美国人中。由于计划将重点放在男男性接触者身上，因此只有男性将被纳入研究。目标如下：目标1：目的：研究滥用冰毒的HIV-1+ MSM、滥用冰毒的HIV-1- MSM和HIV-1-无冰毒对照参与者的肾上腺活性（ACTH和皮质醇水平）以及对地塞米松-CRH联合激发的反应。目标二：目的：探讨吸毒HIV-1阳性MSM、吸毒HIV-1阳性MSM和HIV-1阴性对照人群的甲状腺功能（TSH、T4、T3）及甲状腺抗体水平。目的3：探讨吸毒HIV-1阳性MSM、吸毒HIV-1阳性MSM和HIV-1阴性对照人群的胰岛素活性。 这些内分泌紊乱可能导致大量严重的医疗后果和结果的巨大负担，并进一步允许开发合适的干预措施。 公共卫生相关性：甲基苯丙胺（冰毒）滥用，特别是在南佛罗里达的男同性恋者中，已经飙升。虽然HIV-1感染以及吸毒者HIV- 1感染的内分泌结果已被调查，但有关HIV-1+冰毒滥用MSM的此类结果的信息很少。该提案调查了这一人群的肾上腺、甲状腺和胰岛素活性。据认为，不良的内分泌结果可能会导致巨大的医疗负担。

DESCRIPTION (provided by applicant): HIV-1 Infection is associated with adverse outcomes in endocrine systems. Illicit drug abuse is a major risk factor for contracting HIV-1 infection and is also associated with abnormal endocrine outcomes. Several studies including ours have reported exacerbated endocrine abnormalities among drug abusing HIV-1+ individuals. But these investigations have been carried out among cocaine and/or opioids addicts, and the culture of drug abuse in the United States is changing. Methamphetamine (meth) is becoming a drug of choice all over the country and its abuse in South Florida particularly among MSM has skyrocketed. There is, however, a scarcity of investigations on the impact of methamphetamine on endocrines in HIV-1 infection. It is hypothesized that adrenal activity will be increased, there will be a hyper activity of thyroid as well as an increased incidence of insulin resistance, among HIV-1+ meth abusing MSM. In order to test these hypotheses, this 5 year application proposes to investigate cross sectionally adrenal, thyroid, and insulin activity in a total of 450 men in three groups: HIV-1+ meth abusers (n=150), HIV-1- meth abusers (n=150), HIV-1 - non-meth abusers (n=150) distributed among African Americans, Caucasians, and Hispanics. Because of the planned focus on MSM, only men will be included in the study. The following are aims: Aim 1: To investigate adrenal activity (ACTH and cortisol levels) as well as response to the combined dexamethasone-CRH challenge among meth abusing-HIV-1+ MSM, meth abusing HIV-1- MSM and HIV-1- meth-free control participants. Aim 2: To investigate thyroid activity (TSH, T4 and T3) as well as thyroid antibodies among meth abusing-HIV-1+ MSM, meth abusing HIV-1- MSM and HIV-1- meth-free control participants. Aim 3: To explore insulin activity among meth abusing-HIV-1+ MSM; meth abusing HIV-1- MSM and HIV-1- meth-free control participants. These endocrine disturbances may lead to enormous burden of a number of serious medical consequences and outcomes in meth abusing MSM and further allow developing suitable interventions. PUBLIC HEALTH RELEVANCE: Methamphetamine (meth) abuse particularly among MSM in South Florida has skyrocketed. Although endocrine outcomes in HIV-1 infection as well as drug abusers with HIV- 1 infection have been investigated, there is scarcity of information regarding such outcomes in HIV-1+ meth abusing MSM. This proposal investigates adrenal, thyroid and insulin activities in this population. It is proposed that adverse endocrine outcomes may result in an enormous medical burden.