Impact of insomnia on substance use in people living with HIV

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Project Summary/Abstract This administrative supplement, in response to PA-18-906: “Research Supplements to Promote Diversity in Health-Related Research (Admin Supp – Clinical Trial Not Allowed)”, will expand the parent project (R01HL147603, PI-Burel R. Goodin), and provide research and career development support for Dr. Shameka L. Cody, a tenure track junior faculty member at The University of Alabama Capstone College of Nursing in Tuscaloosa, AL. Numerous reports of co-occurring symptoms such as poor sleep quality and pain exist among people living with HIV (PLWH) which can negatively impact quality of life. Insomnia, which is characterized by difficulty falling asleep, staying asleep or both, has been reported among 70% of PLWH compared to less than 35% of the general population. Similar to insomnia, over half of PLWH are likely to experience recurring pain symptoms. Pain is a growing concern for PLWH and has been associated with poor sleep quality. Laboratory- based studies have shown that sleep deprivation is associated with increased inflammatory effects, and these same inflammatory effects are associated with increased pain sensitivity. The parent grant for this Diversity Supplement has been designed to examine the impact of insomnia on pain and pain-related inflammatory processes in PLWH. Substance use is another mechanism by which insomnia may promote pain and inflammatory effects in PLWH. Nearly 50% of PLWH report current or past histories of drug or alcohol disorders. Substance use is associated with increased systematic inflammation, and in PLWH, these effects may be more profound and hasten disease progression. Exploring the impact of insomnia on pain and pain-related inflammatory processes in substance users with HIV will enhance the parent study, and represents an innovative training opportunity for a junior faculty. The scientific goals of the supplement are to: (1) augment the parent study with recruitment of PLWH and substance use, (2) examine whether the impact of insomnia on pain and pain-related processes differ by HIV+ substance users, (3) identify the interaction of substance use and insomnia in predicting increased pain sensitivity and elevated inflammatory biomarker levels (i.e., IL-6, TNF-α, and C- reactive protein). This supplement also has three career development goals for Dr. Cody, a promising junior faculty with a background in Nursing, HIV and aging, and sleep quality: (1) acquire expertise in clinical and translational research training in Sleep Medicine; (2) advance her knowledge of poor sleep quality in PLWH and its effects with substance use on quality of life determinants; (3) learn how to build multidisciplinary research teams, present at national and international conferences, develop first-author peer-reviewed manuscripts, and develop a competitive proposal for an early-career investigator R01.