Alcohol and HIV Treatment and Clinical Progression

描述（由申请人提供）：在美国，现代抗逆转录病毒（ARV）疗法已经将HIV感染从一种绝症转变为一种具有潜在正常寿命的慢性感染。由于寿命长，酒精使用更有可能通过影响抗逆转录病毒（ARV）治疗的使用、免疫恢复以及艾滋病相关和非艾滋病相关临床事件的发生，在艾滋病毒疾病的进展中发挥重要作用。危险饮酒与一系列广泛的不良健康影响有关。在HIV感染中，我们已经表明危险饮酒（NIAAA定义）与arv使用率降低、HIV病毒载量抑制和免疫恢复较差独立相关。由于危险使用酒精会干扰有效的抗逆转录病毒药物治疗，因此很可能与艾滋病毒疾病的更快进展有关。然而，由于艾滋病毒感染的特点是慢性炎症和免疫功能低下，合并感染，如病毒性肝炎，以及可能增加非艾滋病相关临床事件（如心血管、肾脏、肝脏、内分泌）的风险，即使是通常不被认为危险的低水平饮酒，也可能对艾滋病毒感染患者产生不利影响。因此，我们建议更广泛地确定酒精使用与HIV治疗和临床疾病进展的关系。我们的研究将使用约翰霍普金斯大学HIV临床队列，这是一个纵向临床队列，研究对象是在约翰霍普金斯大学HIV/AIDS服务中心接受初级HIV/AIDS治疗的患者。该队列建立于1991年，为160多篇论文提供了丰富的数据来源，这些论文研究了在护理患者中艾滋病毒感染的自然历史、治疗和结果。我们使用多个有效的消费问卷评估特定的酒精消费水平，并每6个月使用音频计算机辅助自我访谈（A-CASI）评估饮酒相关问题。我们建议解决以下具体目标：1)评估饮酒与艾滋病毒治疗反应之间的关系（病毒学和免疫反应，艾滋病毒抗性突变的发展，机会性感染的发展和生存），2)评估饮酒与抗逆转录病毒治疗毒性发展之间的关系。通常被认为无害的酒精使用水平可能是艾滋病毒感染的有效长期管理和结果的一个未被认识到的重大障碍。我们的研究可以产生有价值的结果，以更好地了解酒精使用与艾滋病毒/艾滋病之间的关系。

DESCRIPTION (provided by applicant): In the U.S., modern antiretroviral (ARV) therapy has transformed HIV infection from a terminal illness to a chronic infection with a potentially normal life span. With long life-spans, alcohol use has a greater opportunity to play an important role in the progression of HIV disease through effects on utilization of antiretroviral (ARV) therapy, immune recovery and the development of AIDS-related and non-AIDS related clinical events. Hazardous alcohol use is associated with a wide range of adverse health effects. In HIV-infection, we have shown that hazardous drinking (NIAAA definition) is associated independently with diminished utilization of ARVs, and poorer HIV viral load suppression and immune recovery. Since hazardous alcohol use interferes with effective ARV treatment, it is therefore likely that it will be associated with more rapid HIV disease progression. However, because HIV infection is characterized by chronic inflammation and immunocompromise, co-infections such as viral hepatitis, and possibly an increased risk of non-AIDS related clinical events (e.g. cardiovascular, renal, liver, endocrine), even lower levels of alcohol use that are not generally considered hazardous may have an adverse impact on patients with HIV-infection. Therefore, we propose to determine the relationship of alcohol use more broadly on HIV treatment and clinical disease progression. Our research will use the Johns Hopkins HIV Clinical Cohort, a longitudinal clinical cohort of patients who receive primary HIV/AIDS care on the Johns Hopkins HIV/AIDS Services. The Cohort was established in 1991, and has provided a rich source of data for over 160 papers that have examined the natural history, treatment and outcomes of HIV infection in patients in care. We assess specific levels of alcohol consumption using more than one validated consumption questionnaire, as well as drinking-related problems every 6 months with an audio computer-assisted self-interview (A-CASI). We propose to address the following specific aims: 1) Evaluate the relationship between alcohol consumption and response to HIV treatment (virologic and immunologic response, development of HIV resistance mutations, development of opportunistic infections, and survival), 2) Evaluate the relationship between alcohol use and development of toxicity from antiretroviral therapy. Alcohol use at levels generally considered non-hazardous may be a significant under- recognized barrier to the effective long-term management and outcomes of HIV infection. Our research can yield valuable results to better understand the relationship between alcohol use and HIV/AIDS. PUBLIC HEALTH RELEVANCE: Modern HIV therapy is allowing people with HIV infection to live longer lives. Because of this, alcohol drinking may have a greater opportunity to cause adverse consequences. Our study is designed to measure alcohol use in a population of HIV- infected patients in care, and to determine levels of alcohol use that increase the risk of bad outcomes.