3/4 Alcohol Research Consortium in HIV - Epidemiological Research Arm (ARCH-ERA)

描述（由申请人提供）：酒精使用、滥用和依赖在艾滋病毒感染者中普遍存在，并且与抗逆转录病毒治疗（ART）的延迟开始和坚持以及艾滋病毒疾病的传播和进展有关。先前关于酒精和艾滋病毒相互关系的研究是在相对较小的样本或选定的群体中进行的，其结果可能无法推广到艾滋病毒感染者的总体人口。艾滋病毒流行病学研究部门酒精研究联盟（ARCH-ERA）将通过研究酒精对艾滋病毒感染者临床结果的短期和长期影响来解决我们知识上的这一缺陷。我们将通过阐明酒精使用的负担、它对艾滋病毒疾病进展的影响以及它对参与临床护理、卫生保健利用和成本的影响来实现这一目标。ARCH-ERA将以CFAR综合临床系统网络（CNICS）为基础，这是一个由8个艾滋病毒临床护理点和2万多名艾滋病毒感染者接受艾滋病毒护理的国家网络。CNICS是ARCH-ERA的理想环境，因为它收集了全面的患者护理和临床结果数据，这些数据与患者提供的有关酒精使用、物质使用、医疗和精神发病率、依从性、艾滋病毒传播风险行为和生活质量（QOL）的信息有关。利用CNICS的资源和基础设施，我们提出以下目标：确定危险酒精消费对艾滋病毒感染者的负担；确定不同酒精使用水平和模式对艾滋病毒疾病长期进展的影响，并评估酒精使用对艾滋病毒卫生保健利用和护理成本的影响。将特别注意性/性别、非法药物使用和精神健康症状在酒精与艾滋病毒之间关系中的作用。

DESCRIPTION (provided by applicant): Alcohol use, abuse, and dependence are prevalent among HIV-infected individuals, and are associated with delayed initiation of and adherence to antiretroviral therapy (ART), and with HIV disease transmission and progression. Prior research on the intersection of alcohol and HIV has been conducted in relatively small samples or in select groups whose results may not be generalizable to the overall population of HIV-infected individuals. The Alcohol Research Consortium in HIV - Epidemiology Research Arm (ARCH-ERA), will address this deficit in our knowledge by studying the short and long-term effects of alcohol on clinical outcomes among persons with HIV. We will accomplish this by elucidating the burden of alcohol use, its effect on HIV disease progression, and its impact on engagement in clinical care, health care utilization and costs. ARCH-ERA will be based in the CFAR Network of Integrated Clinical Systems (CNICS), a national network of 8 HIV clinical care sites and over 20,000 HIV-infected men and women receiving HIV care. CNICS is the ideal setting for ARCH-ERA because of its collection of comprehensive patient care and clinical outcomes data that is linked to patient-provided information on alcohol use, substance use, medical and psychiatric morbidities, adherence, HIV transmission risk behaviors, and quality of life (QOL). Capitalizing on the resources and infrastructure of CNICS, we propose the following aims: To determine the burden of hazardous alcohol consumption to HIV infected individuals; to determine the impact of different levels and pattern of alcohol use on HIV disease progression over time, and to evaluate the impact of alcohol use on HIV health care utilization and costs of care. Particular attention will be paid to the roles of sex/gender, illicit drug use, and mental health symptoms in the relationship between alcohol and HIV. PUBLIC HEALTH RELEVANCE: Alcohol use, abuse and dependence are prevalent among HlV-infected individuals and are associated with poor outcomes, more severe psychiatric and medical comorbidities, and high individual and social costs. Elucidating how alcohol affects HIV in the short- and long-term, and the associated economic costs, will inform interventions to improve HIV care, reduce alcohol use, and improve quality of life and survival among persons with HIV.