COVID-19 Pandemic-Related Changes in Alcohol use among Persons with HIV

新冠肺炎的流行以及随之而来的居家限酒措施可能会极大地影响饮酒。 由于由此产生的心理困扰、焦虑、无聊和社会孤立。我们在这里提议 检查酒精使用的变化及其对持续队列人群中抗逆转录病毒(ART)依从性的影响 在美国(波士顿)和乌干达大流行期间和之后有饮酒史的艾滋病毒(PWH)患者 (姆巴拉拉)。在美国，酒类销售、工作日饮酒以及人们提到的饮酒行为都在激增 在互联网上。目前尚不清楚新冠肺炎限制措施对乌干达的影响。有一些轶事 有报道称，由于酒精可获得性较低，饮酒量减少，但当受到限制时，饮酒量可能会反弹 都被解除了。威斯康星医院有高水平的酒精使用和其他精神健康并存，因此可能在 在任何情况下增加或复发的风险都很高。因此，迫切需要研究来量化大流行- 威尔斯亲王在不同环境下大量饮酒时饮酒情况的相关变化。此外，酒精的使用 是抗逆转录病毒(ART)依从性差和病毒抑制差的持续强烈的风险因素； 酗酒与艾滋病毒病毒控制不力有关；呆在家里的措施对 服药依从性尚不清楚。社会期望和回忆偏见阻碍了使用自我报告进行的调查 酒精和药物依从性，但药物水平和酒精消费的直接代谢物 客观标记物，为剂量-反应研究产生定量结果，具有较长的半衰期 回溯性测量。因此，我们将使用酒精代谢物来衡量以前的酒精使用情况 干血斑点(DBS)中的磷脂酰乙醇(PEH)(测量2-3周的酒精使用量)和乙基 头发中的葡萄糖醛酸苷(EtG)(测量1-3个月的饮酒量)以及头发中的ART浓度 (衡量数周至数月的ART)，以补充自我报告。我们将利用正在进行的队列，这些队列是 NIAAA资助的城市ARCH财团以及加州大学旧金山分校的头发分析实验室(HAL)， 丰富的经验，测量头发的ART，使现有的实验室方案适合头发EtG测试，并 为peth开发自动化的DBS处理。我们的目标是(1)确定有规律饮酒的人的比例 乌干达和美国威斯康星医院在居家限制之前、期间和之后的重度酒精使用(n=125) 并描述每个队列中饮酒的变化；(2)检查头发和病毒中的ART水平 抑制率从冠状病毒感染前变化到居家限制取消后，角色变化 酒精使用；以及(3)修改现有的HAL ART毛发分析方法以分析EtG，以达到上述目的，以及 开发和验证自动化DBS处理，以创建高通量的PEH测试。这项工作将 加深我们对新冠肺炎对酒精使用的影响及其在艺术中的作用的理解 粘附性和病毒抑制，同时扩展酒精生物标记物测试能力 易于收集和运输，以改进未来对酒精使用的客观监测。

The COVID-19 pandemic and the resulting stay-home restrictions are likely to drastically impact alcohol use, due to the resulting psychological distress, anxiety, boredom, and social isolation. We propose here to examine changes in alcohol use and the impact on antiretroviral (ART) adherence in ongoing cohorts of people with HIV (PWH) with histories of alcohol use during and after the pandemic in the US (Boston) and Uganda (Mbarara). In the US, there has been a surge in alcohol sales, weekday drinking, and references to alcohol use on the internet. The impact of the COVID-19 restrictions in Uganda is not yet known. There are anecdotal reports of decreased drinking due to low accessibility of alcohol, but drinking may rebound when restrictions are lifted. PWH have high levels of alcohol use and other mental health co-morbidities, and therefore may be at high risk for increases or relapses in any setting. Research is hence urgently needed to quantify pandemic- related changes in alcohol use among PWH with heavy alcohol use in various settings. In addition, alcohol use is a consistently strong risk factor for poor antiretroviral (ART) adherence and poor viral suppression; changes in alcohol use are associated with poor HIV viral control; and the impact of the stay-home measures on medication adherence is unknown. Social desirability and recall bias impede investigations using self-report of alcohol and medication adherence, but drug levels and direct metabolites of alcohol consumption serve as objective markers, yielding quantitative results for dose-response investigations, with long half-lives for retrospective measurement. Thus, we will measure prior alcohol use using alcohol metabolite phosphatidylethanol (PEth) in dried blood spots (DBS) (measuring 2-3 weeks' alcohol use) and ethyl glucuronide (EtG) in hair (measuring 1-3 months' alcohol use), as well as ART concentrations in hair (measuring weeks to months' ART), to supplement self-report. We will leverage ongoing cohorts that are part of the NIAAA-funded URBAN ARCH consortium, as well as the UCSF Hair Analytic Laboratory (HAL), with vast experience measuring ART in hair, to adapt existing laboratory protocols to hair EtG testing, and to develop automated DBS processing for PEth. We aim to (1) determine the proportion of drinkers with regular heavy alcohol use before, during, and after stay-home restrictions among PWH in Uganda and the US (n=125 each), and characterize changes in drinking in each cohort; (2) examine whether ART levels in hair and viral suppression rates change from pre-COVID to after stay-home restrictions are lifted, and the role of changing alcohol use; and (3) adapt existing HAL ART hair assay protocols for analysis of EtG for the above aims, and to develop and validate automated DBS processing to create high-throughput PEth testing. This work will advance our understanding of the impact of the COVID-19 pandemic on alcohol use and its role in ART adherence and viral suppression, while expanding alcohol biomarker testing capability in specimens which are easy-to-collect and ship to improve objective monitoring of alcohol use into the future.