OPTIMIZING AURICULAR ACUPUNCTURE FOR HIV+ DRUG ABUSERS

艾滋病毒阳性个体滥用可卡因是艾滋病毒向艾滋病毒阴性人群传播的一个主要因素；因此，在艾滋病毒阳性患者中开发和测试有效的治疗这种疾病的方法是一个紧迫的公共卫生问题。我们网站的初步数据表明，一种替代疗法，耳穴针灸，可能会减少艾滋病毒阳性患者的可卡因滥用，但在进行全面的临床试验之前，必须解决一些问题。拟议的一系列研究将调查耳穴治疗方案的三个关键维度——剂量、人际关系、治疗的急性生理和主观效应——这可能会影响hiv阳性患者的预后。所有的研究都将招募hiv阳性的可卡因滥用和美沙酮维持患者。研究1目的：在一项为期8周的试验中，招募40名患者，比较非互动针灸师和互动针灸师风格对耳穴针灸的保留和临床结果的影响；研究2的目的：在一系列的单期研究中，每个研究招募12名患者，以确定插入耳廓的针（1、3或5）的数量，与彼此以及放松和针插入控制相比，是否会影响β -内啡肽水平和急性主观效应；研究3的目的：在一项8周的随机试验中，招募了40名患者，比较标准的5针耳针方案和“滴定剂量”方案（第一个月一针，第二个月三针）的临床疗效和线索诱发的可卡因渴望，当使用在研究1中发现最有益的患者-针灸师互动水平时。其他目的：探讨：(a)耳针对认知功能测量的影响，以及这种相互作用对治疗保留的影响；(b)耳针对艾滋病毒相关症状的影响，以及(c)抗逆转录病毒药物与耳针治疗反应之间的关联。这些研究的发现将指导hiv阳性患者耳针治疗可卡因滥用的全面临床试验的设计，并将为关于耳针作用机制的假设提供信息。

Cocaine abuse by HIV-positive individuals is a major factor in the transmission of HIV to the HIV-negative population; consequently, developing and testing effective treatments for this disorder among HIV- positive patients is an urgent public health concern. Preliminary data from our site suggest that an alternative therapy, auricular acupuncture, may reduce cocaine abuse among HIV-positive patients, but that a number of issues must be addressed before conducting a full-scale clinical trial. The proposed series of studies will investigate three critical dimensions of the auricular protocol -- dose, interpersonal context, and acute physiological and subjective effects of treatment -- that may influence outcome in HIV-positive patients. All studies will enroll HIV-positive cocaine-abusing, methadone-maintained patients. Study number 1 Aim: In an 8-week trial enrolling 40 patients, to compare a non-interactive and an interactive acupuncturist style on retention in, and clinical outcome of, auricular acupuncture; Study number 2 Aims: In a series of single session studies, each enrolling 12 patients, to determine whether the number of needles inserted into the auricle (1,3,or 5), compared to each other and to relaxation and needle insertion controls, influences beta-endorphin levels and acute subjective effects; Study number 3 Aims: In an 8-week randomized trial enrolling 40 patients, to compare the standard 5-needle auricular acupuncture protocol to a "titrating dose" protocol (one needle in month one; three needles in month two), on clinical efficacy and cue-elicited cocaine craving, when delivered using the level of patient-acupuncturist interaction found to be most beneficial in Study number 1. Additional aims: To explore: (a) auricular acupuncture's effects on measures of cognitive functioning, and the influence of this interaction upon treatment retention; (b) auricular acupuncture's effects on HIV-related symptoms, and (c) the association between antiretroviral medications and response to auricular acupuncture treatments. Findings from these studies will guide the design of a full-scale clinical trial of auricular acupuncture for cocaine abuse in HIV-positive patients, and will provide information for generating hypotheses concerning auricular acupuncture's mechanism of action.