HIV-Infected IDU Living with HCV Coinfection

描述(由申请人提供)：高效抗逆转录病毒疗法(HAART)延长了许多感染人类免疫缺陷病毒(HIV)的人的生存时间。因此，这些人正经历着其他感染或合并疾病的发病率和死亡率，在HAART之前，患者没有活到足够长的时间来面对这些疾病。因此，我们认为，我们正处于一种范式的转变中，在这种转变中，将把艾滋病毒感染作为一种慢性病来思考和管理，并将重点转向艾滋病毒感染作为一种共病的医疗状况，必须在临床上加以管理，并对其进行心理调整，以适应一种或多种其他重要的慢性病或状况。在许多方面，与丙型肝炎(丙型肝炎)合并感染是新范式的例证。这是一种共同发病，影响到美国大约三分之一的艾滋病毒+患者和超过80%的艾滋病毒+注射吸毒者(IDU)，他们已经注射了多年。此外，丙型肝炎病毒影响艾滋病毒+成年人的所有年龄段。虽然医学文献中关于艾滋病毒/丙型肝炎病毒混合感染的文章迅速增加，但在关于艾滋病毒/艾滋病的心理社会和行为文献中，与联合感染共同生活的问题实际上被忽视了。然而，这一群体的重要性有望与日俱增，这既是因为他们将处于两种流行病--艾滋病疫情和丙型肝炎病毒感染的“影子流行病”--的中心，也是因为他们代表着越来越多的艾滋病毒携带者现象，随着生存时间的延长，他们将同时生活和应对另一种严重的慢性病或疾病。合并感染的患者也给医生带来了许多挑战，因为他们同时处理两种严重的病毒感染，往往具有不可预测的疾病轨迹。为了开始解决现有艾滋病毒/艾滋病心理学文献中的这些重要差距，我们建议定性地调查合并感染丙型肝炎病毒如何阻碍或复杂化艾滋病毒+个体面临的几个关键疾病相关适应任务的掌握，并确定它构成的任何独特的适应挑战。研究样本将由140名有注射吸毒史的艾滋病毒/丙型肝炎病毒共同感染的成年人组成。为了开始了解他们在照顾合并感染患者方面面临的挑战如何影响患者适应，还将采访在艾滋病诊所治疗患者的所有14名医生，患者样本将从这些诊所招募。

DESCRIPTION (provided by applicant): Highly active antiretrovial therapy (HAART) has extended survival for many people infected with human immunodeficiency virus (HIV). As a result, these individuals are experiencing morbidity and mortality from other infections or co-morbid diseases that, prior to HAART, patients did not live long enough to confront. Consequently we believe that we are in the midst of something of a paradigm shift in which thinking about, and managing HIV infection as a chronic illness, will shift to a focus on HIV infection as a co-morbid medical condition that must be clinically managed, and psychosocially adjusted to, alongside one or more other signficant chronic illnesses or conditions. In many ways co-infection with hepatitis C (HCV) exemplifies the new paradigm. It is a co-morbidity that affects approximately a third of all HIV+ persons in the US and upwards of 80% of HIV+ injecting drug users (IDUs) who have been injecting for a number of years. Moreover, HCV impacts all age groups of HIV+ adults. While there has been a rapid proliferation of articles in the medical literature on HIV/HCV co-infection, the problems of living with co-infection have been virtually overlooked in the psychosocial and behavioral literature on HIV/AIDS. Yet this population promises to be one of growing importance, both because it will be at the center of two epidemics, the AIDS epidemic and the "shadow epidemic" of HCV infection - and because it is representative of the growing phenomenon of HIV+ individuals who, as survival continues to extend, will simultaneously be living and coping with another serious chronic illness or condition. Co-infected patients also present many challenges for physicians as they simultaneously manage two serious viral infections with often, unpredictable disease trajectories. To begin addressing these important gaps in the extant HIV/AIDS psychosocial literature, we propose to qualitatively investigate how co-infection with HCV impedes or complicates the mastery of several key illness-related adaptive tasks that HIV+ individuals confront, as well as to identify any unique adaptive challenges that it poses. The study sample will be composed of 140 HIV/HCV-co-infected adults with a history of injecting drug use. To begin to understand how the challenges they face in caring for co-infected patients impact patient adjustment, all 14 physicians treating patients at the AIDS clinics from which the patient sample will be recruited will also be interviewed.