HIV-Infected IDU Living with HCV Coinfection

描述（由申请人提供）：高效抗逆转录病毒治疗（HAART）延长了许多人类免疫缺陷病毒（HIV）感染者的生存期。因此，这些人正在经历其他感染或合并症的发病率和死亡率，在HAART之前，患者寿命不够长，无法面对这些疾病。因此，我们相信，我们正处于一种范式转变之中，在这种转变中，把艾滋病毒感染作为一种慢性疾病来思考和管理，将把重点转移到把艾滋病毒感染作为一种必须在临床上进行管理的共病医学状况，以及与一种或多种其他重大慢性疾病或状况一起进行心理社会调整。在许多方面，合并感染丙型肝炎（HCV）是这种新模式的例证。这是一种合并症，影响了美国约三分之一的艾滋病毒阳性患者和超过80%的注射吸毒多年的艾滋病毒阳性注射吸毒者（IDUs）。此外，丙型肝炎病毒影响所有年龄组的艾滋病毒阳性成年人。虽然医学文献中关于艾滋病毒/丙型肝炎病毒合并感染的文章迅速增加，但关于艾滋病毒/艾滋病的社会心理和行为文献实际上忽视了合并感染的生活问题。然而，这一人群有望成为越来越重要的群体之一，因为它将成为两种流行病的中心，艾滋病流行病和HCV感染的“影子流行病”，而且因为它代表了艾滋病毒+个体日益增长的现象，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疾病或病症。同时感染的患者也给医生带来了许多挑战，因为他们同时要处理两种严重的病毒感染，这些感染往往具有不可预测的疾病轨迹。为了开始解决现有HIV/AIDS社会心理文献中的这些重要空白，我们建议定性地研究HCV合并感染如何阻碍或复杂化HIV+个体面临的几个关键疾病相关适应性任务的掌握，以及确定它所带来的任何独特的适应性挑战。研究样本将由140名有注射吸毒史的HIV/ hcv合并感染的成年人组成。为了开始了解他们在照顾合并感染患者方面所面临的挑战如何影响患者的适应，还将对将招募患者样本的艾滋病诊所的所有14名治疗患者的医生进行访谈。

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.