Evaluation Of Treatments Of Drug Dependence In HIV+

该项目评估减少药物滥用者艾滋病毒风险行为的方法，并评估对已经感染艾滋病毒的阿片类药物依赖的药理学和行为治疗的安全性和有效性。我们已经完成了一项随机临床试验，检查是否可以通过在基于凭证的应急管理中增加认知行为应对技能和复发预防干预来实现持续的艾滋病毒保护行为。在市中心，以美沙酮维持的可卡因滥用者被教导：1)识别并寻找不会带来艾滋病毒风险的强化来源；2)对可能引发艾滋病毒风险行为的一般和药物特异性压力源，发展适应性的以问题为中心和以情绪为中心的应对反应。研究样本（n=81）中52%为女性，70%为非洲裔美国人，37.9 ？7岁。艾滋病毒风险行为大幅减少：49.4%的人停止注射毒品，51.9%的人停止共用针头，27.2%的人停止无保护的性行为，25.9%的人停止性交易。与对照组相比，接受CBT的参与者更有可能停止无保护的性行为（OR=5.44, 95% CI 1.14-26.0, p=0.034），但在调整了药物阴性尿后，这种影响降低了。这些结果表明，美沙酮维持和行为干预对减少艾滋病毒风险行为有广泛的有益作用，而CBT对减少性风险行为的额外益处有限。

This project assesses methods for decreasing HIV-risk behaviors in substance abusers, and assesses the safety and efficacy of pharmacological and behavioral treatments for opioid dependence in those already infected with HIV. We have completed a randomized clinical trial examining whether sustained HIV-protective behaviors can be achieved by adding a cognitive-behavioral coping-skills and relapse-prevention intervention to voucher-based contingency management. Inner-city methadone-maintained cocaine abusers were taught: 1) to identify and seek out sources of reinforcement that do not carry risks of HIV, and 2) to develop adaptive problem-focused and emotion-focused coping responses to general and drug-specific stressors that might otherwise trigger HIV-risk behaviors. The study sample (n=81) was 52% female, 70% African American, and 37.9 ? 7.0 years old. There were substantial decreases in HIV-risk behaviors: 49.4% stopped injection drug use, 51.9% stopped sharing needles, 27.2% stopped unprotected sex, and 25.9% stopped trading sex for money or drugs. Participants receiving CBT were more likely to stop unprotected sex relative to controls (OR=5.44, 95% CI 1.14-26.0, p=0.034), but this effect was reduced when adjusted for drug-negative urines. These results suggest broad beneficial effects of methadone maintenance augmented with behavioral interventions for reducing HIV risk behaviors, with limited additional benefit from CBT for reduction of sexual risk behaviors.