Substance Use, HIV Progression and Mortality in a Cohort of Aging Veterans

描述（由申请人提供）：来自美国和欧洲艾滋病毒感染者的大型观察性队列研究的数据在药物滥用与艾滋病毒进展之间的关系方面产生了模棱两可的发现。一个关键问题是分析中对药物滥用的定义不一致和不同。为了解决这些限制，本研究提案将采用一种涉及新型统计技术的药物滥用暴露测量方法，以更好地捕捉药物滥用随时间的轨迹，并评估其对相关临床和公共卫生艾滋病毒结果的影响。首先，将分析艾滋病毒阳性和阴性成人长期滥用药物（酒精和非医学规定的精神活性药物）的模式，以确定其不同的轨迹类别。然后，在艾滋病毒感染者中，本研究将检查药物滥用模式在确定老年成年人群中艾滋病毒临床和公共卫生管理的几个重要结果中的作用：疾病进展，艾滋病毒药物依从性和死亡率。利用一项大型、多地点前瞻性队列研究——退伍军人老龄化队列研究（VACS）积累的数据，我们旨在更好地了解药物使用和滥用对艾滋病毒治疗和护理的影响。分析还将探讨更广泛的背景特征，如人们对医疗保健提供者的可及性的感知和社区一级的劣势，如何与药物滥用模式和艾滋病毒健康结果相互关联。本研究的结果可能有助于临床医生对药物滥用HIV阳性患者的治疗决策，并有助于识别那些健康状况不佳的风险最大的患者。研究结果还可能提出针对艾滋病毒阳性和药物滥用人群采取更有针对性的公共卫生预防和治疗干预措施的领域，并有助于为毒品、酒精、精神健康和艾滋病毒/艾滋病治疗指南提供信息。

DESCRIPTION (provided by applicant): Data from large observational cohort studies of people with HIV in the US and Europe have yielded equivocal findings on the relationship between substance abuse and progression of HIV. A key problem is the inconsistent and varied definition of substance abuse employed in the analyses. To address such limitations, this research proposal will use an approach to substance abuse exposure measurement involving novel statistical techniques to better capture trajectories of substance abuse over time and to assess their effects on relevant clinical and public health HIV outcomes. First, the patterns of substance abuse (alcohol and non-medically prescribed psychoactive drugs) over time among HIV positive and negative adults will be analyzed to characterize their distinct trajectory classes. Then, among those with HIV, this study will examine the role of the substance abuse patterns in determining several outcomes important to the clinical and public health management of HIV in an aging, adult population: progression of the disease, adherence to HIV medication, and mortality. Using data accumulated from a large, multi-site prospective cohort study, the Veteran's Aging Cohort Study (VACS), we aim to provide a better understanding of the influence of substance use and abuse in HIV treatment and care. Analyses will also explore how broader, contextual characteristics such as perceived accessibility of one's healthcare provider and neighborhood-level disadvantage, inter-relate with the patterns of substance abuse and HIV health outcomes. Results from this study may assist clinicians in treatment decisions about their substance abusing HIV positive patients and help identify those at greatest risk for poor health outcomes. Findings may also suggest areas for more targeted public health preventive- and treatment-interventions for HIV positive, substance abusing populations and help to inform drug, alcohol, mental health, and HIV/AIDS treatment guidelines.