Alcohol and HIV: Biobehavioral Interactions and Intervention

说明(申请人提供)：酒精使用以多种方式导致与艾滋病毒有关的发病率和死亡率，包括(A)减少抗逆转录病毒药物的依从性和疗效，(B)导致病毒学结果和免疫功能恶化，(C)加剧肝功能障碍和肝炎合并感染，以及(D)加剧与艾滋病毒有关的神经认知缺陷。此外，无论是艾滋病毒感染者还是非感染者，饮酒都与导致艾滋病毒传播的高危性行为有关。鉴于酒精影响艾滋病毒发病率、死亡率和传播的多种途径，我们提出了一种综合的、多方面的、跨学科的方法，以推动关于酒精/艾滋病毒相互作用的科学，并为护理艾滋病毒携带者的临床方法和在国内和国际上预防艾滋病毒传播的努力提供信息。这个综合酒精研究中心(CARC)的总体目标是进行和传播关于酒精和艾滋病毒之间的生物行为相互作用的多学科最先进的研究，以及关于减少艾滋病毒感染患者和艾滋病毒传播高危个人酒精使用的干预措施的研究。CARC有9个综合部分：一个行政核心、四个研究部分、两个科学核心(病毒学和生物统计学)、一个试点项目部分和一个作为国家培训和传播资源的教育/传播部分。研究活动使用不同的方法(动物和人类研究)和人群，解决了关于关键变量(酒精使用、病毒学、肝功能、神经认知功能、抗逆转录病毒治疗的使用和高危性行为)以及这些变量之间的相互关系的重叠假设。这些活动提供了一个创新的酒精/艾滋病毒研究的综合机构，可以产生比任何一个或全部单独进行的更大的总体公共卫生影响。此外，该CARC将作为将酒精/艾滋病毒科学整合到拟议组成部分、创新的试点项目、补充性研究以及与其他NIAAA中心的联系，从而对酒精与艾滋病毒之间的相互作用以及减少艾滋病毒携带者和其他有传播风险的人饮酒的干预措施产生新的见解。 公共卫生相关性：通过增加对过度饮酒和减少过度饮酒的干预措施如何影响艾滋病毒相关结果的了解，这个关于艾滋病毒/艾滋病的综合酒精研究中心可以为改善艾滋病毒携带者的健康和减少艾滋病毒的传播做出巨大贡献。

DESCRIPTION (provided by applicant): Alcohol use contributes to morbidity and mortality associated with HIV in numerous ways including (a) reducing antiretroviral medication adherence and efficacy, (b) contributing to worse virologic outcomes and immune functioning, (c) exacerbating liver dysfunction and hepatitis co-infection, and (d) exacerbating neurocognitive deficits associated with HIV. In addition, alcohol use among both HIV-infected and uninfected individuals is implicated in high-risk sexual behavior that leads to HIV transmission. Given multiple pathways through which alcohol impacts HIV morbidity, mortality and transmission, we propose an integrated, multifaceted, interdisciplinary approach to forward science on alcohol/HIV interactions and inform clinical approaches to caring for people living with HIV and efforts to prevent HIV transmission, both nationally and internationally. The overall aim of this Comprehensive Alcohol Research Center (CARC) is to conduct and disseminate multidisciplinary state-of-the-art research on biobehavioral interactions between alcohol and HIV and on interventions to reduce alcohol use among HIV-infected patients and individuals at high risk for HIV transmission. The CARC has 9 integrated parts: an Administrative Core , four Research Components, two Scientific Cores (Virology and Biostatistics), a Pilot Projects Component, and an Education/Dissemination Component that serves as a national resource for training and dissemination. Research activities address overlapping hypotheses regarding key variables (alcohol use, virology, hepatic function, neurocognitive function, use of antiretroviral therapy, and high-risk sexual behavior) and interrelationships among these variables using diverse methodologies (both animal and human research) and populations. These activities provide an integrated body of innovative alcohol/HIV research that can yield far greater total public health impact than any or all of them could if conducted independently. Further, this CARC will serve as the nexus for integration of alcohol/HIV science across proposed components, innovative pilot projects, complementary studies, and with other NIAAA Centers, yielding new insights into interactions between alcohol and HIV and into interventions to reduce drinking among those with HIV and others at risk for transmission. PUBLIC HEALTH RELEVANCE: By increasing understanding of how excessive alcohol consumption and interventions to reduce excessive drinking can impact HIV-related outcomes, this Comprehensive Alcohol Research Center on HIV/AIDS can contribute greatly to efforts to improve the health of those living with HIV and to reduce the spread of HIV.