HIV/AIDS & Alcohol-Related Outcomes:Translational Evidence-Based Interventions

描述（由申请人提供）：慢性酒精消费是美国最常见和最昂贵的药物滥用形式。酒精使用障碍（AUD）在艾滋病毒/艾滋病（PLWHA）感染者中很常见，与抗逆转录病毒治疗（ART）的依从性和有效性降低以及感染和病毒复制的易感性增强密切相关。路易斯安那州州立大学健康科学中心（LSUHSC）综合酒精研究中心（CARC）的科学家使用猿猴免疫缺陷病毒感染的非人灵长类动物模型进行的研究结果提供了慢性饮酒对疾病进展的生物医学后果的额外证据。我们的研究结果表明，长期饮酒会提高病毒设定点;在细菌感染期间增加肺部病毒水平;促进肠道CD 4+和CD 8 + T淋巴细胞群的变化，有利于疾病传播;对骨代谢，氮平衡和骨骼肌消耗产生负面影响。最终，这些因素导致疾病加速进展为终末期疾病。因此，临床和临床前证据支持这一假设，即针对PLWHA中AUD的干预措施有可能对患有AUD的HIV/AIDS患者的结局产生显著和积极的影响。具体来说，我们建议，整体健康恢复计划（HRP+），循证行为干预（EBI）最初开发的目标性和药物相关的风险在HIV+静脉注射吸毒者，可以适应目标AUD。此外，在一个真正的翻译方法，我们建议使用我们的基础科学派生的知识，以丰富的健康信息内容的HRP+。本申请中提出的研究将遵循ADAPT-ITT模型，使HHRP+适应目标AUD。我们将对新型EBI在实现和/或维持病毒载量抑制、减少AUD和HIV风险行为以及改善HIV+门诊患者的ART依从性方面的疗效进行初步测试。这种干预措施的成功适应及其未来的实施将通过提高患者对艾滋病毒感染者/艾滋病患者使用酒精的生物医学和心理社会后果的认识，并通过提高知识，动机和必要的技能来改变对艾滋病毒疾病进展产生负面影响的行为，从而改善临床结果（即病毒抑制）。干预措施的有效性将提高抗逆转录病毒疗法的依从性和有效性，改善生活质量，减少促进艾滋病毒传播的危险行为。 公共卫生相关性：慢性酒精消费是美国最常见和最昂贵的药物滥用形式。酒精使用障碍（AUDs）和HIV经常在同一个体中共存，并且它们的共存与药物非依从性和加速疾病进展密切相关。针对AUD和对HIV疾病进展产生负面影响的因素的有效循证行为干预措施将使大量患有合并症AUD的HIV+个体显著受益，这些患者传统上获得综合治疗的机会有限。

DESCRIPTION (provided by applicant): Chronic alcohol consumption is the most common and costly form of substance abuse in the United States. Alcohol use disorders (AUD) are frequent in people living with HIV/AIDS (PLWHA) and are strongly associated with decreased adherence to and effectiveness of antiretroviral therapy (ART), and enhanced susceptibility to infection and viral replication. Results from studies conducted by scientists at the Louisiana State University Health Sciences Center (LSUHSC) Comprehensive Alcohol Research Center (CARC) using the Simian Immunodeficiency Virus infected non-human primate model have provided additional evidence of the biomedical consequences of chronic alcohol consumption on disease progression. Our results show that chronic alcohol consumption elevates viral set point; increases lung viral levels during bacterial infection; promotes intestinal CD4+ and CD8+ T lymphocyte population changes that favor disease transmission; negatively affects bone metabolism, nitrogen balance, and skeletal muscle wasting. Ultimately these factors lead to accelerated disease progression to end-stage disease. Thus, clinical and preclinical evidence supports the hypothesis that interventions targeting AUDs in PLWHA have the potential to significantly and positively impact outcomes in HIV/AIDS patients with AUD. Specifically, we propose that the Holistic Health Recovery Program (HHRP+); an evidence-based behavioral intervention (EBI) originally developed to target sex- and drug-related risk-taking in HIV+ intravenous drug users, can be adapted to target AUD. Furthermore, in a truly translational approach, we propose to use our basic science derived knowledge to enrich the health information content of the HHRP+. Studies proposed in this application will follow the ADAPT-ITT model in adapting the HHRP+ to target AUD. We will pilot-test the novel EBI for efficacy in achieving and/or maintaining viral load suppression, reducing AUD and HIV risk behaviors, and improving ART adherence among in- care HIV+ outpatients. The successful adaptation of this intervention and its future implementation will improve clinical outcomes (i.e. viral suppression) by enhancing patients' awareness of the biomedical and psychosocial consequences of alcohol use in PLWHA, and by enhancing the knowledge, motivation, and skills necessary to modify behaviors negatively impacting on HIV disease progression. Efficacy of the intervention will lead to improved adherence to and effectiveness of ART, improved quality of life, and decreased risky behaviors that promote HIV transmission. PUBLIC HEALTH RELEVANCE: Chronic alcohol consumption is the most common and costly form of substance abuse in the United States. Alcohol use disorders (AUDs) and HIV frequently coexist in the same individual and their co-existence is strongly associated with medication non- adherence and accelerated disease progression. Effective evidence-based behavioral interventions that target AUD and factors that negatively impact on HIV disease progression will significantly benefit a large number of HIV+ individuals with co-morbid AUD who traditionally had limited access to comprehensive treatment.