Alcohol and HIV: Biobehavioral Interactions and Intervention

酒精使用在许多方面导致与艾滋病毒相关的发病率和死亡率，包括(a)降低抗逆转录病毒药物的依从性和疗效，(b)导致更差的病毒学结果和免疫功能，(c)加剧肝功能障碍和肝炎合并感染，以及(d)加剧与艾滋病毒相关的神经认知缺陷。此外，艾滋病毒感染者和未感染者之间的酒精使用与导致艾滋病毒传播的高风险性行为有关。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、跨学科的方法来推进酒精/艾滋病毒相互作用的科学研究，并为在国内和国际上照顾艾滋病毒感染者和预防艾滋病毒传播的临床方法提供信息。该综合酒精研究中心（CARC）的总体目标是开展和传播有关酒精与艾滋病毒之间生物行为相互作用以及减少艾滋病毒感染患者和艾滋病毒传播高风险个体饮酒的干预措施的多学科最新研究。该中心有9个组成部分：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教育/传播部分，后者作为培训和传播的国家资源。研究活动利用不同的方法（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）和这些变量之间相互关系的重叠假设。这些活动提供了一整套创新的酒精/艾滋病毒研究，其对公共卫生的总体影响远远大于任何一项或全部独立开展的研究。此外，该CARC将作为酒精/艾滋病毒科学在拟议组成部分、创新试点项目、补充研究以及与其他NIAAA中心之间整合的纽带，对酒精和艾滋病毒之间的相互作用以及减少艾滋病毒感染者和其他有传播风险的人饮酒的干预措施产生新的见解。

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.