Should screening and treatment strategies for unhealthy alcohol misuse in HIV-infected persons vary with smoking, depression, and substance abuse?

项目摘要/摘要： 一项新兴的研究表明，不健康的酒精使用物质使用，吸烟，和 抑郁症经常在感染艾滋病毒的患者中并存。在一项大型的多地点观测研究中 老龄化和艾滋病、不健康的饮酒、吸烟和抑郁都很常见 在HIV携带者中，表现出显著的时间一致性，通常是缓解性和 反复出现在一起。例如，更多的饮酒会降低戒烟的几率。 虽然不健康的酒精使用、药物使用、吸烟和抑郁经常同时发生，但他们的 筛查和治疗并非如此。针对这些疾病的筛查和治疗策略是 由于多种因素，通常单独规定和单独制定， 包括不同的临床指南，这些指南背后的不同证据 以及针对每种疾病的不同提供者和方案。因此，患者 接受一项筛查的患者不能进行另一项筛查，接受治疗的患者也不能接受另一项筛查 一个人可能不会为另一个人治疗。 我们建议开发一个决策分析模型来评估收益影响以及 综合筛查和治疗的潜在有害影响和所涉资源。

Project Summary/Abstract: An emerging body of work shows that unhealthy alcohol use substance use, smoking, and depression often co-occur in HIV-infected patients. In a large multisite observational study of aging and HIV, unhealthy alcohol use, substance use smoking, and depression were common among those with HIV and exhibited striking temporal concordance, often remitting and recurring together. For example, greater alcohol use decreases the odds of smoking cessation. While unhealthy alcohol use, substance use, smoking, and depression often co-occur, their screening and treatment does not. Screening and treatment strategies for these conditions are typically specified separately and enacted separately because of a multitude of factors, including distinct clinical guidelines, varying strength of evidence underlying those guidelines and distinct providers and programs for the treatment of each condition. As a result, patients who are screened for one may not be screened for another, and patients who are treated for one may not be treated for another. We propose developing a decision-analytic model to evaluate beneficial effects as well as potentially harmful effects and resource implications of integrated screening and treatment.