Alcohol and HIV Treatment and Clinical Progression

描述（由申请人提供）：在美国，现代抗逆转录病毒（ARV）疗法已将艾滋病毒感染从绝症转变为具有潜在正常寿命的慢性感染。随着寿命的延长，酒精的使用有更大的机会通过影响抗逆转录病毒（ARV）疗法的使用，免疫恢复和艾滋病相关和非艾滋病相关临床事件的发展，在艾滋病毒疾病的进展中发挥重要作用。危险的酒精使用与广泛的不良健康影响有关。在艾滋病毒感染中，我们已经证明危险饮酒（NIAAA定义）与抗逆转录病毒药物使用减少、艾滋病毒病毒载量抑制和免疫恢复较差独立相关。由于危险的酒精使用会干扰有效的抗逆转录病毒治疗，因此很可能与更快的艾滋病毒疾病进展有关。然而，由于HIV感染的特点是慢性炎症和免疫功能低下，合并感染如病毒性肝炎，并可能增加非艾滋病相关临床事件（如心血管，肾脏，肝脏，内分泌）的风险，即使是一般认为不危险的较低水平的酒精使用也可能对HIV感染患者产生不利影响。因此，我们建议更广泛地确定酒精使用对艾滋病毒治疗和临床疾病进展的关系。我们的研究将使用约翰霍普金斯艾滋病毒临床队列，这是一个纵向临床队列，患者接受约翰霍普金斯艾滋病毒/艾滋病服务的初级艾滋病毒/艾滋病护理。该队列成立于1991年，为160多篇论文提供了丰富的数据来源，这些论文研究了护理患者艾滋病毒感染的自然史，治疗和结果。我们使用一个以上经过验证的消费问卷来评估酒精消费的具体水平，以及每6个月使用音频计算机辅助自我访谈（A-CASI）来评估与饮酒相关的问题。我们建议解决以下具体目标：1）评价饮酒与HIV治疗反应（病毒学和免疫学反应，HIV耐药突变的发展，机会性感染的发展和生存）之间的关系，2）评价饮酒与抗逆转录病毒治疗毒性发展之间的关系。一般认为无危害的酒精使用水平可能是对艾滋病毒感染的有效长期管理和结果的一个严重的未被认识的障碍。我们的研究可以产生有价值的结果，以更好地了解酒精使用和艾滋病毒/艾滋病之间的关系。 公共卫生相关性：现代艾滋病毒治疗使艾滋病毒感染者寿命更长。正因为如此，饮酒可能有更大的机会造成不良后果。我们的研究旨在测量艾滋病毒感染者在护理中的酒精使用情况，并确定增加不良后果风险的酒精使用水平。

DESCRIPTION (provided by applicant): In the U.S., modern antiretroviral (ARV) therapy has transformed HIV infection from a terminal illness to a chronic infection with a potentially normal life span. With long life-spans, alcohol use has a greater opportunity to play an important role in the progression of HIV disease through effects on utilization of antiretroviral (ARV) therapy, immune recovery and the development of AIDS-related and non-AIDS related clinical events. Hazardous alcohol use is associated with a wide range of adverse health effects. In HIV-infection, we have shown that hazardous drinking (NIAAA definition) is associated independently with diminished utilization of ARVs, and poorer HIV viral load suppression and immune recovery. Since hazardous alcohol use interferes with effective ARV treatment, it is therefore likely that it will be associated with more rapid HIV disease progression. However, because HIV infection is characterized by chronic inflammation and immunocompromise, co-infections such as viral hepatitis, and possibly an increased risk of non-AIDS related clinical events (e.g. cardiovascular, renal, liver, endocrine), even lower levels of alcohol use that are not generally considered hazardous may have an adverse impact on patients with HIV-infection. Therefore, we propose to determine the relationship of alcohol use more broadly on HIV treatment and clinical disease progression. Our research will use the Johns Hopkins HIV Clinical Cohort, a longitudinal clinical cohort of patients who receive primary HIV/AIDS care on the Johns Hopkins HIV/AIDS Services. The Cohort was established in 1991, and has provided a rich source of data for over 160 papers that have examined the natural history, treatment and outcomes of HIV infection in patients in care. We assess specific levels of alcohol consumption using more than one validated consumption questionnaire, as well as drinking-related problems every 6 months with an audio computer-assisted self-interview (A-CASI). We propose to address the following specific aims: 1) Evaluate the relationship between alcohol consumption and response to HIV treatment (virologic and immunologic response, development of HIV resistance mutations, development of opportunistic infections, and survival), 2) Evaluate the relationship between alcohol use and development of toxicity from antiretroviral therapy. Alcohol use at levels generally considered non-hazardous may be a significant under- recognized barrier to the effective long-term management and outcomes of HIV infection. Our research can yield valuable results to better understand the relationship between alcohol use and HIV/AIDS. PUBLIC HEALTH RELEVANCE: Modern HIV therapy is allowing people with HIV infection to live longer lives. Because of this, alcohol drinking may have a greater opportunity to cause adverse consequences. Our study is designed to measure alcohol use in a population of HIV- infected patients in care, and to determine levels of alcohol use that increase the risk of bad outcomes.