Alcohol and HIV Treatment and Clinical Progression

描述(申请人提供)：在美国，现代抗逆转录病毒(ARV)疗法已经将艾滋病毒感染从晚期疾病转变为具有潜在正常生命周期的慢性感染。由于人的寿命较长，饮酒对抗逆转录病毒(ARV)疗法的使用、免疫恢复以及艾滋病相关和非艾滋病相关临床事件的发展产生影响，因此有更大的机会在艾滋病毒疾病的进展中发挥重要作用。有害酒精的使用会对健康产生广泛的不良影响。在艾滋病毒感染方面，我们已经表明，危险饮酒(NIAAA定义)与抗逆转录病毒药物使用量的减少以及较差的艾滋病毒病毒载量抑制和免疫恢复独立相关。由于危险酒精的使用干扰了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，由于艾滋病毒感染的特点是慢性炎症和免疫损害，合并感染，如病毒性肝炎，以及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，即使较低水平的饮酒通常不被认为是有害的，也可能对艾滋病毒感染者产生不利影响。因此，我们建议更广泛地确定酒精使用在艾滋病毒治疗和临床疾病进展之间的关系。我们的研究将使用约翰霍普金斯艾滋病毒临床队列，这是一个在约翰霍普金斯艾滋病毒/艾滋病服务中心接受初级艾滋病毒/艾滋病护理的患者的纵向临床队列。该队列成立于1991年，已为160多篇论文提供了丰富的数据来源，这些论文研究了护理中患者感染艾滋病毒的自然历史、治疗和结果。我们使用一个以上有效的消费问卷来评估特定的酒精消费水平，以及每6个月通过音频计算机辅助自我访谈(A-CASI)评估与饮酒相关的问题。我们建议解决以下具体目标：1)评估酒精消费和HIV治疗反应之间的关系(病毒学和免疫学反应、HIV耐药性变异的发展、机会性感染的发展和生存)，2)评估酒精使用和抗逆转录病毒治疗毒性发展之间的关系。在一般认为无害的水平上饮酒，对于艾滋病毒感染的有效长期管理和后果可能是一个未被认识到的重大障碍。我们的研究可以产生有价值的结果，以更好地理解酒精使用和艾滋病毒/艾滋病之间的关系。 与公共卫生相关：现代艾滋病毒疗法使艾滋病毒感染者能够活得更长。正因为如此，饮酒可能有更大的机会造成不良后果。我们的研究旨在衡量护理中艾滋病毒感染患者的酒精使用情况，并确定增加不良结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.