Evaluations of medication assisted treatments for substance use disorders among persons living with and at risk for HIV infection

对 HIV 感染者和高危人群物质使用障碍药物辅助治疗的评估

• 批准号: 10394890
• 负责人: SANDRA Ann SPRINGER
• 金额: $ 0.59万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2022-05-02
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10394890
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; Advocate; Agonist; Alcohol consumption; Area; Award; Awareness; Biochemical; Book Chapters; Buprenorphine; Caring; Chronic; Clinical; Communicable Diseases; Communities; Connecticut; Criminal Justice; Disease Outbreaks; Disease Progression; Drug Rehabilitation Centers; Drug usage; Evaluation; Faculty; Failure; Fostering; Funding; Gene Expression; General Population; Goals; Grant; Guidelines; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; HIV/HCV; Healthcare Systems; High Prevalence; Immune response; Independent Scientist Award; Indiana; Individual; Inflammation; Injectable; Injecting drug user; Interdisciplinary Study; International; Interruption; Intervention; Journals; Longitudinal Studies; Manuscripts; Medical; Medicine; Mentors; Mentorship; Methadone; Methods; NCI Scholars Program; Naltrexone; National Institute of Drug Abuse; National Institute on Alcohol Abuse and Alcoholism; Natural Immunity; Needle-Exchange Programs; North America; Opiate Addiction; Opioid; Opioid Antagonist; Opioid agonist; Outcome; Peer Review; Persons; Pharmacology; Physicians; Population; Prevalence; Prisoner; Protocols documentation; Publications; Publishing; Randomized Controlled Trials; Recommendation; Relapse; Reporting; Research; Research Personnel; Research Proposals; Risk; Risk Reduction; Scholarship; Services; Societies; Suboxone; Substance Use Disorder; System; Systems Biology; Time; Training; Translational Research; Treatment outcome; United States National Institutes of Health; Viral; Wood material; addiction; alcohol use disorder; antiretroviral therapy; career; cost; experience; heroin use; immunoregulation; improved; interest; medical schools; medication-assisted treatment; member; mortality; novel; opioid agonist therapy; opioid injection; opioid overdose; opioid use; opioid use disorder; prevent; programs; prospective; recruit; response; success; symposium; transmission process; uptake

Project Abstract: This is an application for a renewal of a fiver-year Independent Scientist Award (K02) to assist in the continued protected time to allow Dr. Sandra Springer to continue her productive research career involving interventions that will improve integration of HIV and substance use disorder (SUD) treatment among persons living with HIV (PLH) and those at risk for HIV infection. This award will also increase her time to devote towards mentoring young investigators who share this interest. The prevalence of HIV infection is 28 to at least 50 times higher among people who inject drugs (PWID) compared to the general population. In North America, there were an estimated 267,000 persons living with HIV infection (PLHs) among 2 million PWIDs in 2012. Opioids represent the dominant class of injected agent, and in 2013 517,000 adults reported heroin use within the past year, representing an approximately 150% increase compared to 2007. Medication-assisted treatment (MAT) for opiate addiction, combined with needle and syringe exchange programs (NESP) have substantially reduced the risk of HIV transmission in PWIDs. Moreover, MAT reduces mortality among HIV-positive PWIDs (which is otherwise 3-fold higher than in PWIDs who are HIV-negative). MAT is predominantly available in the form of opioid agonist treatment with methadone or buprenorphine, with emerging use of opioid antagonist treatments (e.g. extended-release naltrexone). However, there are no recommendations currently available to guide the selection of MAT agent. Moreover, despite substantial evidence for immunomodulatory effects of opioids on immune responses, no studies have employed systems biology methods to evaluate MAT agents for their effects on parameters such as chronic inflammation—particularly important for HIV disease progression and present even in elite controllers or individuals who have achieved virologic control without antiretroviral therapy (ART). To address these questions, Dr. Springer has been awarded a NIDA funded 5 year R01 to evaluate innate immunity and inflammation with her co-PI at Yale School of Medicine, Dr. Shaw, to carry out a prospective, longitudinal study of HIV-positive (on ART) vs. HIV-negative PWIDs starting MAT, recruited from the largest drug treatment center in New Haven, Connecticut. The strength of this proposal is that Dr. Springer is: (1) experienced in HIV and Addiction Medicine; (2) experienced in the novel use of pharmacologic interventions (MAT) to treat SUDs to prevent relapse to opioid and alcohol use as a means to improve HIV viral suppression; (3) has over 15 years experience of conducting NIH-funded research among PLH with SUD and using MAT interventions; and (4) is a co-PI on a successful R01 affiliated with this application that is extending her experience with using systems biology to evaluate MAT on chronic inflammation of HIV infection. As such, the individual, our health care system and society have a high likelihood to benefit – especially on the reduction of HIV within the community.

项目摘要： 这是续签Fluver年独立科学家奖（K02）的申请，以协助继续 受保护的时间，允许桑德拉·斯普林格博士继续她的富有成效的研究职业，涉及干预措施 这将改善艾滋病毒患者中艾滋病毒和药物使用障碍（SUD）治疗的整合 （PLH）和有艾滋病毒感染风险的人。该奖项还将增加她投入指导的时间 具有这种兴趣的年轻调查员。艾滋病毒感染的患病率是28至少50倍 与普通人群相比，注射药物（PWID）的人中。在北美，有一个 2012年，有200万个PWID在200万个PWID中估计有267,000人。阿片类药物代表 注射剂的主要类别，2013年517,000名成年人在过去一年中报告了海洛因的使用， 与2007年相比，代表大约150％。 优化成瘾，结合针头和注射器交换程序（NESP）已大大减少 PWIDS中HIV传播的风险。此外，MAT降低了HIV阳性PWID的死亡率（即 否则，比HIV阴性的PWID高3倍）。垫子主要以 阿片类药物治疗阿片类酮或丁丙诺啡，并使用阿片类药物拮抗剂治疗 （例如，扩展释放纳曲酮）。但是，目前尚无建议指导 垫子代理的选择。此外，尽管有充分的证据表明阿片类药物对 免疫反应，没有研究有效的系统生物学方法来评估其MAT剂 对诸如慢性炎症等参数的影响 - 尤其对于HIV疾病进展至关重要 甚至在没有抗逆转录病毒疗法的精英控制器或实现病毒控制的个人中也存在 （艺术）。为了解决这些问题，Springer博士被授予NIDA资助5年R01的资助 与耶鲁大学医学院的副驾驶肖（Shaw）博士与先天的免疫力和炎症 艾滋病毒阳性（On Art）与HIV阴性PWID的前瞻性纵向研究，从 康涅狄格州纽黑文最大的药物治疗中心。该提议的优势是施普林格博士 IS：（1）艾滋病毒和成瘾医学经验； （2）在新颖的药理中经历了 干预措施（MAT）治疗SUD，以防止中继阿片类药物和酒精使用作为改善HIV病毒的手段 抑制; （3）拥有超过15年的经验，在使用SUD和SUD和 使用垫子干预措施； （4）是该应用程序成功的R01分支机构的Co-Pi，它正在扩展 她使用系统生物学来评估HIV感染的慢性感染的MAT。像这样， 个人，我们的医疗保健系统和社会很有可能受益 - 尤其是在减少方面 社区内的艾滋病毒。

项目成果

The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review.

• DOI: 10.1007/s10461-012-0212-3
• 发表时间: 2012-11
• 期刊: AIDS AND BEHAVIOR
• 影响因子: 4.4
• 作者: Springer, Sandra A.;Dushaj, Azem;Azar, Marwan M.
• 通讯作者: Azar, Marwan M.

Commentary on Murphy et al.: What will it take to prescribe extended-release naltrexone to treat alcohol use disorder?

墨菲等人的评论：开缓释纳曲酮治疗酒精使用障碍需要什么？

• DOI: 10.1111/add.15668
• 发表时间: 2022
• 期刊: Addiction (Abingdon, England)
• 作者: Springer,SandraA

A Systematic Review and Meta-Analysis of Studies Evaluating the Effect of Medication Treatment for Opioid Use Disorder on Infectious Disease Outcomes.

• DOI: 10.1093/ofid/ofab289
• 发表时间: 2021-08
• 期刊: Open forum infectious diseases
• 影响因子: 4.2
• 作者: McNamara KF;Biondi BE;Hernández-Ramírez RU;Taweh N;Grimshaw AA;Springer SA
• 通讯作者: Springer SA

The Impact of Medications for Opioid Use Disorder on Hepatitis C Incidence Among Incarcerated Persons: A Systematic Review.

阿片类药物使用障碍药物对被监禁者丙型肝炎发病率的影响：系统评价。

• DOI: 10.1016/j.idc.2020.06.011
• 发表时间: 2020
• 期刊: Infectious disease clinics of North America
• 影响因子: 4.4
• 作者: Seval,Nikhil;Wurcel,Alysse;Gunderson,CraigG;Grimshaw,Alyssa;Springer,SandraA
• 通讯作者: Springer,SandraA

High rates of depressive symptomatology among injecting drug users in Saskatoon, Canada.

加拿大萨斯卡通注射吸毒者的抑郁症状发生率很高。

• DOI: 10.1136/ebmh.2011.100199
• 发表时间: 2012
• 期刊: Evidence-based mental health
• 影响因子: 5.2
• 作者: Springer,SandraA