HIV/AIDS & Alcohol-Related Outcomes:Translational Evidence-Based Interventions

HIV爱滋病

• 批准号: 8700690
• 负责人: PATRICIA E. MOLINA
• 金额: $ 5.14万
• 依托单位: LSU HEALTH SCIENCES CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-15 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8700690
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adherence; Affect; Alcohol abuse; Alcohol consumption; Alcohols; Ambulatory Care Facilities; Area; Awareness; Bacterial Infections; Basic Science; Behavior; Behavior Therapy; CD8-Positive T-Lymphocytes; Caring; Chronic; Clinic; Clinical; Communities; Consequences of HIV; Diagnosis; Disease Progression; Effectiveness; Epidemic; Evidence based intervention; Foundations; Future; Goals; HIV; HIV Infections; HIV risk; Health; Health Sciences; Holistic Health; Incidence; Individual; Infection; Intervention; Intestines; Knowledge; Lead; Life; Louisiana; Lung; Modeling; Motivation; Outcome; Outpatients; Patients; Persons; Pharmaceutical Preparations; Population; Predisposition; Preparation; Prevalence; Primary Health Care; Production; Public Health; Public Hospitals; Quality of life; Recovery; Research Personnel; Risk; Risk Behaviors; Risk-Taking; SIV; Science; Scientist; Services; Substance abuse problem; Testing; Training; Translating; Treatment Efficacy; United States; Universities; Viral; Viral Load result; Virus Diseases; alcohol effect; alcohol research; alcohol use disorder; antiretroviral therapy; base; bone metabolism; chronic alcohol ingestion; disease transmission; effective intervention; end stage disease; evidence base; improved; intravenous drug user; knowledge base; metropolitan; multidisciplinary; nitrogen balance; nonhuman primate; novel; pre-clinical; programs; psychosocial; reduced alcohol use; sex; skeletal muscle wasting; skills; therapy adherence; translational approach; transmission process

DESCRIPTION (provided by applicant): Chronic alcohol consumption is the most common and costly form of substance abuse in the United States. Alcohol use disorders (AUD) are frequent in people living with HIV/AIDS (PLWHA) and are strongly associated with decreased adherence to and effectiveness of antiretroviral therapy (ART), and enhanced susceptibility to infection and viral replication. Results from studies conducted by scientists at the Louisiana State University Health Sciences Center (LSUHSC) Comprehensive Alcohol Research Center (CARC) using the Simian Immunodeficiency Virus infected non-human primate model have provided additional evidence of the biomedical consequences of chronic alcohol consumption on disease progression. Our results show that chronic alcohol consumption elevates viral set point; increases lung viral levels during bacterial infection; promotes intestinal CD4+ and CD8+ T lymphocyte population changes that favor disease transmission; negatively affects bone metabolism, nitrogen balance, and skeletal muscle wasting. Ultimately these factors lead to accelerated disease progression to end-stage disease. Thus, clinical and preclinical evidence supports the hypothesis that interventions targeting AUDs in PLWHA have the potential to significantly and positively impact outcomes in HIV/AIDS patients with AUD. Specifically, we propose that the Holistic Health Recovery Program (HHRP+); an evidence-based behavioral intervention (EBI) originally developed to target sex- and drug-related risk-taking in HIV+ intravenous drug users, can be adapted to target AUD. Furthermore, in a truly translational approach, we propose to use our basic science derived knowledge to enrich the health information content of the HHRP+. Studies proposed in this application will follow the ADAPT-ITT model in adapting the HHRP+ to target AUD. We will pilot-test the novel EBI for efficacy in achieving and/or maintaining viral load suppression, reducing AUD and HIV risk behaviors, and improving ART adherence among in- care HIV+ outpatients. The successful adaptation of this intervention and its future implementation will improve clinical outcomes (i.e. viral suppression) by enhancing patients' awareness of the biomedical and psychosocial consequences of alcohol use in PLWHA, and by enhancing the knowledge, motivation, and skills necessary to modify behaviors negatively impacting on HIV disease progression. Efficacy of the intervention will lead to improved adherence to and effectiveness of ART, improved quality of life, and decreased risky behaviors that promote HIV transmission.

描述（由申请人提供）：长期饮酒是美国最常见和昂贵的滥用药物。在艾滋病毒/艾滋病（PLWHA）患者中，饮酒障碍（AUD）经常存在，并且与抗逆转录病毒疗法（ART）的依从性降低和有效性密切相关，并增强了对感染和病毒复制的易感性。路易斯安那州立大学卫生科学中心（LSUHSC）综合酒精研究中心（CARC）的科学家进行的研究的结果，使用了邻国免疫缺陷病毒感染的非人类灵长类动物模型，为疾病进展中慢性酒精消耗的生物医学后果提供了其他证据。我们的结果表明，慢性酒精消耗升高了病毒设定点。在细菌感染期间增加肺病毒水平；促进肠道CD4+和CD8+ T淋巴细胞种群变化，有利于疾病传播；负面影响骨代谢，氮平衡和骨骼肌浪费。最终，这些因素导致疾病加速发展为终阶段疾病。因此，临床和临床前证据支持以下假设：针对PLWHA中AUD的干预措施有可能显着和积极影响AUD的HIV/AIDS患者的结果。具体而言，我们建议整体健康恢复计划（HHRP+）；最初开发的基于证据的行为干预（EBI）可以针对艾滋病毒+静脉吸毒者中的性别和药物相关的冒险，可以适应目标AUD。此外，在一种真正的翻译方法中，我们建议使用我们的基础科学知识来丰富HHRP+的健康信息内容。本应用程序中提出的研究将遵循适应性-ITT模型，以使HHRP+适应目标AUD。我们将对新型EBI进行试验，以实现和/或维持病毒载荷抑制，减少AUD和HIV风险行为以及改善Incar Incar Incar Incar Incar Incar Incar Incar Incre+门诊病人的艺术依从性。通过增强患者对酒精使用在PLWHA中的生物医学和心理社会后果的认识，并增强对艾滋病毒疾病进展的行为产生负面影响，成功地适应了这种干预措施及其未来的实施将改善患者对酒精使用的生物医学和社会心理后果的认识，从而改善临床结果（即病毒抑制）。干预的疗效将提高对艺术的依从性和有效性，改善生活质量以及降低促进HIV传播的风险行为。