Addressing Alcohol/HIV Consequences in Substance Dependence - Boston ARCH Cohort

解决酒精/艾滋病毒对药物依赖的后果 - 波士顿 ARCH 队列

• 批准号: 8211194
• 负责人: RICHARD SAITZ
• 金额: $ 48.6万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-20 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8211194
• 关键词: AIDS/HIV problem; Accounting; Address; Adult; Affect; Agonist; Alcohol consumption; Alcohols; Biometry; Bone Density; Boston; Buprenorphine; Caring; Chronic Disease; Clinical; Cohort Analysis; Cohort Studies; Collaborations; Complement; Consequences of HIV; Data; Dependence; Disease; Dose; Drug Addiction; Drug usage; Ethanol; Fracture; Future; Goals; HIV; HIV Infections; Health; Heavy Drinking; Heterogeneity; Heterosexuals; High Resolution Computed Tomography; Individual; Inflammatory; Injection of therapeutic agent; Intervention; Intervention Studies; Knowledge; Laboratories; Learning; Naloxone; Observational Study; Opiate Addiction; Opioid; Osteopenia; Participant; Patients; Persons; Pharmaceutical Preparations; Principal Investigator; Prospective Studies; Randomized; Research; Risk; Risk Factors; Russia; Sampling; Statistical Methods; Substance Addiction; Substance of Abuse; Supplementation; Testing; Uganda; Woman; Zinc; addiction; adverse outcome; alcohol and other drug; alcohol consequences; alcohol effect; alcohol intervention; alcohol misuse; alcohol research; alcohol risk; antiretroviral therapy; bone; bone health; bone loss; cohort; data management; design; double-blind placebo controlled trial; drinking; high risk drinking; improved; instrument; men; policy implication; prevent; prospective; response; sex

DESCRIPTION (provided by applicant): Unhealthy alcohol use is common among HIV-infected persons and it adversely affects health. Injection drug use accounts for 1 in 5 cases of HIV infection, thus opioid dependence is also common. More than one-third of those with HIV infection and other drug use drink too much alcohol. Research has focused on either alcohol or drug use in HIV-infected individuals, but much less is known about alcohol's health effects in HIV- infected people affected by multiple substances of abuse. This proposal is a component of the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS (URBAN ARCH) Consortium, whose goal is to examine the consequences of alcohol on HIV disease and to mitigate its harms. The objective of this proposal is to accurately characterize alcohol use and consequences in people with HIV infection affected by multiple substances, and to implement observational and intervention studies to understand and reduce alcohol's harm. The proposal has 3 specific aims: 1) To expand and continue an existing cohort to establish the longitudinal Boston ARCH Cohort of 250 HIV-infected men and women affected by multiple substances-a spectrum of alcohol use, and all with substance dependence or Injection drug use. 2) To treat both heavy drinking and opioid dependence with one medication. The Treating With Opioids For Ethanol Risks (TWOFER) trial will assess if high-dose buprenorphine (32mg) reduces heavy drinking compared to standard-dose (16mg) at 3 months in a randomized double-blind placebo-controlled trial among 100 HIV-infected adult Cohort participants with opioid dependence and heavy drinking. If efficacious, buprenorphine, a treatment for opioid dependence, could be easily disseminated as a treatment for unhealthy alcohol use in people with HIV infection and opioid dependence as only dose adjustment is required. 3) Because alcohol, opioid use, HIV infection and antiretroviral therapy may affect bone health and increase fracture risk, analysis of cohort data will determine the independent effect of alcohol consumption on changes in bone mineral density and microarchitecture (by high-resolution computed tomography) prospectively in all Cohort participants over 12-42 months. The Cohort will yield data on alcohol effects on bone, important information for defining risky drinking amounts in people with HIV infection and for advising them on alcohol-related risks. Thus, these studies will provide substantial new knowledge for mitigating alcohol consequences among HIV-infected adults affected by multiple substances. PUBLIC HEALTH RELEVANCE: HIV disease can be treated effectively, but drinking too much interferes with treatment and causes bone loss, especially among those who abuse other drugs. This research will study people with HIV infection to discover what amounts of alcohol increase risk of fractures, and to see whether a medication used for drug addiction can also reduce heavy drinking. Findings will be useful for advising people with HIV infection about drinking limits to prevent fractures and may identify a new treatment to reduce drinking and improve health.

描述（由申请人提供）：在艾滋病毒感染者中使用不健康的饮酒很常见，并且会对健康产生不利影响。注射药物使用占5例HIV感染中有1例，因此阿片类药物依赖性也很常见。超过三分之一的艾滋病毒感染和其他毒品使用过多的酒精。研究集中在感染HIV的人中的酒精或药物使用，但对受艾滋病毒感染的人的健康影响知之甚少。该提案是乌干达俄罗斯波士顿酒精网络艾滋病毒/艾滋病（Urban Arch）财团合作的组成部分，其目标是研究酒精对艾滋病毒疾病的后果并减轻危害。该提案的目的是准确表征受多种物质影响的艾滋病毒感染患者的饮酒和后果，并实施观察和干预研究以理解和减少酒精的伤害。该提案具有3个具体目标：1）扩展并继续现有的队列，以建立波士顿弓形弓形拱门队列，由250名受HIV感染的男性和女性受到多种药物影响 - 饮酒谱，所有这些都具有物质依赖或注射药物的使用。 2）用一种药物治疗大量饮酒和阿片类药物依赖性。在100个随机的双盲安慰剂对照试验中，用阿片类药物治疗乙醇风险（TWOFER）试验将评估高剂量丁丙诺啡（32mg）在3个月中的标准剂量（16mg）比标准剂量（16mg）在100种HIV感染的成人成人群体参与者中与阿片类阿片类药物依赖和大量饮酒相比是否减少了大量饮酒。如果有效的丁丙诺啡是对阿片类药物依赖性的治疗方法，则很容易被传播，以治疗HIV感染和阿片类药物依赖性患者的不健康饮酒，因为仅需要调整剂量。 3）由于酒精，阿片类药物的使用，HIV感染和抗逆转录病毒疗法可能会影响骨骼健康并增加骨折风险，因此对队列数据的分析将确定饮酒对在12-42个月内所有队列参与者的前瞻性参与者的前瞻性饮酒对骨矿物质密度和微结构变化的独立影响。该队列将产生有关酒精对骨骼影响的数据，这是定义艾滋病毒感染患者危险饮酒量的重要信息，并就与酒精有关的风险提供建议。因此，这些研究将为减轻受多种物质影响的HIV感染的成年人的饮酒后果提供大量新知识。 公共卫生相关性：可以有效治疗艾滋病毒疾病，但饮酒过多地干扰治疗并导致骨质流失，尤其是在滥用其他药物的患者中。这项研究将研究患有艾滋病毒感染的人，以发现何种酒精量增加了骨折的风险，并查看用于吸毒的药物是否也可以减少大量饮酒。调查结果对于向艾滋病毒感染的人提供有关饮酒极限的建议将很有用，以防止骨折，并可能确定一种新的治疗方法来减少饮酒和改善健康。