The Veterans Aging Cohort Study (VACS) is the largest clinical cohort of HIV infected Individuals (HIV+) in North America and includes in depth, longitudinal data on alcohol, multisubstance use (MSU), and outcomes over 7 years on 7,312 HIV+/- veterans at 8 sites (VACS 8). We have observed that among HIV+ drinkers, MSU is the norm (64% also use tobacco, opioids, or cocaine), but we do not know its implications for alcohol treatment. As the naturalistic observation study in the Consortium to improve OutcoMes in hiv/Aids, Alcohol, Aging, and multi-Substance use (COMpAAAS), we propose to build on the prior work of VACS to contribute to our consortium mission, """"""""to build and disseminate the evidence needed to optimize health care for HIV+ harmed by alcohol, MSU, HCV, and depression through coordinated, integrated, and externally validated observation, operations research (OR) modeling, and intervention studies."""""""" In this proposal we seek to characterize long-term (>10 year) longitudinal patterns and consequences of alcohol and MSU. This information that is essential to our mission and will inform all three U01 projects. We use this data to explore whether individually tailored health information on risks of alcohol and MSU increases motivation to change compared to generic advice to curtail alcohol use. To this end, we have developed and internationally validated the VACS Index (based on clinical biomarkers) and created a prototype VACS Index Calculator. While VACS analyses are essential to the COMpAAAS mission, our alcohol funding ends September 2011. Without additional follow up, our ability to characterize long-term longitudinal patterns and consequences of alcohol and MSU within important subgroups will be limited. Further, we hope to study contemporary patterns and consequences of alcohol and MSU among those initiating care since increased non medical use of prescription opioids (NMU) and changes in ART may be altering both patterns and consquences. Finally, Time Line Follow Back data (TLFB) are the gold standard for alcohol research but difficult to collect. By transitioning survey collection to a Web-Based format we will be able to collect TLFB data on alcohol and MSU and begin the transformation of VACS from a clinic cohort to an Interactive Web-Based Laboratory.

Public Health Relevance

Among HIV infected individuals (HIV+) who drink, concurrent use of other substances (tobacco, opioids, or cocaine) is the norm. While we know that alcohol use can be harmful, we do not know the implications of this multisubstance use (MSU) for optimal alcohol treatment among HIV+. The first step in studying this problem will be to characterize patterns and consequences of alcohol and MSU in important subgroups.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project--Cooperative Agreements (U01)
Project #
1U01AA020790-01
Application #
8211446
Study Section
Special Emphasis Panel (ZAA1-DD (04))
Program Officer
Roach, Deidra
Project Start
2011-09-10
Project End
2016-08-31
Budget Start
2011-09-10
Budget End
2012-08-31
Support Year
1
Fiscal Year
2011
Total Cost
$596,217
Indirect Cost
Name
Yale University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
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Sigel, Keith; Wisnivesky, Juan; Crothers, Kristina et al. (2017) Immunological and infectious risk factors for lung cancer in US veterans with HIV: a longitudinal cohort study. Lancet HIV 4:e67-e73
Drozd, Daniel R; Kitahata, Mari M; Althoff, Keri N et al. (2017) Increased Risk of Myocardial Infarction in HIV-Infected Individuals in North America Compared With the General Population. J Acquir Immune Defic Syndr 75:568-576
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Marshall, Brandon D L; Tate, Janet P; McGinnis, Kathleen A et al. (2017) Long-term alcohol use patterns and HIV disease severity. AIDS 31:1313-1321
Marshall, Brandon David Lewis; Tate, Janet P; Mcginnis, Kathleen A et al. (2017) Long-term alcohol use patterns and HIV disease severity: A joint trajectory analysis. AIDS :
Freiberg, Matthew S; Chang, Chung-Chou H; Skanderson, Melissa et al. (2017) Association Between HIV Infection and the Risk of Heart Failure With Reduced Ejection Fraction and Preserved Ejection Fraction in the Antiretroviral Therapy Era: Results From the Veterans Aging Cohort Study. JAMA Cardiol 2:536-546

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