This application is an extensive revision of the K02 application which had been entitled """"""""HIV disease and Drug Abuse: Medications Development."""""""" This resubmission expands upon the career development plan to describe related grants and collaborations that link drug abuse, infectious disease with a principal emphasis on HIV disease, and epidemiology using the human laboratory as a tool to explore research questions that span these areas. As a result the resubmission has been retitled """"""""The Human Laboratory: Enhancing Health Care of Drug Users with HIV."""""""" This K02 is built around RO1 grant DA13004 """"""""Opiolds and HIV Medications: Interactions in Drug Abusers"""""""" (PI: E. McCance-Katz).
The aim of this project is to enhance the care of patients with HIV disease and opiold dependence by using the human laboratory setting to identify significant drug interactions between opioids and antiretroviral medications. These findings will assist clinicians by identifying drug combinations likely to have substantial interactions that can lead to non-adherence, by assisting with the process of matching patients to treatments, and may improve adherence with decreased medical complications of AIDS as well as reduced transmission of the virus. Related collaborative efforts are a key component of the career development plan and include a study of directly observed HAART therapy in methadone maintained individuals (PI: E. McCance-Katz, M. Gourevitch, J. Arnsten), determination of methadone and antiretroviral drug concentrations and correlation with HIV therapeutics adherence (PI: J. Amsten, E. Schoenbaum), determination of HAART effectiveness in late stage HIV in drug users (PI: D. Vlahov, B. Greenberg), and methadone maintenance in primary care settings (PI: S. Magura). Additional prongs of the career development plan include didactics specifically aimed at enhancing knowledge and ability to contribute to these projects. Molecular pharmacology, epidemiology, and research ethics courses are proposed as is substantial time meeting with other experts and mentors including T. Kosten, R. Schottenfeld, P. Jatlow, G. Friedland, P. Rainey, E. Morse, and M. Fischman. This revised application also includes a career development path in teaching and mentoring trainees with an interest in drug abuse research. The Albert Einstein College of Medicine and the surrounding, New York City and New Haven areas provide an ideal environment for continuing progression as an independent clinical researcher in drug abuse and HIV disease.
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