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.

Public Health Relevance

Chronic alcohol consumption is the most common and costly form of substance abuse in the United States. Alcohol use disorders (AUDs) and HIV frequently coexist in the same individual and their co-existence is strongly associated with medication non- adherence and accelerated disease progression. Effective evidence-based behavioral interventions that target AUD and factors that negatively impact on HIV disease progression will significantly benefit a large number of HIV+ individuals with co-morbid AUD who traditionally had limited access to comprehensive treatment.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZAA1-DD (09))
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Roach, Deidra
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Louisiana State Univ Hsc New Orleans
Schools of Medicine
New Orleans
United States
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Katz, Paige S; Siggins, Robert W; Porretta, Connie et al. (2015) Chronic alcohol increases CD8+ T-cell immunosenescence in simian immunodeficiency virus-infected rhesus macaques. Alcohol 49:759-65
Armstrong, M L; LaPlante, A M; Altice, F L et al. (2015) Advancing Behavioral HIV Prevention: Adapting an Evidence-Based Intervention for People Living with HIV and Alcohol Use Disorders. AIDS Res Treat 2015:879052
Vagenas, Panagiotis; Azar, Marwan M; Copenhaver, Michael M et al. (2015) The Impact of Alcohol Use and Related Disorders on the HIV Continuum of Care: a Systematic Review : Alcohol and the HIV Continuum of Care. Curr HIV/AIDS Rep 12:421-36
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