There is increasing evidence that psychosocial processes influence the immune system and that these effects may contribute to the onset and course of disease. These factors, especially stress and depression, are common in alcohol dependent persons and, together with the direct effects of alcohol may seriously compromise immune function in this population. Alcohol use is also associated with behavioral disinhibition that can increase high risk behaviors linked to the transmission of HIV. The co-occurrence of these factors in alcoholics may pose a substantial public health threat. The implications of these interactions are particularly serious in inner city settings where the prevalence of HIV is high. Research is therefore urgently needed to understand factors that may contribute to the spread of HIV in high risk groups such as inner city alcoholics. The overall goal of the proposed research is to investigate the psychoimmunology of inner city alcoholics at risk for AIDS by: 1. comparing immune function in inner city alcohol-dependent subjects with that of matched controls; 2. assessing the immune effects of specific characteristics of alcoholics, including alcohol use, stress and depression; and, 3. concurrently assessing high risk behaviors for HIV transmission and the determinants of such behaviors. 150 alcohol-dependent patients enrolled in an ambulatory alcohol treatment program who have not abused other substances and 150 matched study controls will be studied utilizing both a cross-sectional and longitudinal study design. Patients with medical disorders, compromised hepatic function, positive for HIV-1 antibody, or using other medications or drugs will be excluded. Subjects will be interviewed concerning patterns of alcohol use, life stress, and depression, screening physical examinations and chemistries will be obtained, and blood drawn for a battery of in vitro immune measures. High risk sexual behaviors for HIV transmission and HIV attitudes, beliefs and peer norms will be documented. Subjects and controls will be re-assessed at 1 and 3 months. Multivariate techniques will analyze the psychoimmunologic and other behavioral relationships.
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