Understanding and intervening with heavy drinking among patients with HIV and HCV

New York State Psychiatric Institute Dba Research Foundation For Mental Hygiene, Inc, New York NY

Investigators

Linked publications, trials & patents

Abstract

DESCRIPTION (provided by applicant): Individuals with HIV face serious risks from heavy drinking, including decreased immune function, poor medication adherence, and risk for liver damage, now a leading cause of mortality in HIV. For individuals with both HIV and hepatitis C virus (HCV), heavy drinking is particularly hazardous, as it limits HCV treatment and exacerbates liver damage. However, despite increasing recognition of the harms associated with drinking in HIV/HCV, little research has investigated possible explanations for this risky behavior, and no interventions exist specifically to reduce heavy drinking in HIV/HCV co-infected patients, who face the highest risk. In this K23 application, I propose a training and research program that will enable me to begin pursuing my long-term goal of advancing understanding and ability to intervene with heavy drinking in the high-risk group of patients with HIV and HCV. My training will focus on HIV and HCV (the diseases, co-infection, and treatment), clinical trials in medical populations, and biostatistics. I will obtain this training through courses and seminars offered by Columbia University Medical Center, as well as regular meetings with expert mentors and consultants. I will use this training to address short-term goals: to investigate factors underlying heavy drinking among patients with HIV (Aim 1a) and HIV/HCV (Aim 1b); to adapt and pilot test a drinking-reduction intervention for HIV/HCV co-infected patients (Aim 2), incorporating information from Aims 1a and 1b; and to develop an R01 proposal for a full clinical trial. For Aim 1a, I will use data from a large clinical trial to invetigate factors underlying heavy drinking among HIV patients. Applying drinking motive constructs from the larger alcohol literature that I have already validated in HIV patients, I will investigate the relationship between motives for drinking and abstaining and drinking outcomes in two different timeframes: as reported daily for 60 days, and from pre-intervention to 12 month follow-up. I will also investigate whether motives for drinking and abstaining change due to intervention. Further, I will investigate whether HIV patients in neighborhoods with permissive drinking norms differ from other patients on drinking, drinking motives, and response to intervention. For Aim 1b, I will use data from a large cross-sectional study of drug users to determine whether drinking differs by patient perceptions of health status and HIV and HCV severity. For Aim 2, I will adapt and pilot test an existing brief, technology- enhanced drinking-reduction intervention for HIV patients to be suitable for HIV/HCV co-infected patients. For this, I will incorporate findings fro Aims 1a and 1b, content from effective interventions for liver disease patients, and input from HIV primary care providers and patients. I will pilot test this intervention, and based on pilot results, design an R01 application for a full clinical trial for co-infected patients. This researc, which is only feasible through the training, research, and protected time offered by a K23 career development award, has strong potential to advance the understanding and ability to intervene with heavy drinking in HIV/HCV patients, a very hazardous behavior that poses substantial risks to patients' long-term survival.