Effective Antiretroviral Treatments Have Significantly Extended the Lifespan of HIV-Infected

Effective antiretroviral treatments have significantly extended the lifespan of HIV-infected persons, making successful management of co-morbid diseases a high priority in care. Hazardous alcohol drinking and alcohol use disorder play an increasingly important role in HIV disease progression and treatment. In Spetmeber, 2011, NIAAA funded the Alcohol Research Consortium on HIV (ARCH) to better understand the intersectionof HIV and alcohol – both in its epidemiology and treatment.

Alcohol Research Consortium in HIV (ARCH) is comprised of one U24 and two U01 applications. It addresses critical questions regarding the clinical epidemiology of hazardous alcohol use/abuse/dependence in HIV infection (Epidemiology Research Arm), and evaluates the implementation andeffectiveness of evidence- based alcohol reduction strategies in real world HIV clinic settings (Intervention Research Arm). This research builds upon the unique strengths of a well-established HIV clinical cohort, the CFAR Network of Integrated Clinical Systems (CNICS), comprised of 8 clinics and over 20,000 HIV-infected individuals across the United States. This dynamic cohort provides an ideal scientific platform for long-term study of HIV and alcohol through the collection of comprehensive clinical data and specimens as well as uniformly-collected patient reported outcomes as a part of the Patient Reported Outcomes Measurement Information System initiative.

The U24 at the heart of ARCH is the Administrative Core (AC), which provides the critical infrastructure to coordinate and facilitate the consortium's scientific goals. ARCH-AC is co-led by national experts (Mary McCaul and Richard Moore, Johns Hopkins University School of Medicine) in alcohol use disorders and HIV, who have over 40 years of combined scientific experience in conducting epidemiologic and clinical research in HIV/AIDS. The intervention U01 (ARCH – IRA led by Michael Saag, University of Alabama at Birmingham) studies the implementation and effectiveness of a computer-delivered brief intervention for reducing hazardous drinking in the HIV clinical care setting. It also examines the effectiveness of HIV provider training in alcoholism pharmacotherapy (APT) on the prescription of these medications for treatment of hazardous alcohol use in HIV-care patients. The epidemiology U01 (ARCH – ERA led by Mari Kitahata, University of Washington) investigates the short and long-term effects of alcohol on clinical outcomes among persons with HIV. Aims include to: determine the burden of hazardous alcohol consumption to HIV infected individuals; determine the impact of different levels and pattern of alcohol use on HIV disease progression over time, and evaluate the impact of alcohol use on HIV health care utilization. Particular attention is paid to the roles of sex/gender, illicit drug use, and mental health symptoms in the relationship between alcohol and HIV. ARCH combines a breadth and depth of investigator experience with a comprehensive multisite US HIV cohort to create a consortium that is accelerating the advancement of new knowledge of the epidemiology of alcohol use and HIV, and identifying promising strategies for moving empirically-validated alcohol interventions into the HIV care setting.

For additional information, contact Betsy McCaul () or visit our website (arch.bewellresearch.org)