CONSORTIA FOR HIV/AIDS & ALCOHOL RESEARCH TRANSLATION (CHAART) Two most common substances used in HIV+ individuals CONSORTIA FOR HIV/AIDS & ALCOHOL RESEARCH TRANSLATION (CHAART) URBAN ARCH (Boston University): http://www.urbanarch.org ARCH (Brown University): http://www.brown.edu/academics/medical/alcohol-research-center-on-hiv ARCH (Johns Hopkins): http://www.arch.bewellresearch.org COMpAAAS (Yale University): http://www.vacohort.org SHARC (University of Florida): http://sharc-research.org Washington D.C. 2014 Harmonization, Collaboration, and Implementation National AIDS Strategic Plan NIH Plan for HIV-Related Research Two stories – Description of the role of alcohol – Driver of the epidemic – susceptibility, disease expression, prevention, transmission, mortality (liver disease) Change in AIDS epidemic to a treatable chronic disease (end AIDS in a decade) Interventions to prevent infection “treatment as prevention” Disease cascade – only 25% have effective treatment Quote NY Times - Instert

Welcome Congratulations - We’ve gotten this far! Continuing our progress Expanding to fill the gaps in research New ideas and new directions Translating and Implementing our insights

What is an Alcohol and HIV/AIDS Consortium: A Platforms for Research? Required Components A) Clinical Cohort Alcohol Measurement HIV Outcomes Morbidity, Mortality B) Interventions Behavioral, Pharmacological, “Integrated/adapted” Comparative Effectiveness Implementation C) Collaboration/Resource Within Components Between consortia Analytic Core/Repository Initiatives? Treatment of Comorbidities: HCV, TB, Alcohol, Tobacco, Polypharmacy, Mental Health… Improving Treatment Cascade Systems of Care, TasP Better Preventive Interventions Reducing Inflammation, “Cure” Cooperative Agreements Clinical Cohort: Pfefferbaum Interventions: Hasin, Molina Concluding Remarks Importance of understanding the role of alcohol use in driving other diseases Expanding role in HIV as a chronic disease Introduce Dr. Justice Insert Introduction Dr Samet insert introduction Most Anti-retrovirals have alcohol warning labels

The Big Questions How does alcohol contribute to HIV transmission and what can be done about it? How does alcohol contribute to HIV disease progression and what can be done about it? How can we most effectively treat HIV and associated comorbidities to control the disease “in a generation”?

HIV/AIDS Statistics: Alcohol Syndemic Model Extent of the Epidemic HIV/AIDS Statistics: Alcohol Syndemic Model Living with HIV/AIDS – 35 Million Number of New Infections – 4 Million Deaths from HIV -3.5 million Low Resource Countries –Africa (Acute)High-Resource Countries – U.S. (Chronic) Est. Alcohol-Related HIV infections 10-20% Est. Simple Alcohol Treatment HIV+ 4-8% 40-60 thousand new infections Locations and Populations with Highest Incidence in the US (annual) U.S. South, Florida Boston, MA Africa, India, Russia (substance abuse) Ron Stall Paper - Quote VA-Yale, CT MSM+ App 50% + have alcohol use disorders AUD 9x Odds of “risky sex under the influence” 2x risk infection Kaiser-CA Brown-RI Hopkins - MD Florida –UF,FIU, Miami Concentration in the East Coast, South and Florida-Highest Incidence

HIV+ Alcohol+ Most Impacted Group Rates per 1000

HIV+ Alcohol+ Most Impacted Group Hospitalizations per 1000

Alcohol-related Mortality Statistics HIV+ vs HIV- Publications Alcohol-related Mortality Statistics HIV+ vs HIV- 5-20x Liver (Alcohol+, Hep C) 4x Cardiovascular 2x Cancer (cigarette) Cascade of Effective HIV Care (25% achieve effective treatment) Treatment as Prevention Seek Test Treat and Retain What abut alcohol use disorders HIV+? Don’t get tested/delay testing Don’t show up for care Return to prior drinking levels Medication Toxicity (actual, beliefs) Non-Adherent “Problem patients” Treatment Failure 50% first year Lost from systems of care Not re-engaged/transient/migrant A wide range of other publications emerging on drinking trajectories Lifetime Drinking Trajectories Among Veterans in Treatment for HIV Interventions Manuals

How Can CHAART Help? Tailoring intervention to target group—Plenary #1 Level and character of immune dysfunction—Monocyte Activation, CD4 Risk group--Men who have sex with men, Substance users Multi-morbid—Depression, CVD, Pain Clinical Setting--Resource limited settings Measurement and analyses problems—Plenary #2 Measuring sexual risk—Semen exposure Cognitive issues—Functional brain response How to measure alcohol exposure accurately and with minimal bias?—PEth How to measure biomedical harm from alcohol?—VACS Index Confounding by indication—Sick Quitters Barriers to effective intervention on alcohol—Plenary #3 Multi-morbid behaviors—PTSD, Sexual risk taking, smoking, opioid use Provider behaviors—barriers to prescription of alcohol treatment Quality of care for alcohol and substance use Adapting interventions to patients not seeking alcohol treatment—Panel Cross Consortia, Multidisciplinary Collaboration—Poster Session, Dinner, Cores and Workgroups, Featured Presentations