1. 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):
ARCH (Brown University):
ARCH (Johns Hopkins):
COMpAAAS (Yale University):
SHARC (University of Florida):
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

2. 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

3. 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

4. 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”?

5. 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

6. HIV+ Alcohol+ Most Impacted Group Rates per 1000

7. HIV+ Alcohol+ Most Impacted Group Hospitalizations per 1000

8. 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

9. 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