#1URBAN ARCH Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS Russia ARCH What We Learned and What We Still Can Learn URBAN ARCH Annual Meeting May 10th, 2022 BOSTON MEDICAL EXCEPTIONAL CARE. WITHOUT EXCEPTION. BU School of Medicine MEDICINA ARS 1897 NOBILISSIM 1st Pavlov First Pavlov State Medical University of St.Petersburg VANDERBILT UNIVERSITY MEDICAL CENTER National Institute NIH on Alcohol Abuse and Alcoholism#2URBAN ARCH Russia ARCH (2011 - 2022) Russia ARCH observational cohort (n=351) HIV+; +/- alcohol use • ZINC nested RCT (n=254) HIV+; heavy alcohol use St PETER RCT (n=400) . • HIV+; daily smokers; heavy alcohol use TMAO nested observational cohort (n=360) ACME nested observational cohort (n=200) •PETER PAIN UH2 (n=11)/UH3 (n=45) • HIV+; chronic pain; alcohol use •SCRIPT Stigma RCT (n=100) . • HIV+; current injection drug use#3Diversity Supplement Russia ARCH N=351 ZINC RCT N=254 Gender Supplement SCRIPT RCT N=100 COVID Supplement ACME ST PETER RCT N=200 N=400 Echo Supplement TMAO PETER N=360 PAIN UH2/UH3 COVID Supplement HIV Latency R61/R33#4URBAN ARCH Published Paper Topics inflammatory biomarkers PrEP care cascade depression Peth mortality injection drug use immune dysfunction HIV alcohol food insecurity T cells HCV smoking liver disease substance use zinc cannabis serodiscordance opioids stigma#5URBAN ARCH The association of alcohol & immune function in people with HIV (PWH) •Greater alcohol use is associated with: • Higher sCD14, IL- 6, D-dimer over time¹ Slower CD4 recovery after ART initiation 2 CD4 count 1000- 900- 800- 700- 600- 500 400- 300- 200- Low alcohol Moderate alcohol 100- 0 High alcohol -400 -200 0 200 400 600 800 1 So-Armah, ACER 2019 Days since ART Initiation 2 McLaughlin, poster 2022 (see more in trainee session)#6URBAN ARCH Unanswered questions • Alcohol and inflammatory burden in PWH • Alcohol and comorbidity in PWH Lung function in TB#7URBAN ARCH ZINC HIV RCT •Zinc supplementation did not reduce mortality risk, increase CD4 T cell counts, lower cardiovascular disease risk, or levels of inflammation and microbial translocation in PLWH with heavy alcohol use¹ 1 Freiberg JAMA Network Open, 2020#8URBAN ARCH Unanswered questions • Post-hoc secondary analysis involving all time-points suggested a "benefit" •Other pilot studies suggest a benefit to zinc for reduction of inflammation² • Should prompt future studies with larger power 2Dirajilal-Fargo JAIDS, 2019#9URBAN ARCH Smoking cessation medications for alcohol reduction (St PETER HIV RCT) • All participants were PWH with risky drinking and daily smoking and received both an active medication and a placebo. We did not detect differences between varenicline, cytisine, and NRT on any alcohol consumption or smoking outcomes¹ •In all arms, there was a reduction in both smoking and drinking • Post-hoc analysis suggests that those who quit smoking also had lower levels of drinking 1 Under review#10URBAN ARCH Unanswered questions • To determine if anti-smoking medications. reduce alcohol directly or indirectly (through smoking cessation) Ст ПИТЕР | St PETER#11URBAN ARCH Novel medications for pain. among PWH with heavy drinking • Pain associated with substance use & HIV risk¹ • Nalmefene was not tolerable² •In an RCT, no significant differences in pain. severity/interference between low-dose naltrexone and placebo, and gabapentin and placebo³ • Pain scores in all 3 groups decreased •Future steps • Gabapentin for HIV and heavy drinking (GRAIL) . • Collect data on pain for secondary analyses 1. Tsui, 2013, 2014, 2016, 2017 2. Bendiks, 2021 3. Tsui, abstract submitted to CPDD 2022#12URBAN ARCH Stigma among people who inject drugs (PWID) with HIV • Poor mental health and unhealthy alcohol use correlate with high stigma¹ •Intersectional stigma is associated with less care utilization² • Behavioral stigma coping intervention increases care engagement³ • Pandemic impact on PWID with HIV in Russia: less policing, less barriers to HIV treatment4 1. Lodi, under review 2. Vetrova, AIDS Behav 2021 3. Rossi, IAS 2022 4. Carroll AJPH 2022#13URBAN ARCH Unanswered questions. •Intersectional stigma •Implementation strategies SCRIPT STIGMA STUDY#14URBAN ARCH What we can still learn •Other examined topics •Food insecurity • Depressive symptoms & anxiety • Serodiscordance • Liver disease • HCV • Other substance use (opioids, cannabis)#15URBAN ARCH Potential future research questions Alcohol/tobacco use impact on pain and other HIV symptoms Co-use of substances- does change in one prompt change in others (i.e., alcohol and smoking)? Social determinants of health among Russian PWH who inject drugs • Screening strategies related to prevention efforts • Intersectional stigma, multi-level interventions Liver fibrosis and TMAO Oxidative stress, alcohol, smoking, and cardiac function • Opioid exposure and cardiac structure and function .#16МИХАЙЛОВСКИЙ TEATP СЕРГЕЙ СЕРГЕЕВИЧ ПРОКОФЬЕВ ЗОЛУШКА 28, 29 АПРЕЛЯ ХОРЕОГРАФИЯ РОСТИСЛАЯ ЗАХАРОВ Questions?