With $7.1M Grant, Professors to Study UnhealthyDrinking, Chronic Pain, Inactivity among People Living with HIV
The five-year award from the National Institute on Alcohol Abuse and Alcoholism will fund the Boston ARCH Comorbidity Center, an interdisciplinary project that will address physical and mental health function among people living with HIV and will be led by Richard Saitz and Michael Stein.
Unhealthy alcohol consumption is common among people living with HIV and is known to accelerate disease progression, interfere with treatment, and exacerbate HIV-related comorbidities. Over the past 10 years, researchers at the School of Public Health have led clinical trials on alcohol and HIV through the Boston cohort of the international URBAN ARCH Consortium—a component of the Uganda Russia Boston Alcohol Network for Alcohol Research Collaboration on HIV/AIDS—to better understand how to reduce excessive drinking among people living with HIV (PLWH).
Now, thanks to a five-year grant totaling $7,113, 473 from the National Institute on Alcohol Abuse and Alcoholism, the work of the consortium will continue through a new initiative called the Boston Alcohol Research Collaboration on HIV/AIDS—Comorbidity Center (Boston ARCH CC).
Led by Richard Saitz, professor of community health sciences, and Michael Stein, chair and professor of health law, policy & management, the Boston ARCH CC will focus on the physical and mental health functioning of PLWH and will examine ways to address two prevalent comorbidities that many PLWH experience: chronic pain and physical inactivity.
“HIV is now a chronic health condition, and the medical focus on this disease has been on reducing viral load and improving immune function,” says Saitz, co-principal investigator of the project with Stein, and a professor of medicine at the School of Medicine (MED). “In our previous work in the Boston ARCH cohort, we found that people reported alcohol and other drug use, and poor health-related quality of life, despite excellent control of HIV disease. That observation led us to propose research that would address common comorbidities and alcohol use that have not been well-studied in this context.”
The Boston ARCH CC will consist of four components, including two clinical trials—one that focuses on chronic pain, and the other on physical activity. Both trials will be run fully online, the former led by Tibor Palfai, clinical program director of psychological & brain sciences in the College of Arts & Sciences, and the latter by Lisa Quintiliani, associate professor of community health sciences and medicine at SPH and MED, along with Ana Abrantes, professor of psychiatry and human behavior, at Brown University. The center will also include an Administrative Core led by Saitz and Stein, and a Biostatistics and Data Management Core, led by Timothy Heeren, professor of biostatistics, that will continue secondary analyses of the data collected from the previous 10-year cohort study, and provide support and mentoring to trainees and investigators.
“This grant is an acknowledgement by NIH that the assembled team of researchers has a long and productive track record and is expected to continue to do great work in the years ago,” says Stein. He calls the award for the Comorbidity Center a “great honor and privilege.”
He says PLWH have nearly normal life expectancies if they take the highly effective antiretroviral treatment now available, so the role of new research is to improve the lives of patients as they age and experience HIV-related conditions.
“One novelty of the center is that we will offer our behavioral interventions via videoconference, reaching participants in their homes, where getting through the activities of the day matters,” Stein says. “We hope that attention to these important conditions will improve the lives of our patients.”
Alcohol use can cause painful conditions that already occur in people with HIV infection, such as neuropathy, liver disease and injuries. “Alcohol is often taken to reduce pain, but it can worsen pain too,” says Saitz. It can also interfere with motivation to be physically active.
Treatment of chronic pain is difficult, he says, particularly for people who consume excessive alcohol or take drugs or medications that interact with alcohol in harmful ways.
“Some people find relief from using alcohol, even when the painful condition is caused by alcohol,” says Saitz. Mental health treatments can be effective in reducing pain, but are often difficult to access, he says.
Both research projects will deliver easily accessible behavioral-based telehealth interventions via online platforms. The clinical trial addressing chronic pain will focus on motivational and cognitive behavioral treatments, while the trial on physical inactivity will offer a home-based lifestyle physical activity that researchers hope participants can maintain over the long term.
“Lifestyle-based approaches to promote physical activity have the potential to reach large populations and to sustain high levels of engagement over time,” says Quintiliani, citing barriers to supervised, gym-based approaches such as transportation issues, not easily integrating into existing daily routines, and cost. “Our lifestyle approach uses mobile health technology, such as a FitBit activity tracker, which encourages brief sessions of activity that more easily fit into daily routines. Our goal is to determine if this approach is effective among people living with HIV who are engaging in unhealthy drinking and if so, for this approach to become more widely available.”
Other SPH researchers associated with Boston ARCH CC are Lewis Kazis, professor of health law, policy & management, and Sara Lodi, assistant professor of biostatistics. Other researchers at BU include Simone Gill, associate professor of medicine and occupational therapy at MED and Sargent College, respectively; Daniel Fulford, associate professor of occupational therapy at Sargent College; John Otis, director of the Behavioral Medicine Program at the Center for Anxiety & Related Disorders; Theresa Kim, assistant professor of medicine at MED and Boston Medical Center (BMC); and Jessica Taylor, clinical associate professor of medicine at MED and BMC.