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Carrico Lab

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Investigator / Contact Person Adam Carrico

Research

Leveraging two successful pilot randomized controlled trials that I conducted, I am leading a R01 to test the efficacy of a positive affect intervention that is designed to boost and extend the effectiveness of contingency management (CM) with HIV-positive, methamphetamine-using men who have sex with men (MSM). The primary outcome of this randomized controlled trial is HIV viral load and my team is banking specimens (i.e., plasma, DNA, RNA) to support biomarker sub-studies. Enrollment of 110 participants is complete and follow-up continues through June of 2018. Leveraging these successes, myteam also recently completed a pilot randomized controlled trial of a trauma-informed intervention to boost the effectiveness of CM with HIV+, cocaine-using women that we will continue to refine in future clinical research. I also served as the lead clinician and co-investigator for a stepped wedge randomized controlled trial of a multi-level intervention that includes a 12-week CM intervention with a 4-session cognitive-behavioral aftercare group that I designed to decrease stimulant use and sexual risk taking among female sex workers in Cambodia. In the coming years, I will continue clinical research to examine novel psychological interventions to boost and extend the effectiveness of CM for HIV/AIDS prevention with stimulant users. 


My team was among the first to examine novel bio-behavioral pathways that explain poorer health outcomes among HIV-positive stimulant users. Using archival data from the NIMH Healthy Living Project, I documented that the effects of baseline depression and weekly stimulant use on higher mean HIV viral load over a 25-month follow-up were partially explained by difficulties with anti-retroviral therapy (ART) persistence. Subsequent research I led within the Multicenter AIDS Cohort Study (MACS) demonstrated that more regular stimulant users receiving ART are at moderately elevated risk for progression to AIDS or mortality, even after controlling for adherence and HIV viral load. My research showing that more frequent stimulant use is independently associated with elevations in clinically relevant biomarkers of immune activation in treated HIV infection provides some of indication of the possible role of stimulant-associated alterations in biological processes. For example, my team recently published in AIDS a paper documenting the associations of recent stimulant use and greater substance use severity with soluble CD14 (sCD14), a clinically relevant marker of monocyte activation. Most recently, we observed that recent stimulant use is associated with differential patterns of leukocyte gene expression that could promote the development of AIDS-related cancers. In the coming years, my bio-behavioral research program will continue to examine whether and how behavioral factors like substance use influence key pathophysiologic processes relevant to HIV/AIDS and cancer prevention.