Elimination of HCV and related liver disease among HIV-infected and -uninfected people who inject drugs

消除艾滋病毒感染者和未感染者注射吸毒者中的丙型肝炎病毒和相关肝脏疾病

基本信息

批准号：
10319551
负责人：
Shruti H Mehta
金额：
$ 68.78万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-01-15 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10319551
关键词：
Ache Alcohols Attenuated Baltimore Benchmarking Blood Caring Communities Data Diagnosis Diffuse Disease Outcome Drops Engineering Enrollment Ensure Epidemiology Fibrosis Future Goals Grant HCV Liver Disease HIV HIV Infections HIV/HCV Hepatitis C Hepatitis C Incidence Hepatitis C Therapy Hepatitis C Viremia Hepatitis C virus Incidence Individual Infection Injecting drug user Left Link Liver Liver Fibrosis Liver diseases Longitudinal trends Maryland Measurement Measures Medicaid Medical Records Medicine Monitor Oral Participant Persons Plasma Population Public Health Practice Research Resolution Risk Serum Markers Structure Testing Time United States National Academy of Sciences Viremia Vital Statistics World Health Organization base cohort design elastography innovation liver biopsy member mortality non-alcoholic non-alcoholic fatty liver opioid epidemic opioid use recruit success trend uptake urban area viral RNA

项目摘要

Project summary Since recent innovations in hepatitis C virus (HCV) treatment make it possible to eradicate HCV infection in nearly every individual, the World Health Organization is calling for global HCV elimination by 2030. Elimination means reducing incident infection by 90% and HCV-related mortality by 65% from a 2015 benchmark. However, a high incidence of new infections and reinfections from the expanding opioid epidemic and historic low HCV treatment uptake might threaten HCV elimination among people who inject drugs (PWID), the primary HCV risk group in the USA. In this grant we asking both whether targets are being met and which subpopulations are being left befind focusing on Baltimore PWID, especially those coinfected with HIV. For more than 25 years, we have investigated HIV, hepatitis C virus (HCV) and liver disease in a community-based cohort of PWID (called ALIVE) and now the cohort is the ideal setting to accomplish our aims which are: (1) to evaluate the trajectory of decline in HCV viremia among a community-based cohort of in- and out-of care PWID in the era of all oral HCV therapy and assess whether this trajectory differs for those who are HIV/HCV co-infected and HCV monoinfected; (2) to estimate the contribution of incidence, treatment, and reinfection to HCV viremia changes among HIV-infected and -uninfected Baltimore PWIDs; and (3) to assess the population impact of expanded HCV treatment on liver disease outcomes including progression and emergence of different types of liver disease in HIV-infected compared to uninfected PWID. We have detailed, longitudinal measures of liver disease in the ALIVE cohort. Now is the right time to accomplish these aims so that we can assess if Baltimore (and possibly other urban areas in the USA) are on track for HCV elimination and to help guide those future efforts in time to adjust public health practices to ensure the goals are met by 2030.

项目概要由于丙型肝炎病毒 (HCV) 治疗的最新创新使得根除 HCV 成为可能几乎每个人都感染丙型肝炎病毒，世界卫生组织呼吁全球关注丙型肝炎病毒到 2030 年消除。消除意味着将事件感染和 HCV 相关感染减少 90% 死亡率较 2015 年基准下降 65%。然而，新感染病例的发生率很高，不断扩大的阿片类药物流行和丙肝治疗历史性低水平可能导致再感染威胁消除注射吸毒者 (PWID) 中的丙肝病毒，注射吸毒者是丙肝病毒的主要危险人群美国。在这笔赠款中，我们询问目标是否得到实现以及哪些亚人群剩下的重点是巴尔的摩吸毒者，特别是那些同时感染艾滋病毒的人。 25 年来，我们一直在研究艾滋病毒、丙型肝炎病毒 (HCV) 和肝脏疾病以社区为基础的吸毒者队列（称为 ALIVE），现在该队列是一个理想的环境实现我们的目标：(1) 评估 HCV 病毒血症下降的轨迹全口服 HCV 治疗时代基于社区的住院和非护理吸毒者队列评估 HIV/HCV 合并感染者和 HCV 感染者的这一轨迹是否不同单一感染； (2) 估计发病率、治疗和再感染对 HCV 的影响感染艾滋病毒和未感染巴尔的摩吸毒者的病毒血症变化； (3) 评估扩大 HCV 治疗对肝病结局（包括进展）的人群影响与未感染的吸毒者相比，艾滋病毒感染者出现不同类型的肝脏疾病。我们对 ALIVE 队列中的肝病进行了详细的纵向测量。现在就是对的是时候实现这些目标了，这样我们就可以评估巴尔的摩（以及可能的其他城市）是否美国地区）正在努力消除丙型肝炎病毒，并及时帮助指导未来的工作调整公共卫生实践，确保到 2030 年实现目标。