Cardiovascular Risk Reduction in an Aging HIV-Infected Population: The Impact of HCV Co-Infection

降低老龄化 HIV 感染人群的心血管风险：HCV 合并感染的影响

• 批准号: 10550253
• 负责人: Virginia Athena Triant
• 金额: $ 80.05万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10550253
• 关键词: Acquired Immunodeficiency Syndrome; Acute myocardial infarction; Adult; Affect; Age; Aging; Algorithms; American; Antiviral Agents; Biometry; Cardiovascular Diseases; Caring; Chronic; Chronic Disease; Clinical; Collaborations; Data; Discipline; Disease Outcome; Early treatment; Epidemiology; Event; Extrahepatic; HIV; HIV Infections; HIV/HCV; Hepatitis C; Hepatitis C Therapy; Hepatitis C co-infection; Hepatitis C virus; Individual; Infection; Inflammation; Inflammatory; International; Knowledge; Long-Term Care; Methods; Modeling; North America; Patients; Performance; Population; Prevention strategy; Public Health; Research; Risk; Risk Assessment; Risk Factors; Risk Reduction; Role; Sample Size; Testing; Viral Load result; adjudication; antiretroviral therapy; barrier to care; burden of illness; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular risk factor; chronic infection; clinical care; clinically relevant; co-infection; cohort; curative treatments; design; effective therapy; improved; innovation; multidisciplinary; novel; prospective; public health priorities; response; risk prediction; risk prediction model; risk stratification

PROJECT SUMMARY/ABSTRACT The proposed study will investigate how Hepatitis C virus (HCV) impacts cardiovascular disease (CVD) risk among individuals co-infected with HIV and HCV: Specific Aim 1. To quantify the impact of HCV co-infection on acute myocardial infarction (AMI) risk in a cohort of HIV-infected patients followed longitudinally in a large prospective clinical care cohort HIV infection increases CVD risk, and this risk is thought to be driven by non-traditional risk factors. Whether patients co-infected with HCV have further increased CVD risk and whether this interaction is influenced by age and HCV treatment status is not well understood. Importantly, CVD risk may persist even after treated HCV, and this question has not been previously answered. It is hypothesized that the presence of two chronic infections will increase risk beyond that of either infection alone. Specific Aim 2. To investigate whether treating HCV, and reducing its associated chronic inflammation, decreases risk of incident AMI The new era of HCV care has brought extremely effective treatment for HCV, yet access remains limited and barriers to treatment persist in co-infected patients. The extra-hepatic effects of HCV treatment – particularly direct-acting antivirals (DAAs) – are not known. With persistent barriers to HCV treatment, knowledge of whether HCV treatment can reduce CVD risk will have important public health implications for prioritizing patients for curative HCV treatment. Specific Aim 3. To assess the impact of HCV co-infection on CVD risk prediction in HIV Whether established CVD risk prediction algorithms provide an accurate assessment of risk in HIV/HCV co- infected patients remains unclear, particularly among co-infected patients. We propose to assess several established algorithms in a large cohort of co-infected patients. Through innovative analyses, we will incorporate HCV as a novel CVD risk factor into risk prediction functions to attempt to improve model performance in HIV. To complete the proposed aims and maximize the number of HIV/HCV co-infected individuals, we will leverage the largest collaboration of observational HIV cohorts in North America – the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). This is a uniquely well-suited cohort given its large sample size, adjudicated CVD events, and rigorously maintained data. Our multidisciplinary team includes internationally regarded epidemiology and biostatistics collaborators with expertise in methods of advanced causal inference and in CVD risk prediction modeling. This timely and clinically relevant study will advance the field by generating new knowledge on the impact of HCV on CVD risk and will directly impact the long-term care of aging HIV populations.

项目摘要/摘要 支撑研究将研究丙型肝炎病毒（HCV）如何影响心血管疾病（CVD）风险 在与HIV和HCV共同感染的个体中： 具体目的1。量化HCV共同感染对加入心肌梗塞（AMI）风险的影响 一群艾滋病毒感染的患者在大型前瞻性临床护理队列中纵向跟踪 HIV感染增加了CVD风险，而这种风险是非传统风险因素所驱动的。 与HCV共同感染的患者进一步增加了CVD风险，并且这种相互作用是否受到影响 年龄和HCV治疗状况尚不清楚。 HCV，此点击尚未得到回答。 感染将增加仅次于任何一种感染的风险。 具体目的2。研究是否治疗HCV并减少其相关的慢性炎症， 降低发生AMI的风险 HCV护理的新Eera为HCV带来了极有效的治疗方法，但访问有限和 治疗的障碍持续存在于联合感染的特定性。 直接作用的抗抗原（DAAS） - 持续不知道HCV治疗的障碍 HCV治疗是否可以减少CVD将具有重要的公共卫生意义含义 治疗性HCV治疗的患者。 特定目标3。评估HCV共感染对CVD风险预测的影响 建立的CVD风险预测算法是否提供了对HIV/HCV共同风险的准确评估 受感染的患者尚不清楚，特别是在共同感染的患者中。 通过创新的分析，在大量共同感染的患者中建立了算法。 将HCV纳入无新颖的CVD因子中的风险预测功能，以改善模型 艾滋病毒的表现。 为了完成支撑目标并最大化艾滋病毒/HCV共同感染的人的数量，我们将利用 北美最大的合作观察艾滋病毒队列 - 北美艾滋病队列 研究与设计的合作（NA-Accord）。 样本量，裁决的CVD事件和严格的数据包括我们的多学科团队。 具有高级方法的专业知识 因果关系和CVD风险预测建模。 通过对HCV对CVD风险的影响产生新知识，并将直接影响。 照顾衰老的艾滋病毒人群。