Using the VACS Index to track health outcomes associated with changes in drug use

使用 VACS 指数跟踪与药物使用变化相关的健康结果

• 批准号: 8626374
• 负责人: David Fiellin
• 金额: $ 39.67万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2016-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8626374
• 关键词: Abstinence; Acquired Immunodeficiency Syndrome; Admission activity; Adverse effects; Age; Aging; Agonist; Alanine Transaminase; Alcohol abuse; Alcohol consumption; Alcohol or Other Drugs use; Anemia; Aspartate Transaminase; Biological Markers; Blood Platelets; CD4 Lymphocyte Count; Cardiovascular system; Caring; Chronic; Clinical; Cocaine; Data; Dependence; Disease; Drug toxicity; Drug usage; Event; Fracture; Functional disorder; Glomerular Filtration Rate; Goals; HIV; HIV Infections; Health; Health Benefit; Hemoglobin; Hepatitis C; High Prevalence; Hospitalization; Illicit Drugs; Immune; Immunologic Markers; Immunologics; Individual; Infection; Infectious Agent; Injury; Intensive Care Units; Interruption; Kidney; Kidney Diseases; Laboratories; Liver; Marijuana; Marijuana Smoking; Measures; Medical; Monitor; Opioid; Outcome; Patient Self-Report; Patients; Pharmaceutical Preparations; Physiological; Physiology; Predisposition; Regimen; Renal function; Reporting; Research; Risk; Self Care; Series; Serologic tests; Severity of illness; Smoking; Substance Use Disorder; Testing; Tobacco; Tobacco use; Toxic effect; Toxicology; Urine; Validation; Veterans; Viral; Viral Load result; Viral hepatitis; Work; addiction; antiretroviral therapy; body system; cocaine use; cohort; effective therapy; frailty; functional status; health related quality of life; immune function; improved; indexing; inflammatory marker; liver injury; medication compliance; mortality; nutrition; prognostic; public health relevance; response; substance abuse treatment; therapy adherence

DESCRIPTION (provided by applicant): The adverse effects of illicit drug use result from both direct toxicities and indirect effects due to infections, non-adherence to medical regimens, poor nutrition, and impaired self- care. These adverse effects are especially evident in HIV-infected individuals due to their high prevalence of comorbid conditions and physiologic frailty. Effective treatment of substance use disorders leading to reductions in illicit drug use can influence physiology in an equally diverse manner by reducing direct toxicities and improving medication adherence, nutrition and self-care. Therefore the health benefits of drug treatment not captured by self-report of illicit drug use or urine toxicology analyses, may be better reflected by markers of liver, hematologic, kidney, and immune function. The Veterans Aging Cohort (VACS) Index adds measures of liver (hepatitis C infection, FIB- 4), kidney (eGFR), and hematologic (hemoglobin, platelets) function to age, CD4 count and HIV viral load and is a validated biomarker index that has been shown to reflect improvement in immune function, alcohol consumption, and overall health in HIV- infected patients. The goals of the proposed research are to evaluate the VACS Index as a biomarker reflecting the benefits of reductions of substance use in a series of three sub studies. Aim 1 will be conducted in HIV-infected opioid dependent individuals receiving opioid agonist treatment. Changes in illicit opioid use assessed using urine toxicology analyses will be correlated with changes in the VACS Index. Aim 2 will correlate changes in self-reported use of individual substances (opioids, cocaine, marijuana, and tobacco) among HIV-infected subjects, with changes in the VACS Index and compare VACS Index results obtained during periods of drug use, with those obtained during periods of abstinence. Aim 3 will evaluate the responsiveness of a modified VACS Index (removing CD4 count and HIV viral load) to changes in opioid use, assessed using urine toxicology analysis, among HIV-uninfected individuals receiving opioid agonist treatment. This line of research conducted in a large and well characterized cohort of HIV-infected and HIV-uninfected patients with extensive data on laboratory values, urine toxicology tests, and medication-assisted treatment, will add to the extensive validation work we have done with the VACS Index. This work has the potential to provide evidence supporting the use of this unique aggregation of commonly available laboratory tests to monitor the health benefits of reduced illicit drug use.

描述（由申请人提供）：非法药物使用的不利影响是由于感染，不遵守医疗方案，营养不良和自我护理受损而引起的直接毒性和间接影响。由于艾滋病毒感染者的合并症和生理脆弱的率很高，这些不良反应在艾滋病毒感染的个体中尤为明显。通过降低直接毒性并改善药物依从性，营养和自我保健，可以有效地治疗药物使用障碍，从而减少非法药物使用的疾病可以以同样多样化的方式影响生理。因此 肝脏，血液学，肾脏和免疫功能。 The Veterans Aging Cohort (VACS) Index adds measures of liver (hepatitis C infection, FIB- 4), kidney (eGFR), and hematologic (hemoglobin, platelets) function to age, CD4 count and HIV viral load and is a validated biomarker index that has been shown to reflect improvement in immune function, alcohol consumption, and overall health in HIV- infected patients.拟议的研究的目标是评估VAC指数作为一种生物标志物，以反映一系列三项Sub研究中减少物质使用的好处。 AIM 1将在接受阿片类激动剂治疗的HIV感染的阿片类药物依赖性个体中进行。使用尿液毒理学分析评估的非法阿片类药物使用的变化将与VACS指数的变化相关。 AIM 2将在HIV感染的受试者中自我报告使用单个物质（阿片类药物，可卡因，大麻和烟草）的变化与VACS指数的变化并比较在毒品使用期间获得的VACS指数的变化，并在禁令期间获得的vac索引结果。 AIM 3将评估修改后的VAC指数（去除CD4计数和HIV病毒载量）对使用阿片类激动剂治疗的HIV未感染的个体在使用尿液毒理学分析中评估阿片类药物使用的变化。在大型且特征良好的HIV感染和HIV未感染的患者中进行的研究系列，这些患者具有有关实验室价值，尿液毒理学测试和药物辅助治疗的广泛数据，将增加我们对VACS指数所做的广泛验证工作。这项工作有可能提供证据，以支持这种常见实验室测试的独特聚合，以监测降低非法药物使用的健康益处。