HIV Disease Outcomes in Drug Users in Clinical Practice

临床实践中吸毒者的艾滋病毒疾病结果

• 批准号: 8874943
• 负责人: RICHARD Douglas MOORE
• 金额: $ 147.41万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8874943
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adherence; Affect; Age; Aging; Alcohol consumption; Alcohol or Other Drugs use; Anti-Retroviral Agents; Antiviral Agents; Antiviral Therapy; Baltimore; Behavioral Research; Cardiovascular system; Caring; Catchment Area; Cells; Chronic; Cities; Clinical; Clinical Research; Clinical Trials; Collaborations; Comorbidity; Data; Data Collection; Data Set; Development; Diabetes Mellitus; Disease; Disease Outcome; Disease Progression; Drug usage; Drug user; Dyslipidemias; Early treatment; Epidemic; Epidemiology; Evolution; Goals; Grant; HIV; HIV Infections; HIV therapy; Health Services; Hepatitis C; Hepatitis C virus; High Prevalence; Hypertension; Illicit Drugs; Immune system; Incidence; Individual; Inflammation; Injecting drug user; Kidney; Licensing; Life; Life Expectancy; Liver; Malignant - descriptor; Manuscripts; Maryland; Medical; Metabolic; Methods; Morbidity - disease rate; National Institute of Drug Abuse; Observational Study; Outcome; Pathogenesis; Patients; Peer Review; Persons; Pharmaceutical Preparations; Phenotype; Population; Premature aging syndrome; Process; Publishing; Recording of previous events; Research; Research Personnel; Resources; Risk; Risk Factors; Smoking; Source; Specimen; Toxic effect; Translational Research; Treatment outcome; United States; Viral Load result; Viral hepatitis; Virus; antiretroviral therapy; care delivery; clinical practice; co-infection; cohort; experience; immune activation; implementation research; instrument; interest; mortality; novel; public health relevance; reconstitution; repository; response; socioeconomics; translational study

DESCRIPTION (provided by applicant): The JHHCC, established in 1989, has been a premier source of HIV longitudinal research with over 250 manuscripts published on the risk factors and outcomes of HIV infection. Almost half of the JHHCC are patients with a history of injecting drug use (IDU), enabling us to conduct studies that directly compare receipt, adherence and clinical outcomes of HIV care between IDU and non-IDU patients from the same geographic and socioeconomic catchment areas of an Eastern city that has a high prevalence and incidence of HIV infection. HIV infection remains at epidemic levels in Baltimore, and substance use is a co-epidemic that is a barrier to receipt and continuity of effective HIV medical care. During the over two-decade existence of the JHHCC, the HIV epidemic in the U.S. has undergone a remarkable evolution. Current antiretroviral therapy (ART) is highly effective in suppressing virus and there has been a dramatic decline in AIDS-related disease and improvement in life-expectancy. However, there is growing evidence of an increased risk for the development of a number of HIV-associated non-AIDS (HANA) comorbidities such as cardiovascular, renal, liver, metabolic and malignant disease. Although controversial, the concept of "premature aging" from HIV infection is a concern. Our first Aim will build upon our strengths in longitudinal research focusing on HIV progression, HANA and aging with HIV infection. Another focus of the JHHCC has been viral hepatitis co-infection, particularly hepatitis C, a comorbidity that is prevalent in 45% of our patients, principally because of IDU. There have been substantial barriers to effective hepatitis C treatment in our population, but again, an evolution in therapy is occurring. Novel direct-acting antiviral drugs are rapidly becoming available that appear to be simpler to use and more effective in achieving a sustained virologic response. Our second Aim will focus on utilization, adherence, barriers and outcomes of these promising new therapies. Finally, the JHHCC has a proven history of collaboration with over 150 epidemiological, clinical, translational and health services investigators by providing existing data, adding new data collection methods and instruments, identifying patient phenotypes for pathogenesis studies, clinical trials and observational studies, supplying repository specimens and serving as a research platform for a variety of investigational interests. Our third Aim is to expand our collaborations with investigators who would benefit from the resources of the JHHCC.

描述（由申请人提供）：1989年成立的JHHCC一直是HIV纵向研究的主要来源，其中有250多种手稿发表了有关HIV感染的危险因素和结果。几乎一半的JHHCC是注射药物使用史（IDU）的患者，使我们能够进行研究，以比较来自同一地理和社会经济集水区的IDU和非IDU患者之间HIV护理的收据，依从性和临床结果，该地区具有较高的艾滋病毒感染率和发病率的东部城市。艾滋病毒感染仍处于巴尔的摩的流行水平，使用物质是一种流行病，是有效HIV医学的收到和连续性的障碍 关心。在JHHCC的两个十年中，美国的艾滋病毒流行经历了显着的进化。当前的抗逆转录病毒疗法（ART）在抑制病毒方面非常有效，并且与艾滋病相关疾病和预期疾病的改善急剧下降。但是，越来越多的证据表明，许多与HIV相关的非AID（HANA）合并症（例如心血管，肾脏，肝脏，代谢和恶性疾病）的风险增加。尽管引起了争议，但艾滋病毒感染的“过早衰老”的概念是一个问题。我们的第一个目标将基于我们在纵向研究中的优势，重点是HIV进展，HANA和HIV感染衰老。 JHHCC的另一个重点是病毒性肝炎共感染，尤其是肝炎 C，一种合并症，在我们45％的患者中普遍存在，主要是由于IDU。在我们的人群中，有效的丙型肝炎治疗已经存在很大的障碍，但是再次发生了治疗的发展。新型的直接作用抗病毒药物正在迅速获得，似乎更易于使用，并且在达到持续的病毒学反应方面更有效。我们的第二个目标将重点放在这些有前途的新疗法的利用，粘附，障碍和结果上。最后，JHHCC通过提供现有数据，添加新的数据收集方法和工具，确定病原体研究，临床试验和观察性研究，提供存储库标本并提供研究平台的研究平台来确定患者表型，以确定患者表型，以确定患者表型，并为各种研究平台提供研究。我们的第三个目标是扩大与将从JHHCC资源中受益的调查人员的合作。