Optimizing Care for HIV/HCV-Coinfected Patients in the New HCV Treatment Era

在新的 HCV 治疗时代优化 HIV/HCV 合并感染患者的护理

• 批准号: 9920080
• 负责人: Julia L. Marcus
• 金额: $ 10.84万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9920080
• 关键词: Address; Affect; Aging; Area; Award; CD4 Lymphocyte Count; California; Cardiovascular Diseases; Caring; Cells; Cessation of life; Chronic; Chronic Hepatitis C; Chronic Kidney Failure; Clinical; Cohort Studies; Communicable Diseases; Cost Effectiveness Analysis; Cost Savings; Data; Diabetes Mellitus; Disease; Economics; Electronic Health Record; Epidemiology; Event; Extrahepatic; Goals; HIV; HIV/HCV; Health; Hepatic; Hepatitis C; Hepatitis C Therapy; Hepatitis C co-infection; Hepatitis C virus; Infectious Diseases Research; Inflammation; Interferons; K-Series Research Career Programs; Kidney Diseases; Link; Liver; Liver Fibrosis; Liver diseases; Malignant Neoplasms; Matched Group; Measures; Mentored Research Scientist Development Award; Mentors; Methods; Myocardial Infarction; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Population; Public Health; Quality-Adjusted Life Years; RNA; Regimen; Research; Research Personnel; Research Training; Risk; Risk Factors; Structural Models; Training; Treatment outcome; Veterans; Virus Diseases; advanced disease; career; clinical care; comparison group; cost; cost effective; cost effectiveness; disease registry; economic impact; effective therapy; experience; follow-up; high risk; high risk population; immune activation; improved; indexing; markov model; member; mortality risk; overtreatment; study population

PROJECT SUMMARY/ABSTRACT This K01 award will provide the training and mentored research experience needed for me to become an independent researcher with a focus on improving the health outcomes of patients with or at risk for chronic viral infections. Chronic hepatitis C virus (HCV) infection affects over 3 million people in the U.S., with 80,000 HCV-related deaths per year. The health impacts of HCV are more severe in human immunodeficiency virus (HIV) patients, in whom HCV-associated liver disease is the leading cause of non-AIDS-related death. HIV/HCV coinfection has also been linked to an increased risk of extrahepatic outcomes, including cardiovascular and kidney disease. With the emergence of interferon-free regimens, most HCV patients can now be cured, regardless of HIV status. However, critical questions remain about 1) the effect of the timing of HCV treatment on hepatic and extrahepatic outcomes, 2) the ongoing risk of hepatic and extrahepatic outcomes after HCV cure, and 3) whether the clinical benefits of HCV treatment in early stages of liver disease warrant the use of costly new regimens in these patients. The high-risk population of HIV/HCV-coinfected patients is ideal for investigating these questions for two reasons. First, because HIV/HCV-coinfected patients are a priority group for HCV treatment, they will have received treatment over a range of liver disease stages, offering a unique opportunity to investigate the clinical and economic impacts of HCV treatment decisions. Second, ongoing risk of HCV-related outcomes after HCV cure may be more readily detectable in HIV/HCV- coinfected patients, for whom increased immune activation and inflammation may cause lasting damage. The proposed research will consist of cohort studies among members of Kaiser Permanente Northern California. The strengths of this setting include a diverse and generalizable population of 3.8 million members, internal HCV- and HIV-monoinfected comparison groups, an electronic health record (EHR) for identification of key risk factors, and infectious disease registries for high-quality ascertainment of HCV and HIV cases. The specific aims are to 1) determine the effect of early versus deferred HCV treatment on hepatic and extrahepatic outcomes among HCV-monoinfected and HIV/HCV-coinfected patients; 2) evaluate the risk of hepatic and extrahepatic outcomes among HCV-monoinfected and HIV/HCV-coinfected patients after HCV cure, and in a matched group of HIV patients without HCV infection; and 3) determine the cost-effectiveness of HCV treatment for all HCV-monoinfected and HIV/HCV-coinfected patients compared with deferral of treatment to later stages of liver disease. This career development award will provide training in 1) HCV and HIV/HCV epidemiology, treatment, and outcomes; 2) leveraging the EHR for infectious disease research; 3) advanced causal inference methods; and 4) cost-effectiveness analysis. This mentored research and training will directly inform the clinical care of HCV patients and establish my career as an independent researcher in the field.

项目摘要/摘要 该K01奖将为我提供所需的培训和指导的研究经验 独立的研究人员，重点是改善患有或有慢性风险的患者的健康状况 病毒感染。慢性丙型肝炎病毒（HCV）感染影响了美国超过300万人，有80,000人 每年与HCV相关的死亡。 HCV的健康影响在人类免疫缺陷病毒中更为严重 （HIV）患者，其中与HCV相关的肝病是与非AIDS相关死亡的主要原因。 艾滋病毒/HCV共感染也与肝外结局的风险增加有关，包括 心血管和肾脏疾病。随着无干扰素方案的出现，大多数HCV患者可以 现在可以治愈，无论艾滋病毒状况如何。但是，关键问题仍然是1） HCV治疗肝和肝外结局，2）肝和肝外的持续风险 HCV治疗后的结果和3）HCV治疗的临床益处是否在肝病的早期 保证在这些患者中使用昂贵的新方案。艾滋病毒/HCV康复的高风险人群 患者是研究这些问题的理想选择，原因有两个。首先，因为艾滋病毒/HCV被感染的患者 是HCV治疗的优先组，他们将在一系列肝病阶段接受治疗， 提供了一个独特的机会来研究HCV治疗决策的临床和经济影响。 其次，HCV治疗后与HCV相关结果的持续风险可能更容易在HIV/HCV-中检测到 与免疫激活和炎症增加的共同感染患者可能造成持久的损害。这 拟议的研究将包括Kaiser Permanente北加州成员的队列研究。 这种环境的优势包括380万成员的多样化且可推广的人口，内部 HCV和HIV - 单人感染的比较组，用于识别关键风险的电子健康记录（EHR） 因素以及高质量确定HCV和HIV病例的传染病注册。具体 目的是1）确定早期和递延HCV治疗对肝和肝外术的影响 HCV - 单人感染和HIV/HCV可感染的患者的结果； 2）评估肝的风险和 HCV治疗后HCV单次感染和HIV/HCV可感染的患者的肝外结局，在A中 匹配没有HCV感染的HIV患者组； 3）确定HCV的成本效益 与延期治疗相比 肝病的后期阶段。该职业发展奖将在1）HCV和HIV/HCV中提供培训 流行病学，治疗和结果； 2）利用EHR进行传染病研究； 3）高级 因果推理方法； 4）成本效益分析。这项指导的研究和培训将直接 告知HCV患者的临床护理，并确立我作为该领域独立研究人员的职业。

项目成果

More Screening or More Disease? Gonorrhea Testing and Positivity Patterns Among Men in 3 Large Clinical Practices in Massachusetts, 2010-2017.

更多筛查还是更多疾病？

• DOI: 10.1093/cid/ciaa066
• 发表时间: 2020
• 期刊: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
• 作者: Willis,SarahJ;Elder,Heather;Cocoros,Noelle;Young,Jessica;Marcus,JuliaL;Eberhardt,Karen;Callahan,Myfanwy;Herrick,Brian;Weiss,Michelle;Hafer,Ellen;Erani,Diana;Josephson,Mark;Llata,Eloisa;Flagg,ElaineW;Hsu,KatherineK;Klompas
• 通讯作者: Klompas

Working Toward Broad and Equitable Access to HIV Preexposure Prophylaxis.

努力实现广泛和公平地获得艾滋病毒暴露前预防。

• DOI: 10.2105/ajph.2019.305254
• 发表时间: 2019
• 期刊: American journal of public health
• 影响因子: 12.7
• 作者: Marcus,JuliaL;Krakower,DouglasS
• 通讯作者: Krakower,DouglasS

Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care.

• DOI: 10.1097/qai.0000000000001014
• 发表时间: 2016-09-01
• 期刊: Journal of acquired immune deficiency syndromes (1999)
• 作者: Marcus JL;Chao CR;Leyden WA;Xu L;Quesenberry CP Jr;Klein DB;Towner WJ;Horberg MA;Silverberg MJ
• 通讯作者: Silverberg MJ

Preexposure Prophylaxis for Human Immunodeficiency Virus Infection for Men Who Have Sex with Men and Transgender Persons:: What Dermatologists Need to Know.

男男性行为者和跨性别者的人类免疫缺陷病毒感染的暴露前预防：：皮肤科医生需要知道什么。

• DOI: 10.1016/j.det.2019.10.008
• 发表时间: 2020
• 期刊: Dermatologic clinics
• 影响因子: 2.4
• 作者: Katz,KennethA;Park,AndrewJ;Marcus,JuliaL
• 通讯作者: Marcus,JuliaL

Immunodeficiency, AIDS-related pneumonia, and risk of lung cancer among HIV-infected individuals.

• DOI: 10.1097/qad.0000000000001434
• 发表时间: 2017-04-24
• 期刊: AIDS (London, England)
• 作者: Marcus JL;Leyden WA;Chao CR;Horberg MA;Klein DB;Quesenberry CP Jr;Towner WJ;Silverberg MJ
• 通讯作者: Silverberg MJ