Johns Hopkins HIV Clinical Cohort

约翰霍普金斯大学艾滋病毒临床队列

• 批准号: 10617707
• 负责人: RICHARD Douglas MOORE
• 金额: $ 147.05万
• 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 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10617707
• 关键词: Acquired Immunodeficiency Syndrome; Address; African American; Age; Aging; Baltimore; Behavioral; Cardiovascular system; Caring; Catchment Area; Chronic; Cirrhosis; Clinical; Clinical Course of Disease; Clinical Research; Clinical Sciences; Clinical Trials; Cocaine; Collaborations; Continuity of Patient Care; Data; Diagnosis; Disease; Drug usage; Epidemic; Epidemiology; Fibrosis; Funding; Future; Geography; Goals; Growth; HIV; HIV Infections; HIV/AIDS; Hepatitis C; Hepatitis C Therapy; Hepatitis C co-infection; Incidence; Infection; Kidney; Life; Life Expectancy; Liver; Liver Fibrosis; Liver diseases; Longevity; Malignant neoplasm of liver; Manuscripts; Maryland; Measurement; Measures; Mental Health; Metabolic; Morbidity - disease rate; National Institute of Drug Abuse; Neurocognitive Deficit; Observational Study; Opioid; Outcome; Overdose; Participant; Pathogenesis; Patients; Peer Review; Persons; Population; Prevalence; Primary carcinoma of the liver cells; Productivity; Publications; Publishing; Recording of previous events; Research; Research Personnel; Resources; Risk; Risk Factors; Site; Socioeconomic Factors; Standardization; Suicide; Time trend; Traumatic injury; Treatment Factor; Viral; Viral hepatitis; Woman; antiretroviral therapy; care delivery; clinical care; co-infection; cocaine use; cohort; comorbidity; effective therapy; follow-up; heroin use; implementation science; improved; mortality; multiple chronic conditions; neoplastic; patient population; prognostic; socioeconomics; substance use; substance use treatment; therapy adherence; translational study; transmission process; treatment and outcome

The Johns Hopkins HIV Clinical Cohort (JHHCC) has been a resource since 1989 for longitudinal research on the risk factors, treatment and clinical outcomes of persons with HIV (PWH). The Baltimore region has overlapping epidemics of HIV infection and substance use, predominantly heroin and cocaine use, and much of our research has focused in this population, with the advantage of directly comparing those who use substances with a non-use population from the same geographic and socioeconomic catchment areas of the region. Our cohort is predominantly African-American with a high proportion of women, providing a needed window into these epidemics in these often understudied populations. Highly-effective antiretroviral therapy (ART) has markedly improved survival; the median age of the JHHCC cohort is 54 years with an expected life-expectancy of 20-30 years. New federal initiatives have a goal of >90% of PWH in HIV care, so that data to better understand and overcome the challenges to long-term HIV care are particularly relevant to the contemporary epidemic. Our current Aims build upon our strengths in longitudinal research, focusing on the chronically-infected patient population on long- term ART. Non-communicable diseases (NCD) appear to be occurring at higher rates and at earlier ages than expected, even in those who are virally suppressed. We and others have shown that substance use is a barrier to achieving the outcomes of the HIV Care Continuum, and increases the risk of comorbidity and mortality in HIV. Our first Aim is to characterize the extended clinical course of PWH in contemporary HIV care, evaluating the associations of opioid and other substance use and its treatment with the HIV Care Continuum, NCD morbidity and mortality in those aging with HIV. Another focus of the JHHCC has been viral hepatitis co-infection, particularly hepatitis C (HCV), a comorbidity that is prevalent in 40% of our patients, principally because of IDU. Although we are now effectively treating HCV, challenges remain in curing those who use substances and in those who are treated, liver fibrosis is common and the future risk of cirrhosis, steatosis and hepatic cancer is unclear, as well as the risk of re-infection. Our second Aim will focus on HCV treatment and the rates and risks of these adverse liver outcomes and re-infection in those who have been treated. Finally, the JHHCC has a proven history of highly productive collaboration, with over 500 publications, half of which are with multisite collaborations. These include not only observational research, but translational studies of pathogenesis, implementation science and clinical trials. Our third Aim is to enhance collaboration with investigators who would benefit from the resources of the JHHCC, and especially as part of the Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO).

自1989年以来，约翰·霍普金斯HIV临床队列（JHHCC）一直是一种资源 研究艾滋病毒患者（PWH）的危险因素，治疗和临床结果。巴尔的摩 区域具有重叠的HIV感染和药物使用，主要是海洛因和可卡因的流行病 使用，我们的大部分研究都集中在该人群中，具有直接比较的优势 那些使用来自同一地理和社会经济的非使用人群的物质的人 该地区的集水区。我们的队列主要是非裔美国人 妇女在这些经常被研究的人群中为这些流行病提供了必要的窗口。 高效有效的抗逆转录病毒疗法（ART）显着提高了存活率。中位年龄 JHHCC队列为54年，预期的寿命为20 - 30年。新的联邦倡议有 在艾滋病毒护理中，PWH> 90％> 90％的目标，以便更好地理解和克服挑战的数据 长期的艾滋病毒护理与当代流行病特别相关。我们目前的目标是 我们在纵向研究中的优势，重点是长期感染的患者人群 术语艺术。非传染性疾病（NCD）似乎以较高的速度发生，并且早期发生 年龄比预期的，即使在那些被病毒抑制的人中。我们和其他人表明 使用物质是实现艾滋病毒护理连续体结果的障碍，并增加了风险 艾滋病毒中合并症和死亡率。我们的第一个目的是表征PWH的扩展临床课程 在当代艾滋病毒护理中，评估阿片类药物和其他物质使用的关联及 艾滋病毒衰老的患者的HIV护理连续性，NCD发病率和死亡率的治疗。其他 JHHCC的重点是病毒性肝炎共感染，尤其是乙型肝炎（HCV），一种合并症 这在我们40％的患者中很普遍，主要是由于IDU。虽然我们现在有效 治疗HCV，挑战在治疗使用物质的人和接受治疗的人中的挑战，肝脏 纤维化是常见的，肝硬化，脂肪变性和肝癌的未来风险尚不清楚，以及 重新感染的风险。我们的第二个目标将重点放在HCV治疗以及这些的速度和风险上 受到治疗的患者的不良肝后果和再感染。最后，JHHCC有一个 经过验证的高产合作历史，有500多个出版物，其中一半与 多站点合作。这些不仅包括观察研究，还包括 发病机理，实施科学和临床试验。我们的第三个目标是加强与 将从JHHCC的资源中受益的调查人员，尤其是作为一部分 合作生产NIDA机会（C3PNO）的协作联盟。