Comparative effectiveness of ART for HIV in patients with comorbidities

ART 对患有合并症的患者的 HIV 治疗效果比较

基本信息

批准号：
7936273
负责人：
DOUGLAS K OWENS
金额：
$ 47.3万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-09-26 至 2012-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7936273
关键词：
Address Age American Anti-Retroviral Agents Area Cardiac Cardiovascular Diseases Cardiovascular system Clinical Comorbidity Congresses Cost Effectiveness Analysis Country Data Data Sources Decision Modeling Disease Effectiveness Ensure Epidemiology Exposure to Generations Grant HIV HIV Infections HIV Seropositivity HIV therapy Health Individual Infection Integrase Inhibitors Knowledge Lead Modeling Morbidity - disease rate Multi-Drug Resistance New Agents Occupations Outcome Patient Care Patients Pattern Performance Pharmaceutical Preparations Population Positioning Attribute Protease Inhibitor Public Health Publishing Quality of life Recovery Regimen Registries Research Research Infrastructure Research Personnel Resistance Risk Source United States Veterans Virus Work antiretroviral therapy cardiovascular risk factor clinical care comparative comparative effectiveness cost effectiveness drug resistant virus economic outcome effectiveness research experience health economics improved inhibitor/antagonist mathematical model mortality patient population public health relevance statistics trend

项目摘要

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (05) Comparative Effectiveness Research, and specific Challenge Topic 05-AI-102: Comparative-effectiveness of Anti Retroviral Therapy (ART). We propose to assess the comparative effectiveness of ART in two specific patient populations of widespread importance: older HIV-infected individuals with cardiovascular risk factors or established cardiovascular disease, and HIV- infected patients with multi-drug resistant virus. We respond to the American Recovery and Reinvestment Act of 2009 by proposing a project which is ready for execution, will be completed within 2 years, will lead directly to the creation of 2 new jobs (programmer and research assistant) and the retention of 2 additional jobs (Bendavid, Sundaram). The project can begin immediately because the data on which we will perform our analyses is currently available. We have unique data sources that will enable us to address these questions more definitively than has been possible previously. We have assembled a multi-disciplinary team of highly experienced investigators with extensive expertise in comparative effectiveness, cost effectiveness, clinical care of HIV disease, statistics, health economics, and mathematical modeling. Our analyses will provide important information for clinicians, patients, and policymakers on the comparative effectiveness of treatments for individuals with HIV. This study has 2 aims. 1. To evaluate the comparative effectiveness and cost effectiveness of treatment for older HIV-positive individuals with cardiovascular risk factors or established cardiovascular disease. We will use the Department of Veterans Affairs (VA) HIV Clinical Case Registry (CCR) of more than 55,000 HIV patients to assess whether exposure to specific antiretroviral drugs or regimens is associated with poorer outcomes in patients with cardiovascular risk or disease. We will develop a decision model to evaluate long-term health and economic outcomes of different regimens. 2. To evaluate the comparative effectiveness and cost effectiveness of the use of new antiretrovirals - including but not limited to second generation protease inhibitors, integrase inhibitors, and entry inhibitors - in treatment-experienced HIV-infected individuals with multi-drug resistant virus. The project will aim to improve treatment choices for individuals with HIV by improving ART choice selection in patients with co-morbid disease or with multi-drug resistant HIV. The project will aid both in creation of new positions and retention of existing positions. PUBLIC HEALTH RELEVANCE: This application addresses broad Challenge Area (05) Comparative Effectiveness Research, and specific Challenge Topic 05-AI-102: Comparative-effectiveness of Anti Retroviral Therapy (ART). The project will compare antiretroviral strategies in HIV-infected individuals with cardiovascular risk factors or cardiovascular disease, and in patients with multi-drug resistant HIV. The project will enhance knowledge about the relationship between exposure to antiretroviral therapy and health outcomes, and improve decisions about choice of ART in individuals with cardiovascular risk factors and with multi-drug resistant infection.

说明（由申请人提供）：本申请涉及广泛的挑战领域 (05) 比较有效性研究，以及具体的挑战主题 05-AI-102：抗逆转录病毒疗法 (ART) 的比较有效性。我们建议评估 ART 在两个具有广泛重要性的特定患者群体中的相对有效性：具有心血管危险因素或已确诊心血管疾病的老年 HIV 感染者，以及患有多重耐药病毒的 HIV 感染者。我们响应 2009 年《美国复苏和再投资法案》，提出了一个已准备好执行的项目，该项目将在 2 年内完成，将直接创造 2 个新工作岗位（程序员和研究助理）并保留另外 2 个工作岗位工作（Bendavid、Sundaram）。该项目可以立即开始，因为我们将进行分析的数据目前可用。我们拥有独特的数据源，使我们能够比以前更明确地解决这些问题。我们组建了一支由经验丰富的研究人员组成的多学科团队，他们在比较有效性、成本效益、艾滋病毒临床护理、统计学、卫生经济学和数学模型方面拥有广泛的专业知识。我们的分析将为临床医生、患者和政策制定者提供关于艾滋病毒感染者治疗的比较效果的重要信息。这项研究有两个目的。 1. 评估对患有心血管危险因素或已确诊心血管疾病的老年艾滋病毒阳性个体进行治疗的比较效果和成本效益。我们将利用退伍军人事务部 (VA) 超过 55,000 名艾滋病毒患者的艾滋病毒临床病例登记处 (CCR) 来评估接触特定抗逆转录病毒药物或治疗方案是否与患有心血管风险或疾病的患者预后较差相关。我们将开发一个决策模型来评估不同治疗方案的长期健康和经济结果。 2. 评估使用新型抗逆转录病毒药物（包括但不限于第二代蛋白酶抑制剂、整合酶抑制剂和进入抑制剂）对经历过治疗且患有多重耐药病毒的 HIV 感染者的相对有效性和成本效益。该项目旨在通过改善患有共病疾病或多重耐药艾滋病毒患者的抗逆转录病毒治疗选择来改善艾滋病毒感染者的治疗选择。该项目将有助于创建新职位和保留现有职位。公共健康相关性：本申请涉及广泛的挑战领域 (05) 比较有效性研究，以及具体的挑战主题 05-AI-102：抗逆转录病毒疗法 (ART) 的比较有效性。该项目将比较具有心血管危险因素或心血管疾病的艾滋病毒感染者以及多重耐药艾滋病毒患者的抗逆转录病毒策略。该项目将增强人们对抗逆转录病毒治疗与健康结果之间关系的认识，并改善患有心血管危险因素和多重耐药感染的个体选择抗逆转录病毒治疗的决策。