Treatment outcomes and comorbidity in HIV-infected IDU

2 K24 DA 035684-06A1 这是Gregory Lucas博士在面向患者的研究（K24）中获得职业中期研究者奖的竞争性续期申请的重新提交。卢卡斯博士是约翰霍普金斯大学的医学教授。他接受过传染病专家的医学培训，并在彭博公共卫生学院完成了临床研究博士学位。20年来，他的研究有两个重点：1）艾滋病毒，丙型肝炎病毒和药物使用对肾脏和心血管疾病的关联，以及2）干预措施，以改善美国和其他地方注射毒品（PWID）人群的艾滋病毒预防和治疗结果。在上一个资助期间，卢卡斯博士对指导和领导做出了重大承诺，同时保持了良好的研究和资金生产力记录。此次更新申请的目的是继续支持指导初级研究人员的计划，并通过跨学科团队建设促进创新研究。该研究战略提出了三个积极的研究平台，供学员参与艾滋病毒和艾滋病相关研究。这三个母目标概述了目前资助的工作，这些工作将作为K24提案的框架。每个母公司目标都与新提出的扩展目标相关联，为初级研究人员提供所有权机会。Lucas博士是巴尔的摩队列研究的主要研究者，该研究目前处于第二个资助期，旨在描述HIV，HCV和可卡因使用在肾脏和心血管疾病中的作用（Parent Aim 1）。该队列在384名参与者中进行了超过1200次碘海醇肾小球滤过率（iGFR）测量，随访时间长达6年。相关扩展目标1提出确定与基于肌酐和胱抑素C的HIV阳性患者GFR斜率估计准确性相关的因素。Parent Aim 2是一项整群随机试验，旨在评价综合护理货车（ICV）在为巴尔的摩的PWID提供PWID和HIV相关循证服务方面的有效性。扩展目标2建议评估在ICV上提供HCV评估和治疗的可行性，并在一项试点随机试验中比较将社区招募的HCV感染的PWID转介到ICV或市卫生部门诊所（标准护理）的策略。 家长目标3描述了一个大型的和正在进行的研究组合，重点是改善艾滋病毒预防和治疗的成果，在国际环境中的关键人群。扩展目标3建议评估应答者驱动的采样作为一种干预工具，以识别不知情/护理外HIV阳性PWID。约翰霍普金斯大学与艾滋病毒和药物使用相关的研究的杰出环境和资源是这一提议的关键背景。最后，卢卡斯博士建议进行培训，以支持他的职业发展和团队建设，以领导对美国阿片类药物流行病的多学科研究反应。

2 K24 DA 035684-06A1 This is a resubmission of a competing renewal application for a mid-career investigator award in patient- oriented research (K24) for Dr. Gregory Lucas. Dr. Lucas is a Professor of Medicine at Johns Hopkins University. He is medically trained as an infectious diseases specialist and he completed a PhD in clinical investigation at the Bloomberg School of Public Health. For 20 years, his research has had a dual focus: 1) associations of HIV, HCV, and drug use on kidney and cardiovascular disease, and 2) interventions to improve HIV prevention and treatment outcomes among people who inject drugs (PWID) in the US and elsewhere. In the previous funding period, Dr. Lucas made a major commitment to mentoring and leadership, while maintaining a strong track record of research and funding productivity. The objectives of this renewal application are to continue to support a program for mentoring junior investigators and to foster innovative research through interdisciplinary team building. The research strategy presents three active research platforms for engaging trainees in HIV- and PWID-related research. These three Parent Aims outline currently funded work that will serve as the framework for the K24 proposal. Each Parent Aim is linked to a newly proposed Expansion Aim that provides ownership opportunity for a junior researcher. Dr. Lucas is PI of a Baltimore-based cohort study, now in its second funding period, designed to characterize the roles of HIV, HCV, and cocaine use in kidney and cardiovascular disease (Parent Aim 1). This cohort is unique in having over 1200 iohexol glomerular filtration rate (iGFR) measurements in 384 participants, with up to 6 years of follow-up. The linked Expansion Aim 1 proposes to determine factors associated with the accuracy of creatinine- and cystatin C-based estimation of GFR slope in HIV-positive persons. Parent Aim 2 is a cluster- randomized trial evaluating the effectiveness of an integrated care van (ICV) in providing PWID- and HIV- related evidence-based services to PWID in Baltimore. Expansion Aim 2 proposes to assess the feasibility of providing HCV evaluation and treatment on the ICV and to compare strategies of referring community-recruited HCV-infected PWID to the ICV or to a city health department clinic (standard care) in a pilot randomized trial. Parent Aim 3 describes a large and ongoing research portfolio focused on improving HIV prevention and treatment outcomes in key populations in international settings. Expansion Aim 3 proposes to assess respondent-driven sampling as an interventional tool to identify unaware/out-of-care HIV-positive PWID. The outstanding environment and resources for HIV- and drug use-related research at Johns Hopkins are a key backdrop to this proposal. Finally, Dr. Lucas proposes training to support his career development and team building to lead a multidisciplinary research response to the opioid epidemic in the US.