Curating a Knowledge Base for Individuals with Coinfection of HIV and SARS-CoV-2: EHR-based Data Mining

为 HIV 和 SARS-CoV-2 混合感染者打造知识库：基于 EHR 的数据挖掘

• 批准号: 10481286
• 负责人: Xiaoming Li
• 金额: $ 22.29万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-13 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10481286
• 关键词: 2019-nCoV; Acquired Immunodeficiency Syndrome; Acute; Address; Adherence; CD4 Lymphocyte Count; CD4 Positive T Lymphocytes; COVID-19; COVID-19 pandemic; COVID-19 risk; COVID-19 severity; COVID-19 vaccination; Cardiovascular Diseases; Cell Count; Cells; Characteristics; Chronic Kidney Failure; Chronic Obstructive Pulmonary Disease; Clinic; Clinical; Clinical Data; Clinical Trials; Clinical Trials Design; Country; Data; Dependence; Diagnosis; Electronic Health Record; Etiology; Event; Exploratory/Developmental Grant; Goals; HIV; HIV Infections; Health; Human immunodeficiency virus test; Immune; Individual; Inflammatory; Intervention; Knowledge; Laboratories; Malignant Neoplasms; Measures; Methodology; Modeling; Natural History; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Ontology; Outcome; Pathway interactions; Patients; Pattern; Pharmaceutical Preparations; Phase; Phenotype; Population; Post-Acute Sequelae of SARS-CoV-2 Infection; Procedures; Prognosis; Provider; Public Health; Referral and Consultation; Reporting; Research; Risk; Risk Factors; Role; SARS-CoV-2 exposure; SARS-CoV-2 infection; Sampling; Series; Services; Severe Acute Respiratory Syndrome; Severities; Social Behavior; Structure; System; Therapeutic Intervention; Time; Training; Viral; Viral Load result; Visit; Work; World Health Organization; antiretroviral therapy; base; biomedical ontology; clinical decision support; clinically actionable; co-infection; cohort; comorbidity; coronavirus disease; data integration; data mining; demographics; design; disease prognosis; evidence base; high risk; knowledge base; machine learning model; outreach; patient screening; pilot test; pre-exposure prophylaxis; prisma; prospective; prototype; screening; severe COVID-19; social health determinants; substance use; therapy adherence; trait; usability

PROJECT SUMMARY The COVID-19 pandemic has cast a heavy burden on individuals with HIV infection. Based on data of 15,522 hospitalized patients with the coinfection of HIV and SARS-CoV-2 from 24 countries, a recent World Health Organization (WHO) report for the first time confirmed that HIV to be an independent risk factor for severe COVID-19. Despite a generally high risk of severe COVID-19 clinical course in individuals with HIV, the interactions between SARS-CoV-2 and HIV infections remain unclear. For example, the severity of COVID-19 in individuals with HIV is correlated with certain comorbidities in which some of these comorbidities are more prevalent in patients with HIV than other populations. Yet, several contradictory findings suggested the predominant role of comorbidities in the severity of COVID-19 regardless of HIV infection. Individuals with low CD4+ T-cell count (e.g., <200~500 cells/µL) and unsuppressed viral load are associated with severe clinical course, yet the role of antiretroviral therapy (ART) exposure and adherence in the context of COVID-19 exposure needs to be examined. Risk factors for the severe clinical course of the coinfection are undetermined because individuals with the same or similar severity level of COVID-19 show different clinical characteristics. To fill address these knowledge gaps, this study will establish an EHR-based cohort for individuals with HIV/SARS- CoV-2 coinfection and develop large-scale EHR-based data mining to examine the interactions between HIV and SARS-CoV-2 infections and systematically identify and validate factors contributing to the severe clinical course of the coinfection. Ultimately, collected clinical evidence will be implemented and used to pilot test a Clinical Decision Support (CDS) prototype to assist providers in screening and referral of at-risk patients in real-world clinics.

项目摘要 COVID-19大流行对HIV感染的个体造成了沉重的烧伤。基于15,522的数据 来自24个国家的HIV和SARS-COV-2的住院患者，最近的世界卫生 组织（WHO）首次报告证实HIV是严重的独立危险因素 新冠肺炎。尽管在患有艾滋病毒的个体的患者中，尽管普遍发生严重的Covid-19临床课程的风险通常很高，但 SARS-COV-2和HIV感染之间的相互作用尚不清楚。例如，Covid-19的严重性 患有艾滋病毒的人与某些合并症相关，其中其中一些合并症更多 与其他人群相比，艾滋病毒患者普遍存在。然而，一些矛盾的发现暗示了 合并症在Covid-19的严重程度中的主要作用不论HIV感染如何。较低的人 CD4+ T细胞计数（例如，<200〜500细胞/µL）和未抑制的病毒载量与严重的临床有关 当然，在COVID-19暴露的背景下，抗逆转录病毒疗法（ART）暴露和依从性的作用 需要检查。严重临床病程的危险因素不确定，因为 COVID-19具有相同或相似严重程度的个体显示出不同的临床特征。填充 解决这些知识差距，这项研究将建立一个基于EHR的队列，用于患有HIV/SARS-的个体 COV-2共同感染并开发基于EHR的大规模数据挖掘，以检查HIV和 SARS-COV-2感染并系统地识别和验证导致严重临床过程的因素 共同感染。最终，将实施收集的临床证据，并用于试点测试临床 决策支持（CD）原型，以帮助提供者筛查和转诊现实世界中的处于危险的患者 诊所。