NATURAL HISTORY OF HEPATITIS C VIRUS INFECTION IN DRUG U

丙型肝炎病毒（HCV）感染是导致发病和死亡的主要原因。注射吸毒者是美国所有高危人群中HCV感染率最高的人群。我们将前瞻性地研究美国所有高危人群中HCV感染的自然史。我们将前瞻性地研究一组有HIV感染或有HIV感染风险的吸毒者中HCV感染的自然史。受试者将从已经参加一项关于吸毒者艾滋病毒感染自然史的大型纵向研究的参与者中招募。 因此，我们将能够利用该研究中收集的大量复杂数据集，并且我们将能够将收集的关于HCV感染自然史的新数据与这些数据联系起来。参与者将进行详细的标准化访谈，内容包括人口统计学、病史、性和药物使用行为、HIV和免疫学检测以及HCV感染检测，包括定量HCV RNA水平，包括定量HCV RNA水平、HCV基因分型、抗HCV抗体以及参与者子集中的HCV测序。发现有HCV感染的患者将被转诊至研究肝病专家处进行肝病评价，并将为其HCV感染提供标准药物治疗。我们的目的是确定1）HIV感染及其相关免疫缺陷、HCV基因型和药物使用行为对HCV病毒载量和肝病进展的影响，2）HIV感染和免疫缺陷对HCV感染治疗反应的影响，3）高效抗逆转录病毒治疗和控制HIV病毒载量对HCV感染自然史的影响，（4）免疫缺陷是否促进了HCV的遗传多样性。

Hepatitis C virus (HCV) infection is a major cause of morbidity and mortality. Injection drug users have the highest prevalence of HCV infection among all populations in the U.S. at risk. We will study prospectively the natural history of HCV infection among all populations in the U.S. at risk. We will study prospectively the natural history of HCV infection in a cohort of drug users with or at risk for HIV infection. Subjects will be recruited from among participants already enrolled in a large longitudinal study of the natural history of HIV infection in drug users. We will, therefore, be able to take advantage of the large and complex sets of data being collected in that study, and we will be able to link new data that will be collecting on the natural history of HCV infection with those data. Participants will have detailed standardized interviews on demographics, medical history, sexual and drug use behaviors, HIV and immunological testing, and testing for HCV infection, including quantitative HCV RNA levels, including quantitative HCV RNA levels, HCV genotyping, anti-HCV antibodies and, in a subset of participants, HCV sequencing. Persons found to have HCV infection will be referred to the study hepatologist to be evaluated for liver disease and they will be offered standard medical therapy for their HCV infection. Our aims are to determine 1) the effects of HIV infection and its associated immunodeficiency, HCV genotype, and drug use behaviors on HCV viral load and progression of liver disease, 2) the effects of HIV infection and immunodeficiency on response to therapy for HCV infection, 3) the effects of highly active anti-retroviral therapy and control of HIV viral load on the natural history of HCV infection, and 4) whether genetic diversity of HCV is facilitated by immunodeficiency.