Continued follow-up of the United Kingdom Collaborative HIV Cohort (UK CHIC) and the UK HIV Drug Resistance Database (UK HDRD), 2014-2019

英国携带人类免疫缺陷病毒(HIV)的人数继续增加。目前对艾滋病毒的治疗非常有效，因此，艾滋病毒携带者的预期寿命在过去15年中大幅增加。然而，艾滋病毒对国家卫生服务来说仍然是极其昂贵的，为了确保艾滋病毒携带者继续过上充实和健康的生活，仍然需要面对许多挑战。特别是，一些人继续在治疗中经历副作用--这些副作用可能危及生命，可能导致生活质量下降，并可能限制患者未来可以接受的药物。如果患者在一段时间内无法接受治疗，那么病毒可能会生长，对目前可用的一些药物产生抗药性。越来越多的艾滋病毒阳性者活到高龄，这也可能导致所看到的副作用的增加以及与年龄有关的一般疾病的增加。此外，许多艾滋病毒阳性儿童也将存活到成年--到目前为止，我们对这一群体的结果知之甚少，因为他们将他们的护理转移到成人艾滋病毒诊所。在英国，一部分艾滋病毒携带者也感染了丙型肝炎病毒(丙型肝炎病毒)，这对可以使用的治疗时间和选择有影响。虽然丙型肝炎病毒传统上很难在同时感染艾滋病毒的人身上治疗，但一些新上市的丙型肝炎病毒药物提供了更大的治愈丙型肝炎病毒的希望。然而，对同样感染艾滋病毒的人使用这些药物的大规模评估仍有待进行。因此，必须解决许多问题，以确保艾滋病毒携带者的结果得到优化。尤其值得一提的是，尽管人们经常说艾滋病毒携带者可以预期活到“接近正常”的寿命，但这最终是否可能实现还远不清楚。为了规划医疗保健服务的需求和了解对新药的需求，监测英国疫情特征的任何变化是至关重要的。自2001年以来，英国艾滋病毒协作队列(CHIC)研究一直在跟踪英国的艾滋病毒携带者，以监测他们对艾滋病毒治疗的使用及其结果。英国艾滋病毒耐药性数据库(UK HDRD)收集有关任何测试结果的信息，以确定感染这些人的病毒是否对目前使用的任何治疗方法产生了抗药性。最新的数据集包括去16家诊所的4.5万名患者的数据，这是全球最大的此类合作之一。这项申请是为了继续支持英国CHIC和英国HDRD的联合研究，直到2019年，原因如下：1.研究英国艾滋病毒携带者的结果，包括对所用药物的描述和任何可能产生的耐药性；2.更好地了解艾滋病毒如何在人群中传播；3.评估新的和不常见的艾滋病毒毒株是否可能对治疗效果不佳；4.描述研究参与者对丙型肝炎病毒的新治疗方法的使用，并描述这些治疗的成功，特别是在可能多次再次感染丙型肝炎病毒的人中；5.描述艾滋病毒阳性青少年将艾滋病毒从儿科服务转向成人服务的结果，并模拟随着艾滋病毒人口老龄化可能导致的问题；6.探索遗传因素可能在多大程度上影响艾滋病毒及其治疗的结果；7.调查治疗、副作用和耐药性对艾滋病毒阳性者预期寿命的潜在影响。第二个目标是通过向国际研究提供高质量的数据，继续确保英国在国际艾滋病毒队列研究中发挥主导作用。

The number of people living with the human immunodeficiency virus (HIV) in the UK continues to increase. Current treatment for HIV is very effective and, as a result, the life expectancy of a person living with HIV has increased substantially over the past 15 years. However, HIV remains extremely costly to the National Health Service and there are still many challenges that must be faced to ensure that people with HIV continue to live full and healthy lives. In particular, some people continue to experience side effects on treatment - these may be life-threatening, may lead to a reduction in quality-of-life, and may limit the drugs that patients can receive in the future. If patients are unable to take their treatment for periods of time, then virus may grow that is resistant to some of the currently available drugs. An increasing number of HIV-positive people are living to older age, which may also lead to an increase in the side effects that are seen as well as an increase in general age-related illness. In addition, many HIV-positive children are also surviving into adulthood - as yet, we have little information on the outcomes of this group as they switch their care to adult HIV clinics. A proportion of people with HIV in the UK are also infected with hepatitis C virus (HCV) which has implications for the timing and choice of treatments that can be used. Whilst HCV has traditionally been hard to treat in those who also have HIV, some of the newly available HCV drugs offer greater promise of a cure for HCV. However, a large-scale assessment of the use of these drugs in people also infected with HIV remains to be undertaken. There are therefore many questions that must be addressed to ensure that the outcomes of those living with HIV are optimised. In particular, although it is often said that people with HIV can expect to live a 'near-normal' lifespan, whether this will ultimately be possible is far from clear. In order to plan the need for health care services and to understand the need for new drugs, it is essential that any changes in the characteristics of the UK epidemic are monitored.Since 2001, the UK Collaborative HIV Cohort (CHIC) Study has followed people with HIV in the UK, to monitor their use of treatments against HIV and their outcomes. The UK HIV Drug Resistance Database (UK HDRD) collects information on the results of any tests that are performed to determine whether the virus that infects these individuals has become resistant to any of the currently used treatments. The latest dataset includes data on >45,000 patients attending 16 clinics and is one of the largest such collaborations worldwide. This application is for continued support of the combined UK CHIC Study and UK HDRD until 2019 for the following reasons:1. To study the outcomes of people with HIV in the UK, including a description of the drugs that are used and any resistance that may develop; 2. To better understand of how HIV spreads between and within subgroups of the population; 3. To assess whether new and infrequently encountered strains of HIV are likely to respond less well to treatment; 4. To describe the use of new treatments for HCV in study participants, and to describe the success of these treatments, particularly in people who may get re-infected with HCV on multiple occasions;5. To describe the outcomes of HIV-positive adolescents who switch their HIV care from paediatric to adult services and to model the likely problems that might result as the HIV population ages;6. To explore the extent to which genetic factors might contribute to the outcomes of HIV and its treatment;7. To investigate the potential effects of treatment, side effects and resistance on life expectancy in HIV-positive people.A secondary aim is to continue to ensure that the UK plays a leading role in international HIV cohort research through the provision of high quality data to international studies.