ANTIRETROVIRAL THERAPY AND LONG-TERM CLINICAL OUTCOMES

描述（改编自申请摘要）： 抗逆转录病毒治疗极大地改变了治疗和临床 艾滋病毒感染者的结果。治疗的目标已经从 延缓HIV疾病进展和死亡，抑制病毒复制 尽可能长时间低于定量水平，以允许免疫学 改善和临床稳定。然而，现在有越来越多的 无法维持病毒抑制的患者比例， 变化和更复杂的治疗方案。候选假设s 在临床环境中，与临床试验环境相比， 稳定增加的患者比例不会持续抑制 病毒复制的过程。更好地定义泛型 纵向泌尿学和免疫学指标之间的关系， 大量抗逆转录病毒药物的长期临床结果 组合可用，将成为越来越重要的临床医生。在 此外，有必要评估早期和晚期化疗的潜在生存益处， 长期有效的抗逆转录病毒治疗与长期影响的关系 治疗相关事件，如神经病变和代谢并发症 (e.g.高脂血症，高血糖症），对健康相关的生活质量， 质量调整生存率补充和扩展从 临床疗效试验，研究者提出流行病学 无艾滋病生存预测因素及质量调整 接受强效复方制剂的艾滋病毒感染者的存活率 抗逆转录病毒疗法为此，她开发了一种计算机化的 华盛顿大学的医疗信息系统， 艾滋病毒诊所人群的实时临床实践信息， 西北收集关于艾滋病毒的全面纵向信息 在这种临床环境中感染的患者，可能会使候选人发展为 病毒学、免疫学和临床反应的一系列措施， 最能预测长期临床结果的抗逆转录病毒治疗。的 指导和额外的培训由指导患者导向 研究奖将为候选人提供一个机会， 使用临床信息研究问题的重大努力 系统，并发展必要的技能，追求研究生涯， 融合流行病学方法和卫生服务研究。

DESCRIPTION (adapted from the application s abstract): Recent advances in antiretroviral therapy have dramatically changed the treatment and clinical outcomes for persons with HIV infection. The goal of therapy has expanded from delaying HIV disease progression and death to suppressing viral replication below the level of quantitation for as long as possible to permit immunologic improvement and clinical stabilization. However, now there is a growing proportion of patients who cannot maintain viral suppression often despite changing and more complex therapeutic regimens. The candidate hypothesis s that in the clinic setting, in contrast to the clinical trials setting, a steadily increasing proportion of patients will not have sustained suppression of viral replication over the long-term. Better definition of the generic relationship between longitudinal urologic and immunologic measures and long-term clinical outcomes across the enormous number of antiretroviral combinations available, will become increasingly essential to clinicians. In addition, there is a need to assess potential survival benefits of early and prolonged potent antiretroviral treatment in relation to the long-term effects of treatment-related events, such as neuropathy and metabolic complications (e.g. hyperlipidemia, hyperglycemia), on health-related quality-of-life and quality-adjusted survival. To complement and extend information available from clinical efficacy trials, the investigator proposes an epidemiological investigation of predictors of AIDS-free survival and quality-adjusted survival among HIV infected individuals receiving potent combination antiretroviral therapies. For this purpose, she has developed a computerized medical information system at the University of Washington that captures real-time clinical practice information for an HIV clinic population in the Northwest. Collection of comprehensive longitudinal information about HIV infected patients in this clinic setting, may enable the candidate to develop sets of measures of virologic, immunologic, and clinical responses to potent antiretroviral treatment that best predict long-term clinical outcomes. The mentoring and additional training provided by the Mentored Patient-Oriented Research Award will provide the candidate with an opportunity to devote significant efforts to research questions using the clinical information system and to develop the skills necessary to pursue a research career that blends epidemiological approaches and health services research.