Treatment Disparities/Outcomes of HCV-HIV Co-Infection

描述（由申请人提供）： 约400万美国人和全世界1.7亿人感染丙型肝炎病毒（HCV）。每年有8，000 - 10，000名美国人死于HCV。在美国，由HCV引起的终末期肝病是肝移植的主要原因之一。HCV和人类免疫缺陷病毒（HIV）的共感染是常见的，在美国超过三分之一的HIV感染患者共感染HCV。尽管HCV的患病率和死亡率很高，但很少有HCV患者接受HCV治疗，HCV-HIV合并感染的患者更少。此外，HCV-HIV合并感染患者接受HCV治疗后的长期结局尚不清楚。本申请的目的是研究HCV在合并和不合并HIV感染的患者中的治疗模式，以及治疗后的临床结局，并为申请人在HCV-HIV合并感染领域的独立研究生涯做好准备。具体的研究目的是确定i）HCV-HIV合并感染患者是否比单独感染HCV的患者更不可能接受HCV治疗，以及这种差异是否可以通过HIV合并感染本身、年龄、种族、性别、精神病史来解释，和药物和酒精使用ii）是否HCV-与单独感染HCV的患者相比，接受HCV治疗的HIV感染患者完成治疗过程的可能性较小，并了解与未能完成治疗相关的因素，以及iii）完成治疗的患者是否具有改善的结果，如通过存活率、急诊科就诊、肝病相关住院和肝细胞癌的发病率所测量的。研究人群将是1999年至2002年期间录入国家VA管理数据库的所有HCV感染退伍军人。1999-2001年期间，VA保健系统新诊断为HCV抗体阳性的患者总数为109 700人。将研究人口统计学和社会变量、HCV治疗的处方和完成情况、临床结局（包括生存率）、肝病相关住院、肝病相关疾病的急诊利用率和肝细胞癌的发生。将使用ICD 9代码从国家VA管理数据库和药房福利管理数据库中检索该信息。为了实现本申请的教育目标，申请人将参加匹兹堡大学临床研究培训计划，完成临床有效性和成果研究理学硕士学位的课程，并积极参加医学院的继续教育活动。申请人的长期目标是对HCV治疗模式和结局产生临床相关影响，特别是在HCV-HIV合并感染患者中。

DESCRIPTION (provided by applicant): About 4 million Americans, and 170 million persons worldwide are infected with the Hepatitis C virus (HCV). Each year, 8,000-10,000 Americans die of HCV. End stage liver disease due to HCV is one of the leading cause for liver transplantation in the United States. Co-infection with HCV and human immunodeficiency virus (HIV) is common with over one-third of the HIV infected patients in the US being co-infected with HCV. Despite high prevalence and mortality, very few patients with HCV and even fewer with HCV-HIV co-infection receive treatment for HCV. Additionally, the long term outcomes after HCV treatment in HCV-HIV co-infected patients are unknown. The goal of this application is to study the treatment patterns of HCV in patients with and without HIV co-infection, and the clinical outcomes after treatment and to prepare the applicant for an independent research career in the field of HCV-HIV co-infection. The specific research aims are to determine i) whether HCV-HIV co-infected patients are less likely to receive treatment for HCV than those infected with HCV alone, and whether this disparity could be explained by HIV co-infection itself, age, race, gender, history of psychiatric illness, and drug and alcohol use ii) whether HCV-HIV infected patients who do receive treatment for HCV are less likely to complete the course of treatment when compared with HCV alone infected patients, and to understand the factors associated with failure to complete treatment, and iii) whether patients who complete the treatment have improved outcomes as measured by survival, emergency department visits, liver disease related hospitalization and incidence of hepatocellular carcinoma. The study population will be all HCV infected Veterans who have been entered in the national VA administrative database between 1999 and 2002. The total number of patients newly diagnosed to be HCV antibody positive in the VA Healthcare System during 1999-2001 was 109,700. Demographic and social variables, prescription and completion of HCV treatment, clinical outcomes including survival, liver disease related hospitalizations, utilization of emergency care for liver disease related conditions and development of hepatocellular carcinoma will be studied. This information will be retrieved from the national VA administrative database using ICD 9 codes, and from the Pharmacy Benefits Management database. To attain the educational goals of this application, the applicant will enroll in University of Pittsburgh Clinical Research Training Program, to complete course work for a Masters of Science degree in Clinical Effectiveness and Outcomes Research, and participate actively in the School of Medicine's continuing educational activities. The long term objective of the applicant is to make a clinically relevant impact on the HCV treatment patterns and outcomes, especially in the HCV-HIV co-infected patients.