HEPATIC STEATOSIS AND MEASURES OF METABOLIC AND MORPHOLOGIC STATUS IN HIV/HCV

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）感染在使用非法药物的人中发生的频率令人震惊。在东巴尔的摩，80%感染艾滋病毒的注射吸毒者是丙型肝炎病毒感染者，5- 10%有持续乙型肝炎病毒（HBV）感染的证据，一半承认经常大量饮酒。这三种情况都会导致肝硬化。最近，由于抗逆转录病毒治疗方法的改进，肝病的重要性被放大了，这种治疗方法大大减少了机会性感染，但本身也可能导致肝毒性。因此，1999年美国公共卫生服务指导方针对HIV机会性感染的管理考虑了丙型肝炎，但由于缺乏支持数据而没有对医疗管理提出建议。在这项研究中，我们假设在控制酒精使用后，治疗HIV和HCV感染将减少肝脏疾病的进展。为了验证这一假设，我们将首先检查先前使用抗逆转录病毒治疗肝纤维化的成功，然后检查三年抗逆转录病毒治疗经验中纤维化的变化。此外，我们将研究基于干扰素治疗丙型肝炎病毒感染在纤维化改变和根除丙型肝炎病毒感染方面的作用。将测试创新工具来评估肝纤维化（数字图像分析），预测肝纤维化（血清标志物），并测量酒精使用和医疗依从性（A-CASI）。乙肝状态将使用常规和分子工具进行评估。鉴于调查小组的经验和广泛的初步数据，我们期望提供的数据将直接影响即将出台的HIV-HCV合并感染的医疗管理指南

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections occur with alarming frequency in persons who use illicit drugs. In East Baltimore, 80% of HIV-infected injection drug users are HCV-infected, 5-10 % have evidence of ongoing hepatitis B virus (HBV) infection and one-half acknowledges regular, heavy alcohol use. All three conditions can cause cirrhosis. Recently the significance of liver disease has been magnified by improved anti-retroviral treatments that dramatically reduce opportunistic infections but may themselves cause liver toxicity. Accordingly, the 1999 US Public Health Service guidelines for management of HIV opportunistic infections considered hepatitis C but withheld recommendations for medical management because of the paucity of supporting data. In this investigation, we hypothesize that treatment of HIV and HCV infections will reduce progression of liver disease, after controlling for alcohol use. To test the hypothesis, we will first examine the success of prior anti-retroviral use with respect to liver fibrosis and then the change in fibrosis over three years of anti-retroviral experience. In addition, we will examine the effect of interferon alfa based treatment for HCV infection with respect to fibrosis changes and eradication of HCV infection. Innovative tools will be tested to assess liver fibrosis (digital image analysis), predict liver fibrosis (serum markers), and measure use of alcohol and medical adherence (A-CASI). Hepatitis B status will be evaluated using conventional and molecular tools. Given the experience of the investigative team and the extensive preliminary data, we anticipate providing data that will directly affect forthcoming guidelines for the medical management of HIV-HCV coinfected